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Adult Health Pt 2 > Renal Disorders > Flashcards

Renal Disorders Flashcards

1
Q

Acute Kidney Injury/Acute Renal Failure

A
  • occurs suddenly/generally reversible

- abrupt loss of kidney function and glomerular filtration rate

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2
Q

Glomerular Filtration Rate (GFR)

A

test used to check how well the kidney’s are working; estimates how much blood passes through the glomeruli each minute

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3
Q

Glomeruli

A

cluster of capillaries around end of kidney’s where waste products are filtered from blood

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4
Q

Causes of Acute Kidney Injury Prerenal

A
  • diabetes
  • fluid volume deficit; GI, hemorrhage, diuretics
  • decreased cardiac output; MI, CHF
  • prolonged hypovolemic status; sepsis, anaphylaxis, antihypertensive
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5
Q

AKI Prerenal

A

blood flow INTO kidney is affected

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6
Q

AKI Intrarenal

A

damage to the actual kidney

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7
Q

AKI Intrarenal Causes

A
  • rhabdomyolysis
  • nephrotoxicity; mycin antibiotics, IV dye, ACE inhib, NSAIDS
  • infections; pyelonephritis
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8
Q

AKI Postrenal Causes

A
  • bilateral kidney stones
  • tumors
  • BPH
  • ureteral strictures
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9
Q

AKI Postrenal

A

flow of urine OUT of kidney is affected

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10
Q

How many phases of AKI are there?

A

4

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11
Q

Phase 1 AKI (onset)

A

triggering event begins—start of kidney injury

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12
Q

Phase 2 AKI (oliguric)

A
  • urine output decreases and fluid volume overload develops

- serum waste begins to increase (BUN, Cr, K+, Mg+, Phosphorus)

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13
Q

Phase 3 AKI (diuretic)

A
  • triggering event is corrected

- urine output increases, sometimes in in large dilute amounts

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14
Q

Phase 4 AKI (recovery)

A
  • kidney function improves

- health status improves/energy increases

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15
Q

S/S of AKI

A
  • Oliguria
  • Anuria
  • low specific gravity
  • hyperkalemia
  • metabolic acidosis
  • increased BUN/Creatinine
  • hypocalcemia/hyperphosphatemia
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16
Q

Oliguria

A

< 400 mL in 24 hrs

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17
Q

Anuria

A

< 50 mL in 24 hrs

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18
Q

Hyperkalemia w/ AKI

A
  • cardiac arrhythmias w/ EKG changes
  • tall peaked T-waves
  • muscle weakness/paralysis
  • nausea/diarrhea
  • decreased or absent DTR’s
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19
Q

Hypocalcemia w/ AKI

A
  • tetany
  • seizures
  • prolonged QT interval on EKG
  • trousseau sign
  • Chvostek sign
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20
Q

Trousseau Sign

A

carpal spasm that is the result of inflation of a BP cuff

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21
Q

Chvostek Sign

A

twitching of facial muscles in response to tapping over the area of facial nerve

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22
Q

Prevention of AKI

A
  • prevent dehydration
  • replace blood and fluids as appropriate
  • strict I&O’s
  • Assess BUN & Creatinine routinely on patients at risk
  • Do NOT give IV contrast w/ elevated creatinine
  • treat infections quickly
  • eliminate use of catheters
  • prompt perineal care
  • assess use of nephrotoxic drugs
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23
Q

Treatment for Prerenal AKI

A

IV fluids / blood transfusions

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24
Q

Treatment for Intrarenal AKI

A

temporary dialysis

-prevent FVE, hyperkalemia, metabolic acidosis

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25
Q

Treatment for Postrenal AKI

A

remove obstruction

  • prostatectomy
  • stents
  • indwelling catheter
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26
Q

Complications of Fluid Volume Excess

A
  • hypertension
  • congestive heart failure
  • pericarditis
  • pulmonary edema
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27
Q

CHF Symptoms

A
  • dyspnea
  • crackles
  • tachycardia
  • JVD
  • dependent edema
28
Q

What is pericarditis?

A

CP that worsens w/ lying down, fever, pericardial friction rub

29
Q

Pulmonary Edema Symptoms

A
  • bloody, frothy sputum
  • orthopnea
  • “air hunger”
  • patient feels like they are drowning
30
Q

Kayexalate

A
  • oral, NG, edema

- for hyperkalemia

31
Q

IV Insulin w/ Dextrose and Diuretic

A

shifts K+ back into cells / dextrose to prevent hypoglycemia / diuretic to remove excess K+

32
Q

IV Ca+ Gluconate

A

protect cardiac function from high K+ levels

33
Q

Sodium Bicarbonate

A

neutralize acidosis

34
Q

Phoslo

A

to absorb and lower phosphorus levels

-give w/ food

35
Q

What medications should you adjust the doses of to help excrete through the kidneys?

A

antibiotics
digoxin
ACE inhibitor

36
Q

Nutrition Facts

A
  • restrict foods high in K+
  • restrict foods high in phosphorus
  • moderately restricted protein intake
  • avoid salt substitutes
37
Q

Considerations of Elderly

A
  • kidney weight and volume decreases
  • blood flow to kidneys decrease
  • number of nephrons decline
  • reduced bladder tone
  • enlarged prostate
  • decreased muscle mass
38
Q

Reduced bladder tone increases the risk of what?

A

UTI secondary to incomplete emptying

39
Q

Chronic Kidney Disease

A

kidney damage or decreased kidney function for 3 or more months
-progresses more quickly in those w/ HTN

40
Q

Uremia

A

build up of urea in the blood

41
Q

Who is at an increased risk for Chronic Kidney Disease?

A
  • HTN
  • 65 and older
  • African American
  • men
42
Q

Stage 1 CKD

A
  • 90%+

- kidney damage w/ normal function

43
Q

Stage 2 CKD

A
  • 60-89%

- kidney damage w/ mild loss of function

44
Q

Stage 3 CKD

A
  • 30-59%

- moderate to severe loss of function

45
Q

Stage 4 CKD

A
  • 15-29%

- severe loss of function

46
Q

Stage 5 CKD

A
  • 15%

- kidney failure and need treatment to live

47
Q

Risks for CKD in Kidney Failure

A
  • diabetes
  • HTN
  • proteinuria
  • family history
  • increasing age
48
Q

Neuro S/S of CKD

A
  • fatigue
  • confusion/disorientation
  • tremors/seizures
  • restless leg
49
Q

Cardiac S/S of CKD

A
  • HTN
  • pitting edema
  • JVD
  • tachycardia
  • pericarditis
  • anemia
  • thrombocytopenia
50
Q

Integumentary S/S of CKD

A
  • dry/flaky/itchy skin
  • ecchymosis
  • thin brittle nails
  • coarse thin hair
  • dark bronze skin
51
Q

Pulmonary S/S of CKD

A
  • crackles
  • thick, bloody frothy sputum
  • pleuritic lung pain
  • dyspnea/tachypnea
52
Q

GI S/S of CKD

A
  • ammonia breath
  • metallic taste in mouth
  • anorexia, N/V
  • change in bowel habits
53
Q

Reproductive S/S of CKD

A
  • ED
  • amenorrhea
  • infertility
  • decreased libido
54
Q

Musculoskeletal S/S of CKD

A
  • muscle cramps/spasms
  • loss of muscle tone/strength
  • bone pain/fractures
  • foot drop
55
Q

What to do for daily weights?

A

Same scale, same time, everyday

56
Q

Fluid Restriction

A
  • amount based on patient condition
  • provider will determine
  • educate to pace amount of fluid through day
57
Q

Methods to help with thirst/

A
  • hard candy
  • chew gum
  • rinse mouth w/ water
  • lip moisturizer
  • sip don’t gulp
  • limit salt
  • limit during day if have evening plans
58
Q

What is dialysis?

A

mechanical method of removing bodily wastes when the kidney is unable to do so

59
Q

Hemodialysis

A
  • machine functions as artificial kidney

- 3 x weekly / 3-5 hrs each

60
Q

Peritoneal Dialysis

A

-uses the peritoneum and a cleaning solution called dialysate to clean the blood

61
Q

Dialysate

A

absorbs waste and fluid from the blood using the peritoneum as a filter

62
Q

Temporary Vascular Access

A
  • double lumen large bore catheter
  • temporary for quick emergency access
  • flushed w/ heparin after use
  • NEVER flush before using
  • aspirate 5-10 mL before using
63
Q

Arteriovenous Fistula

A
  • usually placed in forearm
  • artery and vein are connected
  • 2 large bore catheters are inserted during dialysis
  • exercises such as squeezing a ball
64
Q

How long does an arteriovenous fistula take to heal?

A

4-6 weeks

65
Q

Education for Fistula

A
  • “feel the thrill and hear the bruit”
  • no labs or BP
  • no IV sticks
  • no tight clothes, jewelry, purses, etc.
  • do not tie or sleep on that arm
66
Q

Nursing Care for Dialysis Patient

A
  • make sure patient eats breakfast
  • most meds will be held
  • daily weights
  • psychosocial support
  • involve case management
67
Q

Kidney Transplant

A
  • treatment of choice w/ end-stage failure
  • helps to avoid dialysis
  • less expensive
  • living/deceased donor
  • blood relatives not required

Adult Health Pt 2 (8 decks)

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