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Nursing Exam 2020 > Renal Scenario > Flashcards

Renal Scenario Flashcards

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1
Q

What are the main structures of the renal system?

A 
2 kidneys 
2 ureters
Bladder
2 sphincter muscles
Urethra
Nerves
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2
Q

What is the function of the kidneys?

A

They maintain homeostasis:
Excrete waste products and drugs
Maintain fluid balance
Blood filtration
Hormone production for BP regulation
Production of RBC’s(erythropoietin production, controls RBC production).
Nephron is the ‘functional unit’ of the kidneys

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3
Q

What are nephrons + what is their function?

A

Functional unit of the kidneys, removing urea from the blood, urine is formed as it filters through the nephrons down the renal tubules.

They feature tubules, closed at one end, joining collecting duct at the other end.
Closed end is indented, forming glomerular capsule (almost completely enclose a network of arterial capillaries called the glomerulus).

There are 1 million nephrons in one kidney.

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4
Q

What does urine consist of?

A

95% water
Urea
Various other chemicals (sodium, chloride, potassium)

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5
Q

What is the function of the ureters?

A

They carry urine from kidneys to bladder.
Muscles in ureter walls continually tighten and relax forcing urine downwards away from kidneys.
Around every 10-15 seconds, small amounts of urine are emptied into bladder from ureters.

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6
Q

What is the function of the bladder?

A

Storage and emptying of urine.
Holds around 300-400mls during the day, roughly 800mls at night.
Sensation to urine increase as bladder fills, brain sends signals to nerves in the bladder to contract to expel urine whilst the brain sends signals to the nerves in the sphincters to relax, allowing the flow of urine through the urethra.

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7
Q

What is the function of the sphincters?

A

Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra.
Damage to area of brain controlling sphincter muscles or damage to pelvic floor muscles can cause incontinence problems.

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8
Q

How do the kidneys maintain fluid balance?

A

They can adjust urine concentration to reflect the body’s water needs.
-conserving water if dehydrated, expelling water in dilute urine if in excess.

Antidiuretic hormone(ADH) stimulates water reabsorbtion by stimulating insertion of "water channels" or aquaporins into the membranes of kidney tubules. These channels transport solute-free water through tubular cells and back into blood, leading to a decrease in plasma osmolarity and an increase osmolarity of urine.
ADH is released by the pituitary gland when hypothalamus sends signals.
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9
Q

What role do the kidneys play in RBC formation?

A

The kidneys produce erythropoietin, a hormone that stimulates RBC formation.
It is produced and expelled into the blood stream if blood oxygen levels are low.
It travels to the bone marrow where it stimulates stem cells to become RBC’s.

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10
Q

What role do the kidneys play in acid base balance?

A

Acid base balance is the balance of acidic and basic compounds in the blood.
the kidneys maintain ABB by reabsorbing bicarbonate from urine and excreting hydrogen ions into urine.

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11
Q

What role do the kidneys play in renin-angiotensin mechanisms?

A

The renin-angiotensin-aldosterone system (RAAS) is a signaling pathway responsible for regulating the body’s blood pressure. Stimulated by low blood pressure or certain nerve impulses (e.g. in stressful situations), the kidneys release an enzyme called renin.

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12
Q

What are the signs and symptoms of kidney disease?

A 
Itching
Muscle cramps
Nausea and vomiting
Decreased appetite
Oedema in feet and ankles
Too much urine or not enough urine
SOB
Trouble sleeping
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13
Q

What are the signs and symptoms of kidney failure?

A 
Itching
Muscle cramps
Nausea and vomiting
Decreased appetite
Oedema in feet and ankles
Polyuria or oliguria 
SOB
Trouble sleeping
(Same as CKD)
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14
Q

What are the causes of kidney failure?

A

Diabetes
Hypertension
Autoimmune diseases, such as lupus and IgA nephropathy
Genetic diseases such as polycystic kidney disease
Nephrotic syndrome
Urinary tract problems

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15
Q

What is kidney failure?

A

Also known as End Stage Renal Disease, it is the last stage of CKD in which the kidneys are no longer able to function without dialysis or a kidney transplant.

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16
Q

What are the 5 stages of renal failure?

A

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

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17
Q

What is GFR?

A

Glomerular filtration rate (GFR) measures kidney function.
It measures how effectively the kidneys clean to blood by measuring creatinine levels.
As kidney function declines, creatinine levels increase.

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18
Q

What is CKD?

A

Chronic kidney disease (CKD) occurs when kidneys are no longer able to clean toxins and waste product from the blood and perform their functions to full capacity.

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19
Q

What causes oedema in CKD?

A

A build up of fluid and sodium in the body.

20
Q

What causes fatigue in CKD?

A

A lack of red blood cells leads to anaemia, causing fatigue.

21
Q

What causes SOB in CKD?

A

Fluid can build up on the lungs causing SOB.

22
Q

What causes nausea/vomiting/loss of appetite/itching in CKD?

A

Uremia- having high levels of urea in the blood as the kidneys are unable to filter waste properly.

23
Q

What causes muscle cramps in CKD?

A

Cramps are thought to be caused by imbalances in fluid and electrolytes, or by nerve damage or blood flow problem

24
Q

What makes you susceptible to kidney failure?

A 
Modifiable: 
Smoking
Obesity
Diabetes
High blood pressure
Non-modifiable:
Heart and blood vessel (cardiovascular) disease
Being African-American, Native American or Asian-American
Family history of kidney disease
Abnormal kidney structure
Older age
25
Q

What is the prevalence of kidney disease in Scotland + UK?

A

3.19 in 100 people (stages 3-5)

3 million in UK.

26
Q

What are the investigations for CKD?

A

Patient history- risk factors
Observations- BP(increased fluid volume causes HTN)
Urea electrolytes serum
creatinine- high urea/creatine indicates kidneys not filtering blood efficiently
eGFR- determine kidney function
FBC- show red blood cell levels
HbA1C IN DIABETES- high linked to increased risk
Lipid profile
Multistix urinalysis- albumin in urine can mean kidney failure
Albumin creatinine ratio
Urine microscopy
Plain xray of abdomen KUB
Intravenous pyelogram
Ultrasound- to evaluate kidneys and assess for any damage/presence of stones etc

27
Q

How can CKD progression be stopped?

A 
Smoking cessation
BP 125/75
Avoid antacids 
Maintain adequate nutrition- limit salt, limit fluid, potassium limit, protein limit.
No OTC medication without approval
Minimise effects of medication on kidney function.
Encourage exercise
Limit alcohol 
Weight management 
Control diabetes/HTN
28
Q

How can the nurse support the patient with diagnosis of renal failure?

A

Perform assessment/investigations
Discuss treatment options
Be empathetic
Give patient time to process, to ask questions
Provide reassurance, leaflets/dvds and support networks
Build therapeutic relationship
Assess motivation/understanding

29
Q

How can the nurse support the patient in decision making?

A

Explain options
Support patient
Involve family/relatives if appropriate

30
Q

What are the treatment options for kidney failure?

A

Dialysis- Peritoneal, Haemodialysis

Kidney transplant

31
Q

What is peritoneal dialysis?

A

Utilises the boy’s peritoneal membrane (in the abdomen) as the filter through which waste products are removed.
The peritoneal membrane is bathed in fluid allowing waste products to pass from capillary blood vessels into the fluid, removing the waste from the blood.
Fluid drains into the peritoneal cavity where it rests for a few hours to allow for absorption of waste products before being drained via a surgically placed catheter.
This is known as Continuous Ambulatory Peritoneal Dialysis (CAPD).

32
Q

How does CAPD work?

A

Catheter placed surgically under local/general anaesthetic, exit site requires regular dressing changes, ready to use after 2-3 weeks.
1-3 litres of dialysis fluid are run via catheter into peritoneal cavity where it remains for several hours before being drained into an empty bag by gravity.
This is known as an ‘exchange procedure’.
It is usually performed 4x daily and takes 30-45 mins.

33
Q

Can patients perform CAPD themselves?

A

Yes - the nurse will provide education on self management of CAPD through teaching aids (videos, practice equipment|).

34
Q

How does CAPD make patients feel and what support is available?

A

Difficult to cope with learning about CAPD.
Can affect daily life
Effect on emotional state- anger, depressed, scared.
Community dialysis nurse available to provide support and answer any questions, as well as clinic nurse and GP.
Can affect sex life due to physical and psychological symptoms.

35
Q

What are the potential complications of CAPD?

A 
Infection- peritonitis or infection of exit site. Can be prevented by following CAPD training.
Draining problems-
treat constipation
ensure correct type/length of catheter 
Kinks in tubing
Fibrin formation
36
Q

What lifestyle changes are required with CAPD?

A

Proteins lost in exchange need replaced- high quality proteins encouraged.
Salt restriction as it raises BP and causes thirst which can cause fluid retention.
Potassium containing foods allowed in moderation.
Phosphate build up can cause bone problems, phosphate-binding medication may be required to take alongside meals if levels are high.
Fluid restriction to maintain good fluid balance, excess fluid can lead to heart problems and high BP.

37
Q

What is haemodialysis?

A

Blood is removed from the circulation and filtered through and artificial kidney, removing waste products, before being returned to the patient.
It requires access to blood vessels and is done up to 3x weekly for 3-4 hours.
This is done through the placing of a catheter in one of the large veins in the neck or groin.
It can also be achieved through the placement of a fistula.

38
Q

What is a fistula?

A

It is an artificially formed link between an artery and a vein, causing the walls of the vein to thicken due to the higher pressure from the artery, making more capable of withstanding repeated puncture.
Generally placed in wrist or inner elbow, under local or general anaesthetic.
6-8 weeks for it to ‘mature’.

39
Q

What lifestyle changes are required with haemodialysis?

A

Diet adjustments:
restricted salt, potassium and phosphate intake.
Urine output decreases with haemodialysis therefore fluid restriction required to prevent fluid build up.

40
Q

What are the benefits/disadvantages of haemodialysis?

A

Carried out by trained professionals
Only 3x weekly
Low infection risk

However:
Travelling back and forth to hospital multiple times a week.
Particular care with diet and fluid restrictions
Needle phobias
Body image effects
Holidays hard to organise

41
Q

What are the benefits/disadvantages of peritoneal dialysis?

A

Self management
Minimal hospital/clinic appointments
Minimal disruption to daily life- can still work, go on holiday

However:
Infection risk
No break from treatment
Physical and psychological effects
Storage of equipment
42
Q

What is the benefit of transplantation?

A

No longer require dialysis if successful
Associated problems may resolve

However:
Likelihood of donor unreliable
Many eventually fail after a number of years - dialysis required again

43
Q

What care is required prior to dialysis?

A

Vital signs- BP, pulse, respirations, lung sounds(provides baseline to evaluate effects of treatment)
Weight (weight changes indicator of fluid volume)
Assess vascular access (access site required, ensure no infection and palpable)
Avoid using extremity with access site for blood pressure or venepuncture to maintain access.

44
Q

What care is required during dialysis?

A

Safety risk assessment- aseptic technique
Hypotension due to excess or rapid fluid removal
Cramp- due to excess fluid removal/sodium shifts
Air embolism-if air is returned to patient via dialysis, can be fatal
Nausea/vomiting/headaches- associated with hypovolaemia, correct with fluids.
Haemolysis- breakdown of RBC’s due to issues with dialysis machine/malfunction of pump/kinks.
Clotting- reduced with heparinisation
Anaemia- dialysis provides no action comparable with endocrine function

45
Q

What care is required after dialysis?

A
  • repeat vital signs, weight, access site condition- rapid fluid removal can cause low BP, cardiopulmonary changes and weight loss.
  • monitor bloods include BUN (Blood urea nitrogen), determines effective of treatment, need for fluid/diet restrictions and timing of future treatments.
  • assess for dialysis disequilibrium syndrome- headache, nausea, consciousness, HTN, dialysis can cause cerebral oedema and raised ICP.
  • adverse response, dehydration, nausea/vomiting/cramps/seizure and treat accordingly.
  • psychological support, active listening, grief support, focus on positives, refer to social services/counselling as indicated..

Nursing Exam 2020 (4 decks)

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