Renal week 3 Flashcards
What do the kidneys do
Make urine Regulate Na Regulate fluid balance Acid base - bicarb excretion and reabsorption BP regulation RBC production Converts inactive vitamin D to active form Prostaglandin secretion
Prostaglandin
vasodilate blood vessels ?
What is released by kidneys for RBC production
Erythropoetin
What is healthy UOP
- 5L Q24 hours
- - 30ml/hour
edema build up after 2.5-3L of fluid retained
how much K excreted by kidneys
90%
Gero: kidney
decreased ability to adjust to the changes in H2O / electrolyte
Gero: blood flow
Increased for for failure r/t polypharm., comorbidities, decreased renal function
Gero: tubule system
Loss of ability to conserve / excrete Na and hydrogen
- decline ability to concentrate
- increased risk for dehydration
Gero: nephrons
altered drug excretion and drug-drug interaction
Glomerulernephritis
infection/inflammation of glomerulers
Polycystic kidneys
patient develops cysts which alters form of nephrons
nephrotic syndrome
common in younger patients
high lipids, high amount of edema
Rhabdomylosis
results in muscle damage
clogged nephrons
Pre-renal disease: impaired perfusion (cause)
- cardiac failure
- sepsis
- blood loss
- dehydration
- vascular occlusion
Renal disease: Glomerularnephritis, small vessel vasculitis, acute tubular necrosis (cause?)
- drugs, toxins, prolonged hypotension, interstitial
Renal disease: interstitial nephritis (cause)
drugs, toxins, inflammatory disease, infection
Post renal disease (cause)?
urinary calculi retroperitoneal fibrosis benign prostatic enlargement prostate cancer cervical cancer urethral stricture/valves meatal stenosis/phimosis
kidneys want MAP to be what?
above 65
Acute kindey injury: Oliguric phase (signs and symptoms)
Oliguria (<40mL/day within 1-7 days of kidney injury)
Urinalysis (casts, RBC, WBC, sp gr fixated at 1.010)
Metabolic acidosis
hyperkalemia and hyponatremia
elevated BUN and creatinine
Fatgue / malaise
Acute kidney injury: diuretic phase (s/s)
gradual increase UOP –> 1-3L/day; may reach 3-5
hypovolemia, dehydration
hypotension
BUN and creatinine levels begin to normalize
Acute kidney injury: recovery phase (s/s)
begins with GFR increases
BUN and creatinine levels plateaus then decreases
Who is at higher risk for developing kidney disease and why
AA and asians – difference levels for GFR
CKD: neuro s/s
weakness, fatigue, confusion, tremors, sz.
CKD: integumentary s/s
gray, bronze skin dry flakey pruritus thin nails
CKD: cardio s/s
HTN edema JVD hyperkalemia hyperlipidemia
CKD: pulmonary s/s
crackles, pleurisy, SOB, tachypnea, kussimuals
CKD: GI
ammonia breath
anorexia
NV
constipation
CKD: heme s/s
anemia
thrombocytopenia
CKD: reproductive
ED amenorrhea testicular atrophy infertility decrease libido
CKD: musculoskeletal s/s
cramps
loss of strength
bone pain
fractures
Chronic renal failure s/s
sallow, yellow discoloration pruritus and uremic frost CNS depression peripheral neuro anorexia NV GI bleed peptic ulcer disease constipation hyperglycemia hyperlipidemia psychological changes (withdrawal, depression, psychosis) anemia (bleeding) hyperparathyroid loss of period infertility impotence gout decrease GFR by 10% renal osteodystrophy
Hemodialysis: notes to remember
Evaluate access site for:
a. patency and signs of infection
b. do NOT take BP or obtain blood from extremity that has access site
CKD: priority assessments
–Fluid Status – Edema HTN Pulmonary Edema Heart Failure
Urine Output I/O Weights
May Have Hyperglycemia
K+ Levels EKG Changes
Metabolic Acidosis
Cardiovascular Assessments
Respiratory – May Have Kussmaul –Depleted
Sodium Bicarb
Infections- Coagulopathy
CKD s/s
Anorexia, N/V, lethargy, fatigue, high to very high bun creatinine
neurological impairment- confusion, HA, drowsiness, encephalopathy
peripheral neuropathy
asterixis
fractures – from calcium imbalances
prescription and OTC medications
emotional status
CKD priority labs/diagnostics
urine for proteinuria
urine- elevated albumin wbc protein casts glucose
GFR- 120-130 mL/min/1.73 m2
K+
BUN 10-20 mg/dL
Creatinine 0.6-1.2 mg/dL
Ultrasound kidneys
CT scans – masses vascular abnormalities
Renal scan renal biopsy
CKD priority interventions
Diuretics for fluid overload- based on urine output
Weigh daily 0.5-1 pound increase daily is fluid retention
diet restrictions, low protein, fluid, K+, Na, phosphorous
Dialysis- hypotension N/V chest pain muscle cramps evaluate fistula (thrill bruit) insertion site for bleeding hematoma infection
Peritoneal- catheter for infection peritonitis hernia backvpain respiratory complications
Hyperkalemia treatment- dialysis calcium gluconate sodium bicarb loop diuretic IV insulin D50 kayexylate
CKD complications
Cardiovascular Dyslipidemia Bone disease ESRD with dialysis or Peritoneal dialysis Renal transplant
CKD priority meds
calcium acetate – bind phosphate calcitrol erythropoietin statins gemfibrozil
CKD education
Diet restrictions dialysis method how to take medications Track weight Blood pressure Follow up appointments
K = low phos = low fluids = 1500mL/day
when can AV fistula start to be used
3-6 months after inserted
describe the red and blue parts and av fistula
blue venous part
red arterial part
Hemodialysis description
s
Hemodialysis: vascular access
Temporary
AV fistula
AV graft
Hemodialysis: medical and nursing management
pharm therapy nutritional and fluid therapy psychosocial care self care home hemodialysis
Who may need dialysis?
people with…
Acid-base issues Electrolyte problems intoxications overload of fluids uremic symptoms
What are additional renal replacement therapies if your patient is not hemodynamically stable enough to develop hemodialysis
Continuous Hemofiltration
Continuous veno-venous hemofiltration
Continuous veno-venous Hemodiafiltration
Continuous veno-venous hemofiltration with dialysis
Peritoneal dialysis: procedure
Preparing the patient
Preparing the equipment
Performing the exchange
Peritoneal dialysis: complications
Peritonitis
Leakage
Bleeding
Incomplete recovery of fluid
Peritoneal dialysis: nursing management
Caring for the catheter site
Meeting psychosocial needs
Teaching patients self care
Continuing care
Kidney transplant: preop management
workup and listing
kidney transplant: postop management
Antirejection medication Assessing for transplant rejection Preventing infection Monitoring urinary function Addressing psychological concerns Monitoring and managing potential complications Teaching self care Continuing care
Renal trauma: manifestations
grey turner sign
cullen sign