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NURSING 2 > Renal week 3 > Flashcards

Renal week 3 Flashcards

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1
Q

What do the kidneys do

A 
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
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2
Q

Prostaglandin

A

vasodilate blood vessels ?

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3
Q

What is released by kidneys for RBC production

A

Erythropoetin

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4
Q

What is healthy UOP

A
  1. 5L Q24 hours
    - - 30ml/hour

edema build up after 2.5-3L of fluid retained

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5
Q

how much K excreted by kidneys

A

90%

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6
Q

Gero: kidney

A

decreased ability to adjust to the changes in H2O / electrolyte

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7
Q

Gero: blood flow

A

Increased for for failure r/t polypharm., comorbidities, decreased renal function

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8
Q

Gero: tubule system

A

Loss of ability to conserve / excrete Na and hydrogen

    • decline ability to concentrate
    • increased risk for dehydration
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9
Q

Gero: nephrons

A

altered drug excretion and drug-drug interaction

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10
Q

Glomerulernephritis

A

infection/inflammation of glomerulers

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11
Q

Polycystic kidneys

A

patient develops cysts which alters form of nephrons

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12
Q

nephrotic syndrome

A

common in younger patients

high lipids, high amount of edema

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13
Q

Rhabdomylosis

A

results in muscle damage

clogged nephrons

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14
Q

Pre-renal disease: impaired perfusion (cause)

A
  • cardiac failure
  • sepsis
  • blood loss
  • dehydration
  • vascular occlusion
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15
Q

Renal disease: Glomerularnephritis, small vessel vasculitis, acute tubular necrosis (cause?)

A
  • drugs, toxins, prolonged hypotension, interstitial
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16
Q

Renal disease: interstitial nephritis (cause)

A

drugs, toxins, inflammatory disease, infection

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17
Q

Post renal disease (cause)?

A 
urinary calculi
retroperitoneal fibrosis
benign prostatic enlargement
prostate cancer
cervical cancer
urethral stricture/valves
meatal stenosis/phimosis
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18
Q

kidneys want MAP to be what?

A

above 65

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19
Q

Acute kindey injury: Oliguric phase (signs and symptoms)

A

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

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20
Q

Acute kidney injury: diuretic phase (s/s)

A

gradual increase UOP –> 1-3L/day; may reach 3-5
hypovolemia, dehydration
hypotension
BUN and creatinine levels begin to normalize

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21
Q

Acute kidney injury: recovery phase (s/s)

A

begins with GFR increases

BUN and creatinine levels plateaus then decreases

22
Q

Who is at higher risk for developing kidney disease and why

A

AA and asians – difference levels for GFR

23
Q

CKD: neuro s/s

A

weakness, fatigue, confusion, tremors, sz.

24
Q

CKD: integumentary s/s

A 
gray, bronze skin
dry
flakey
pruritus
thin nails
25
Q

CKD: cardio s/s

A 
HTN
edema
JVD
hyperkalemia 
hyperlipidemia
26
Q

CKD: pulmonary s/s

A

crackles, pleurisy, SOB, tachypnea, kussimuals

27
Q

CKD: GI

A

ammonia breath
anorexia
NV
constipation

28
Q

CKD: heme s/s

A

anemia

thrombocytopenia

29
Q

CKD: reproductive

A 
ED
amenorrhea
testicular atrophy
infertility
decrease libido
30
Q

CKD: musculoskeletal s/s

A

cramps
loss of strength
bone pain
fractures

31
Q

Chronic renal failure s/s

A 
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
32
Q

Hemodialysis: notes to remember

A

Evaluate access site for:

a. patency and signs of infection
b. do NOT take BP or obtain blood from extremity that has access site

33
Q

CKD: priority assessments

A

–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

34
Q

CKD s/s

A

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

35
Q

CKD priority labs/diagnostics

A

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

36
Q

CKD priority interventions

A

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

37
Q

CKD complications

A 
Cardiovascular 
Dyslipidemia 
Bone disease 
ESRD with dialysis or Peritoneal dialysis 
Renal transplant
38
Q

CKD priority meds

A 
calcium acetate – bind phosphate 
 calcitrol 
  erythropoietin 
 statins 
 gemfibrozil
39
Q

CKD education

A 
Diet restrictions 
dialysis method 
how to take medications 
Track weight 
Blood pressure 
Follow up appointments
K = low
phos = low 
fluids = 1500mL/day
40
Q

when can AV fistula start to be used

A

3-6 months after inserted

41
Q

describe the red and blue parts and av fistula

A

blue venous part

red arterial part

42
Q

Hemodialysis description

A

s

43
Q

Hemodialysis: vascular access

A

Temporary
AV fistula
AV graft

44
Q

Hemodialysis: medical and nursing management

A 
pharm therapy
nutritional and fluid therapy
psychosocial care
self care
home hemodialysis
45
Q

Who may need dialysis?

A

people with…

Acid-base issues
Electrolyte problems
intoxications
overload of fluids
uremic symptoms
46
Q

What are additional renal replacement therapies if your patient is not hemodynamically stable enough to develop hemodialysis

A

Continuous Hemofiltration

Continuous veno-venous hemofiltration

Continuous veno-venous Hemodiafiltration

Continuous veno-venous hemofiltration with dialysis

47
Q

Peritoneal dialysis: procedure

A

Preparing the patient
Preparing the equipment
Performing the exchange

48
Q

Peritoneal dialysis: complications

A

Peritonitis
Leakage
Bleeding
Incomplete recovery of fluid

49
Q

Peritoneal dialysis: nursing management

A

Caring for the catheter site
Meeting psychosocial needs
Teaching patients self care
Continuing care

50
Q

Kidney transplant: preop management

A

workup and listing

51
Q

kidney transplant: postop management

A 
Antirejection medication
Assessing for transplant rejection
Preventing infection
Monitoring urinary function
Addressing psychological concerns
Monitoring and managing potential complications
Teaching self care
Continuing care
52
Q

Renal trauma: manifestations

A

grey turner sign

cullen sign

NURSING 2 (12 decks)

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