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NURSADN6 Med Surg > Week 2 GU > Flashcards

Week 2 GU Flashcards

1
Q

Kidney Disorders include

A
  1. Fluid and electrolyte imbalances
  2. Most accurate indicator of fluid loss or gain, in an acutely ill patient is weight
  3. Refer to table 48-1
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2
Q

Gerontologic Considerations for Kidney Disorders

A
  1. Less able to respond to F&E changes
  2. Atypical/ nonspecific/sx of altered renal function
  3. Fluid Balance diet
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3
Q

Fluid balance deficit includes?

A
  1. Constipation
  2. Falls
  3. Medication Toxicity
  4. UTIs/ URIs
  5. Delirium
  6. Seizures
  7. Hyperthermia
  8. Delayed Wound Healing
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4
Q

Name Primary Glomerular Diseases

A
  • Diseases that destroy the glomerulus of the kidney
  • 3rd most common cause of stage 5 CKD
  • Glomerulonephritis
    -acute or chronic
    -Nephrotic Syndrome
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5
Q

Inflammation of the glomerular capillaries and can be acute or chronic

A

Glomerulonephritis

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6
Q

Kidney is damage with mild kidney loss of function
EGFR is 60-89
60-89 % kidney function

A

Stage 2

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6
Q

Kidney function is 90-100%
GFR is 90 or above
- May have kidney damage (Protein in urine with normal kidney function)

A

Stage 1

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7
Q

Mild to moderate loss of kidney function
eGFR is 45-59
45-59% Kidney function

A

Stage 3a

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8
Q

Moderate to severe loss of kidney function
eGFR is 30-44
Kidney Function is 30-44%

A

Stage 3b

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9
Q

Severe loss of kidney function
eGFR is 15-29
15-29% Severe loss of kidney function

A

Stage 4

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10
Q

Kidney Failure
eGFR is less than 15
Less than 15%

A

Stage 5

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11
Q

Glomerulus

A

The main function of the glomerulus is to filter plasma to produce glomerular filtrate, which passes down the length of the nephron tubule to form urine.

Bowman’s Capsule

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12
Q

Nephron

A

The nephrons work through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes wastes. Each nephron has a glomerulus to filter your blood and a tubule that returns needed substances to your blood and pulls out additional wastes.

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13
Q

Podocytes cooperate with mesyngal cells to do what

A

Support the structure and function of the glomerulus

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14
Q

Proximal loop located in

A

Renal cortex
closest to bowman’s capsule
Freely permeable cell membrane allows for reabsorption

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15
Q

Loop of Henle

A

Renal pyramids in the medulla

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16
Q

Distal Loop

A

Furthest away
Collecting tubule in renal cortex

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17
Q

Type of acute glomerular nephritis
Renal failure with glomerular inflammation

A

Acute Nephritic Syndrome

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18
Q

Manifestations of of Acute Nephritic Syndrome

A

Hematuria- may be microscopic or look like cola d/t glomerular bleeding
- Pus and cellular/ granular casts in urine
- Protein variable
- Sever cases decreased GFR

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19
Q

This may be mild or may progress to acute renal failure or death

A

Acute Nephritic Syndrome

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20
Q

What is the medical management of acute nephritic syndrome

A

Supportive care and dietary modifications
- Treat cause if appropriate- abx, corticosteroids, and immunosuppressants

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21
Q

Name the types of Nephritic Syndrome

A
  1. Post- infectious
  2. Rapidly progressive
  3. Membrane Proliferative
  4. Membranous
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22
Q

Inflamed glomerulus compromises blood flow and filtration

A

Post Infectious Nephritic Syndrome

23
Q

Oliguria
Hematuria
Azotemia
HTN
Mild Edema

A

Post Infectious Nephritic Syndrome

24
Q

This disease includes
-early fibrin crescent
-later cells move in Fibrin Scabs
in Bowman’s space prevent filtration and become permanent scars, ruining kidneys

A

Rapidly Progressive Glomerulonephritis

25
Q

RPGN results when and with what?

A

When most of the glomeruli are damaged severely enough to allow fibrin to enter Bowman’s spaces

  • Rapidly Progressive Glomerulonephritis
26
Q

Thickening of the glomerular basement membrane type of nephritic syndrome

A

Membrane Proliferation

27
Q

What is the sequence of Nephritic Syndrome ?

A

Antigen Group A Beta Hemolytic Strep
THEN
Antigen antibody product
THEN
Deposition of antigen- antibody complex in glomerulus
THEN
Increased production of epithelial cells lining the glomerulus
THEN
Leukocyte infiltration of the glomerulus
THEN
Thickening of the glomerular filtration membrane
THEN
Scarring and loss glomerular filtration membrane
THEN
Decreased GFR

28
Q

Clinical Manifestations of Acute Nephritic Syndrome

A
  • Decreased Hematuria
  • Azotemia
  • Proteinuria
  • Edema
  • HTN
    Labs: Decreased albumin, increased Lipids, fatty casts in urine, Increased BUN/ Cr
29
Q

Name complications of Acute Glomerulonephritis

A
  • HTN Encephalopathy
  • Heart Failure
  • Pulmonary Edema
30
Q

What is the medical management of Acute Glomerulonephritis ?

A
  • Tx of sx
  • Treatment of complications
  • Managing HTN
    Controlling proteinuria- diet low in prot and Na
  • Pharmacologic Therapy depends on cause / corticosteroids
31
Q

Name the diagnostic findings of acute glomerulonephritis

A

1, Enlarged liver, neck veins
2. General swelling
3. Elevated BP
4. Tests include
- electrolytes
- BUN/Creatinine
- Urinalysis : protein, appearance, and color
- Kidney Biopsy

32
Q

Repeated acute glomerular nephritis, HTN nephrosclerosis, hyperlipidemia, an other causes of glomerular damage

A

Chronic Glomerulonephritis

33
Q

Renal insufficiency or failure: asymptomatic for years as glomerular damage increases before signs and symptoms develop

A

Chronic Glomerulonephritis

34
Q

What are abnormal lab test results of acute Glomerulonephritis?

A
  • Urine with fixed specific gravity
  • Casts
  • Proteinuria
  • Electrolyte imbalances and hypoalbuminemia

Medical management is determined by symptoms

35
Q

Name the clinical manifestations of Chronic Glomerulonephritis

A
  • Appears poorly malnourished
  • Yellow - grey skin coloring
  • Peri- orbital- peripheral edema
    -Retina: hemorrhage, exudate, papilledema. tortuous AV
  • Cardiomegaly: gallop rhythm, distended neck veins
  • Crackles bases of lungs
36
Q

Management of Chronic Glomerular Nephritis includes ?

A
  • Aggressive tx of high blood pressure
  • Na and water restriction
  • Weights daily > diuretic fluid overload
  • Diet: high in proteins, calories
  • tx UTIs promptly
  • Dialysis
37
Q

Describe the Nephrotic Syndrome Concept Map

A

Glomerular Damage
—– Increased permeability to proteins - Proteinuria greater 3.5 g/ 24 hr

THEN

Leads to
PROTEINURIA
1. Decreased plasma oncotic pressure- Edema
2. Compensatory synthesis of proteins by liver - Hyperlipidemia

38
Q

What is the nursing process of patients with Chronic Kidney Disease and Acute Kidney Injury - Assessment

A
  1. Fluid status
  2. Nutritional status
  3. Patient Knowledge
  4. Activity tolerance
  5. Self- Esteem
  6. Potential Complications
39
Q

What do we also assess for in collaborative problems and complications?

A
  1. Hyperkalemia
  2. Pericarditis
  3. Pericardial effusion
  4. Pericardial Tamponade
  5. HTN
  6. Anemia
  7. Bone Disease and metastatic calcifications
40
Q

The nursing process of patients with chronic kidney disease and acute kidney injury diagnosis includes what?

A
  1. Excess fluid volume
    2 Imbalanced Nutrition
  2. Deficient knowledge
  3. Risk for situational low self- esteem
41
Q

Nursing process of planning for patients chronic kidney disease and Acute kidney injury planning includes ?

A

Goals may include maintaining of IBW without excess fluid, maintenance of adequate nutritional intake, increased knowledge, participation of activity within tolerance improved self esteem, and absence of complications

42
Q

Kidneys are reduced to little as …

A

1/5th normal size

43
Q

With excess fluid volume we do what?

A

Assess- s/s of fluid volume excess, keep accurate I&), and daily weights
Limit- Limit fluid to prescribe
Identify- Sources of fluid
Explain- Explain to pt and family the rationale for fluid restrictions
Assist- Patient to cope with the fluid restrictions
Provide or encourage- Frequent oral hygiene

44
Q

What are some assessments one will do with imbalanced nutrition?

A
  • Nutritional status, weight changes, lab data
  • Nutritional patterns, history preferences
  • Provide food preferences within restrictions
  • Encourage high quality nutritional foods while maintaining nutritional restrictions
  • Stomatitis or anorexia: modify intake related to factors tat contribute to alterations
  • adjust medications times related to meals
45
Q

Risk for Situational Low Self Esteem

A

Assess patient and family responses to illness and tx
- Assess relationships and coping patterns
- Encourage open discussion about changes and concerns
- Explore- Alternate ways of sexual expression
Discuss- role of giving and receiving love, warmth, and affection

46
Q

Urolithiasis

Nephrolithiasis

A
  • Calculi (stones) in the urinary tract or kidney
  • Causes may be unknown
  • Depend on location and presence of obstruction or infection
  • Pain and hematuria

Diagnosis: Radiography, blood chem., and stone analysis, strain all urine and save stones

47
Q

Name the potential sites of urinary calculi

A

-Right kidney
- renal stones
–Left kidney– renal stones
- Ureters
Bladder

48
Q

Name the manifestations of urolithiasis and nephrolithiasis

A

Infection UTI: chills, fever
Intense CVA tendrness
- Hematuria
- Pyuria
- Pain radiates : Bladder -Female; Testes- Males
N/V
Urinary Retention

49
Q

Name the Diagnostics of Urolithiasis and nephrolithiasis

A
  1. KUB
  2. Ultrasonography
  3. IV urography
  4. Retrograde Pylography
  5. 24 hr urine test Ca, uric acid, creatinine, Na, pH
  6. Passed stone
50
Q

Management to eradicate the stone includes what?

A

-Pain- opioid analgesic
- Inflammatory - NSAIDs
- Hot baths or moist heat
- Prevention- Nutritional
- Fluids; Oral or IV

51
Q

Name natural remedies for Kidney Stones include

A
  1. lemon juice
  2. Olive oil
  3. Raw apple cider vinegar
  4. Dandelion Root
  5. Celery
  6. Basil
  7. Leafy green vegetables
    8 Exercise
  8. Drink plenty of water
  9. Avoid sugar and soy
52
Q

Name methods of removing or treating Renal Stones

A
  1. Use of cystoscope
  2. Use of ureteroscope
  3. Use of Xray imaging/ Lithotripsy
  4. Use of alligator forceps to remove kidney stone fragments
53
Q

Patient Education of urolithiasis and nephrolithiasis includes

A
  • S/ S to report
  • Follow up care
  • Urine ph monitoring
  • Measures to prevent recurrent stones
  • Importance of fluid intake
  • Dietary education
  • Medication education as needed
54
Q

Nursing Diagnosis of preoperative urolithiasis and nephrolithiasis

A
  • Anxiety
  • Imbalanced Nutrition
  • Deficient knowledge
55
Q

Nursing Diagnosis Postoperative of Stones

A
  • Risk of impaired skin integrity
  • Acute pain
  • Disturbed body image
  • Potential sexual dysfunction
  • Deficient Knowledge

NURSADN6 Med Surg (9 decks)

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