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3910 Health Promotion & Caring: Client's with Health Challenges I > Week 3 Renal Dysfunction > Flashcards

Week 3 Renal Dysfunction Flashcards

1
Q

BP Regulation Hormones

A
  • Renin
  • Angiotensin
  • Aldosterone
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2
Q

Strong Bone Construction

A
  • Convert vit D from active form
  • Increases Calcium levels in bone
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3
Q

Waste Excretion

A
  • Protein metabolites
  • Nitrogen & urea
  • Water-soluble medication metabolites
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4
Q

Salt & Water Balance

A
  • Respond to ADH & aldosterone
  • Affect water reabsorption
  • Maintain healthy plasma levels of salt
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5
Q

RBC Production Boost

A
  • Produce erythropoietin
  • Stimulates bone marrow to manufacture RBCs
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6
Q

Low Aldosterone

A
  • Decrease Na+ retention
  • Decrease fluid volume
  • Decrease BP
  • Increase urine output (diuresis)
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7
Q

High Aldosterone

A
  • Increase Na+ retention
  • Increase fluid volume
  • Increase BP
  • Decrease urine output
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8
Q

High ADH

A
  • Increase fluid volume
  • Increase BP
  • Decrease urine output
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9
Q

Low ADH

A
  • Decrease fluid volume
  • Decrease BP
  • Increase urine output (diuresis)
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10
Q

Renal Nursing Assessments

A
  1. Health & family history
  2. Medication history
  3. Physical exam
  4. Labs & investigations
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11
Q

Health & Family History

A
  • Comorbidities that increase kidney damage risk
  • Diabetes
  • Neuromuscular
  • Conditions affecting bladder emptying
  • Family history of kidney disease
  • Age (increased age = increased kidney damage risk)
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12
Q

Medication History

A
  • Identify nephrotoxic meds
  • NSAIDs
  • Antibiotics (vancomycin)
  • Loop diuretics (Furosemide)
  • Contrast dyes (MRI)
  • Metformin
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13
Q

Physical Exam

A
  • Urinary output
  • Pain - mid/lower back, lower groin
  • Signs of waste build-up
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14
Q

Signs of Waste Build-Up - GI

A
  • Nausea, vomit, diarrhea
  • Abdominal discomfort/distension
  • Ulceration - bleeding
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15
Q

Signs of Waste Build-Up - Integumentary

A
  • Itching/skin irritation
  • Azotemia
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16
Q

Signs of Waste Build-Up - Neuro

A
  • Interrupts normal neruo function
  • Early: lethargy, forgetfulness, mild confusion
  • Late: seizures, coma
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17
Q

Micturition

A
  • Voiding
  • 30mL/h - 1-2L/day
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18
Q

Anurea

A

No urine output

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19
Q

Oligurea

A

Low urine output

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20
Q

Polyurea

A

Excessive urine output

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21
Q

Heamturea

A

Blood in urine

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22
Q

Proteinurea

A

Protein in urine

23
Q

eGFR

A
  • Difficult to measure
  • 120-130mL/min/1.73m2
  • 24 hour urine collection + blood draw
  • Decreased value indicates poor function
24
Q

GFR

A
  • 90 mL/min
  • Decreased value indicates poor function
25
Creatinine Levels
- M 49-93micromol/L - F 22-75 micromol/L - Elevated levels indicate poor function
26
BUN
- 2.1-8.0mmol/L - Elevated levels indicate poor function
27
Hemoglobin
- Decrease production with kidney dysfunction - 120-160g/L - Decreased values, poor function
28
Electrolyte Dysfunction
- Abnormal filtration, secretion, retention
29
ABGs Dysfunction
- Decreased ability to filter & excrete H
30
HCO3
- Likely decreased to reflect renal involvement
31
Potassium Elevation
- Due to retention - Acidosis
32
Bone Health Dysfunction
Vit D levels decrease, calcium decreases
33
Acute Kidney Injury (AKI)
- Sudden loss of renal function - Fluid, electrolyte, pH balances - Waste buildup - Metabolic acidosis - Impacting renal function <3 months
34
Nurse Role in AKI
- Monitor function & act when identifying concerns - Know drugs - risk of nephrotoxicity - Follow transfusion protocol - reactions can cause AKI - Prevent hypoperfusion - adequate hydration, treat hypotension promptly - Prevent infections - catheter care
35
AKI Phases
1. Initiation - initial loss of function 2. Oliguria - reduction in urine output - Increased Creatinine, BUN, K (hyperkalemia) 3. Diuresis - tissues return to function, normalized output 4. Recovery - labs normalize >3 months
36
AKI Nurse Interventions
- Monitor fluid/electrolyte balance - Promote pulmonary function - Infection prevention - Psychosocial support
37
AKI Goals of Care
- Treat underlying cause of AKI - Dialysis to remove toxins/fluids - Diuretic medications
38
Continuous Renal Replacement Therapy
- Machine that mimics kidney function - Filters blood to provide kidney rest/healing - Filters extracellular fluid - Removes H2O, solutes through hemofilter - Clears urinary toxins
39
Chronic Kidney Disease Stages
1. GFR>90 - damage but normal 2. GFR 60-89 - mild decrease 3. GFR 30-59 - moderate decrease 4. GFR 15-29 - severe decrease 5. GFR<15 - end stage
40
CKD Patient Education
- Control blood sugars - Control blood pressure - Diet - restrict fluid, sodium, low protein, high carb - Smoking cessation - Alcohol intake - Weight reduction - Exercise - Avoid nephrotoxic meds (NSAIDs over the counter)
41
CKD Pharm Interventions
Delay Progression
42
ACE Inhibitors
- PRILs, Rami-, Perindo, Lisino- - Antihypertensive - Dry cough, drowsiness, dizziness, headache - Monitor for hypotension
43
ARBs
- SARTANs: Cande-, Lo-, Val- - N/V/D, Dizziness, headache - Monitor for hypotension - Appropriate for clients who cannot tolerate ACE inhibitors
44
Biquandies
- Metformin - Antihyperglycemic - Stomach pain, GI upset, gas/bloating, N/V/D, constipation - Risk of hypoglycemia - monitor - Potentially hepatotoxic drug (ALT & AST) - Contraindicated in eGFR <30
45
HMG-CoA Reductase Inhibitor
- STATINs: atrova-, rosuva- simvas- - Antihyperlipidemia - Treat dyslypidemia - Muscle pain, GI upset, insomnia, dizziness, headaches - Lipid labs require fasting - eat nothing after 2000 for morning labs - HDLs (good) LDLs (bad) - Hepatotoxic drug (ALT & AST)
46
Dialysis
- Intermittent treatment to provide extracellular fluid filtration - Required when kidney function drops below baseline - Maintain fluid electrolyte balance
47
Dialysis Goal
- Remove fluid volume excess - Filter electrolytes
48
Dialysis Assessment
1. Vital signs (BP, HR, RR - fluid status) (temp - infection) 2. Fluid balance - weight 3. Labs (adjust dialysis settings based on electrolytes, add/remove as needed **Pre vs post assessment, compare to identify improvement
49
Peritoneal Dialysis
- Filter via passive filtration through peritoneal cavity - Fill with hypertonic solution, water moves into peritoneal cavity via osmosis, cavity drained - Gravity or continuous cyclic
50
Peritoneal Dialysis - Nursing Actions
- Warm up solution before administration - Infection prevention - Monitor for peritonitis - febrile, cloudy drainage, tachycardia
51
Hemodialysis
- External filtration of intravascular fluid - Attach dialysis machine via fistula
52
Fistula Care & Assessment
- Avoid BP on arm - Neurovascular assessment - Do not use for other purposes or touch
53
Kidney Transplant
- Healthy kidney replaces - Most effective treatment for stage 5 - Immunosuppressants for life

3910 Health Promotion & Caring: Client's with Health Challenges I (15 decks)

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