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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
Q

Creatinine Levels

A
  • M 49-93micromol/L
  • F 22-75 micromol/L
  • Elevated levels indicate poor function
26
Q

BUN

A
  • 2.1-8.0mmol/L
  • Elevated levels indicate poor function
27
Q

Hemoglobin

A
  • Decrease production with kidney dysfunction
  • 120-160g/L
  • Decreased values, poor function
28
Q

Electrolyte Dysfunction

A
  • Abnormal filtration, secretion, retention
29
Q

ABGs Dysfunction

A
  • Decreased ability to filter & excrete H
30
Q

HCO3

A
  • Likely decreased to reflect renal involvement
31
Q

Potassium Elevation

A
  • Due to retention
  • Acidosis
32
Q

Bone Health Dysfunction

A

Vit D levels decrease, calcium decreases

33
Q

Acute Kidney Injury (AKI)

A
  • Sudden loss of renal function
  • Fluid, electrolyte, pH balances
  • Waste buildup
  • Metabolic acidosis
  • Impacting renal function <3 months
34
Q

Nurse Role in AKI

A
  • 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
Q

AKI Phases

A
  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
Q

AKI Nurse Interventions

A
  • Monitor fluid/electrolyte balance
  • Promote pulmonary function
  • Infection prevention
  • Psychosocial support
37
Q

AKI Goals of Care

A
  • Treat underlying cause of AKI
  • Dialysis to remove toxins/fluids
  • Diuretic medications
38
Q

Continuous Renal Replacement Therapy

A
  • Machine that mimics kidney function
  • Filters blood to provide kidney rest/healing
  • Filters extracellular fluid
  • Removes H2O, solutes through hemofilter
  • Clears urinary toxins
39
Q

Chronic Kidney Disease Stages

A
  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
Q

CKD Patient Education

A
  • 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
Q

CKD Pharm Interventions

A

Delay Progression

42
Q

ACE Inhibitors

A
  • PRILs, Rami-, Perindo, Lisino-
  • Antihypertensive
  • Dry cough, drowsiness, dizziness, headache
  • Monitor for hypotension
43
Q

ARBs

A
  • SARTANs: Cande-, Lo-, Val-
  • N/V/D, Dizziness, headache
  • Monitor for hypotension
  • Appropriate for clients who cannot tolerate ACE inhibitors
44
Q

Biquandies

A
  • 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
Q

HMG-CoA Reductase Inhibitor

A
  • 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
Q

Dialysis

A
  • Intermittent treatment to provide extracellular fluid filtration
  • Required when kidney function drops below baseline
  • Maintain fluid electrolyte balance
47
Q

Dialysis Goal

A
  • Remove fluid volume excess
  • Filter electrolytes
48
Q

Dialysis Assessment

A
  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
Q

Peritoneal Dialysis

A
  • 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
Q

Peritoneal Dialysis - Nursing Actions

A
  • Warm up solution before administration
  • Infection prevention
  • Monitor for peritonitis - febrile, cloudy drainage, tachycardia
51
Q

Hemodialysis

A
  • External filtration of intravascular fluid
  • Attach dialysis machine via fistula
52
Q

Fistula Care & Assessment

A
  • Avoid BP on arm
  • Neurovascular assessment
  • Do not use for other purposes or touch
53
Q

Kidney Transplant

A
  • 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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