Week 3 Renal Dysfunction Flashcards
1
Q
BP Regulation Hormones
A
- Renin
- Angiotensin
- Aldosterone
2
Q
Strong Bone Construction
A
- Convert vit D from active form
- Increases Calcium levels in bone
3
Q
Waste Excretion
A
- Protein metabolites
- Nitrogen & urea
- Water-soluble medication metabolites
4
Q
Salt & Water Balance
A
- Respond to ADH & aldosterone
- Affect water reabsorption
- Maintain healthy plasma levels of salt
5
Q
RBC Production Boost
A
- Produce erythropoietin
- Stimulates bone marrow to manufacture RBCs
6
Q
Low Aldosterone
A
- Decrease Na+ retention
- Decrease fluid volume
- Decrease BP
- Increase urine output (diuresis)
7
Q
High Aldosterone
A
- Increase Na+ retention
- Increase fluid volume
- Increase BP
- Decrease urine output
8
Q
High ADH
A
- Increase fluid volume
- Increase BP
- Decrease urine output
9
Q
Low ADH
A
- Decrease fluid volume
- Decrease BP
- Increase urine output (diuresis)
10
Q
Renal Nursing Assessments
A
- Health & family history
- Medication history
- Physical exam
- Labs & investigations
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)
12
Q
Medication History
A
- Identify nephrotoxic meds
- NSAIDs
- Antibiotics (vancomycin)
- Loop diuretics (Furosemide)
- Contrast dyes (MRI)
- Metformin
13
Q
Physical Exam
A
- Urinary output
- Pain - mid/lower back, lower groin
- Signs of waste build-up
14
Q
Signs of Waste Build-Up - GI
A
- Nausea, vomit, diarrhea
- Abdominal discomfort/distension
- Ulceration - bleeding
15
Q
Signs of Waste Build-Up - Integumentary
A
- Itching/skin irritation
- Azotemia
16
Q
Signs of Waste Build-Up - Neuro
A
- Interrupts normal neruo function
- Early: lethargy, forgetfulness, mild confusion
- Late: seizures, coma
17
Q
Micturition
A
- Voiding
- 30mL/h - 1-2L/day
18
Q
Anurea
A
No urine output
19
Q
Oligurea
A
Low urine output
20
Q
Polyurea
A
Excessive urine output
21
Q
Heamturea
A
Blood in urine
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
- Initiation - initial loss of function
- Oliguria - reduction in urine output
- Increased Creatinine, BUN, K (hyperkalemia)
- Diuresis - tissues return to function, normalized output
- 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
- GFR>90 - damage but normal
- GFR 60-89 - mild decrease
- GFR 30-59 - moderate decrease
- GFR 15-29 - severe decrease
- 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
- Vital signs (BP, HR, RR - fluid status) (temp - infection)
- Fluid balance - weight
- 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
