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NURS 2514 > Week 3 - Seminar > Flashcards

Week 3 - Seminar Flashcards

1
Q

what are the 3 primary functions of the urinary system

A
  1. filter waste from blood
  2. balance electrolytes & acid/base
  3. excrete metabolic wastes
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2
Q

what are 3 secondary functions of the urinary system

A
  1. regulate BP
  2. regulate bone density
  3. regulate erythropoiesis
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3
Q

define chronic kidney disease

A
  • a state in which the kidneys no longer function adequately to rid the body of wastes
  • unable to maintain homeostasis
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4
Q

CKD is an example of_____

A
  • altered elimination
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5
Q

list 7 risk factors of CKD

A
  • diabetes
  • HTN
  • smoking
  • heart disease
  • over 65
  • meds
  • ethnicity
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6
Q

which ethnicities are risk factors for CKD (7)

A
  • indigenous
  • asian
  • south asian
  • pacific island
  • african
  • caribbean
  • latin canadian
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7
Q

what 2 things are monitored for those at risk of CKD

A
  • blood work

- urine

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8
Q

diagnosis of CKD is made when…

A

GFR < 60 ml/min/1.73 m2 for 3 months or longer

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9
Q

what is the most common renal disease that leads to dialysis & transplantation

A
  • diabetic nephropathy
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10
Q

how long after the onset of diabetes does proteinuria appear?

A
  • 10 years
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11
Q

what is an important way to prevent renal disease in pts w diabetes

A
  • blood glucose control
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12
Q

how many clinical stages of CKD are there?

A
  • 5
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13
Q

describe symptoms & GFR in stage 1

A
  • GFR = >90

- likely asymptomatic bc kidneys can compensare well

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14
Q

descibre symptoms & GFR in stage 2 (2)

A
  • GFR = 60-89
  • may have decreased ability to conc urine
  • develop symptoms of anemia
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15
Q

describe symptoms in stage 3-4 of CKD (5)

A
  • electrolyte & fluid imbalances
  • oliguria
  • more severe anemia
  • metabolic acidosis
  • azotemia
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16
Q

what is stage 5 of CKD? describe symptoms instage 5 of CKD (3)

A
  • end stage renal disease needing dialysis/transplant
  • anuria
  • severe electrolyte & fluid imbalance
  • uremia
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17
Q

is CKD progressive or sudden?

A
  • progressive deterioration
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18
Q

what 3 functions of the kidenys are lost during CKD

A
  • excretory
  • regulatory
  • endocrine
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19
Q

list 6 substances the kidneys retain during CKD

A
  • urea
  • creatinine
  • phenols
  • hormones
  • electrolytes
  • water
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20
Q

what is uremia

A
  • constellation of symptoms r/t to buildup of waste products & excess fluid
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21
Q

at what stage(s) do we see uremia in CKD

A
  • 4/5
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22
Q

what should we consider during health history for CKD (8)

A
  • current health (OPQRSTU)
  • PMHx (diseases that are risk factors)
  • PSHx
  • famHx
  • meds
  • allergies
  • social
  • occupation/enviro
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23
Q

why is it important to ask about meds for health history of CKD

A
  • some meds are nephrotoxic
  • consider compliance for drugs that help reduce risk factors ex. diabetes meds –> glucose regulaion is important for preventing kidney disease
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24
Q

list 5 electrolyte that will be effected by CKD

A
  • potassium –> hyperkalemia
  • sodium –> normal or low –> dilutional (from retaining so much water)
  • calcium
  • phosphate
  • magnesia –> hypermagnesia
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25
Q

what causes hypermagnesia in CKD

A
  • will only occur if ingesting Mg
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26
Q

what are 2 examples of sources of magnesium

A
  • supplements

- milk of Mg

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27
Q

list 2 symptoms r/t to hypermagnesia

A
  • decrease in mental status

- dysarrthymia

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28
Q

what acid-base imbalance may occur due to CKD

A
  • metabolic acidosis
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29
Q

what are symptoms of hyperkalemia

A

Muscle weakness
Urine output little or none
Resp failure (due to muscle weakness)
Decreased cardiac contractility (weak pulse, low HR again due to muscle weakness)
Early: muscle cramps/twitches
Rhythm changes (tall T waves, prolonged PR interval)

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30
Q

what are symptoms of hyponatremia

A

Stupor/coma
Abdominal cramping, NV
Lethargy
Trouble concentrating

Loss of urine & appetite, overactive bowel sounds
Orthostatic hypotension
Seizures, spasms of muscles
Shallow resp

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31
Q

what are 2 possible diagnostic test for electrolyte/acid-base imbalances r/t CKD

A
  • electrolytes (for imbalances)

- ABGs (for metabolic acidosis)

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32
Q

list 3 hematological symptoms r/t to CKD

A
  1. anemia
  2. bleeding tendencies
  3. infection
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33
Q

list 3 causes of anemia r/t to CKD

A
  • decreased erythropoitin
  • dialysis –> causes damaged RBC
  • frequent blood draws
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34
Q

what kind of anemia is seen in CKD

A
  • normocytic (normal size)

- normochromic (conc of hgb is normal)

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35
Q

what causes bleeding tendencies r/t to CKD

A
  • defect in platelet function r/t uremia
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36
Q

what causes infection r/t to CKD

A
  • change in leukocyte function & altered immune response r/t aztoemia
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37
Q

describe physical assessment for hematological symptoms of CKD (4)

A
  • observe for SOB, pale skin (for anemia)
  • auscultate for tachy
  • assess for unusual bleeding
  • assess for infection
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38
Q

how can we assess for unusual bleeding

A
  • easy bruising
  • bleeding nose
  • bleeding gums
  • abdominal exam
  • blood in stool
  • signs of strok
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39
Q

how can we assess for infection (4)

A
  • vital signs (temp)
  • increased pain
  • redness
  • purulence
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40
Q

what are potential diagnostics for hematological signs of CKD (5)

A

CBC:

  • low hgb
  • increased WBC (infection)
  • normal plt (defect, not thrombocytopenia**)
  • normal pt/ptt
  • ferritin/iron low
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41
Q

what are CNS symptoms of CKD (3)

A
  • CNS depression
  • seizures, coma (uncommon)
  • peripheral neuropathy
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42
Q

what signs of CNS depression are seen in CKD (4)? what causes this?

A

due to uremia

  • fatigue
  • decreased loc
  • irritability
  • decreased conc
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43
Q

what are 4 signs of peripheral neuropathy

A
  • restless legs
  • paresthesia in feet/legs
  • muscle weakness
  • muscle twitch, asterixis
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44
Q

what is asterixis

A
  • uncontrolled movement in hands = hand flapping
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45
Q

describe physical assessment of CNS symptoms of CKD (2)

A
  • observe/ inspect thru change in conciousness, behavior, convo
  • palpate extremities to assess for changes in sensation, unusual reflexes/tremors
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46
Q

what are 3 potential diagnostics for CNS symptoms of CKD

A
  • increased BUN
  • electrolytes (decreased Na)
  • ABG –> acidosis
47
Q

list 5 CVs symptoms of CKD

A
  • HTN
  • accelerated artherosclerosis
  • HTN can lead to HF
  • cardiac dysrhythmias
  • uremic pericarditis
48
Q

list 2 things that cause cardiac dysrythmias

A
  • hyperkalemia

- hypocalcemia

49
Q

describe physical assessment for CVS symptoms of CKD

A
  • vital signs (BP, temp, HR, RR)
  • inspect for dyspnea, edema
  • auscultate lungs
50
Q

why would you asculate lungs for CVS symptoms of CKD? What should you look for?

A
  • to look for symptoms r/t to HF

- look for crackles, heart sounds

51
Q

list 3 potential diagnostic tests for CVS symptoms of CKD

A
  • EKG
  • electrolytes (increased K, decreased Ca, increased P)
  • BG
52
Q

what are respiratory symptoms of CKD (3)

A
  • dyspnea
  • secondary infections
  • kussmaul’s breathing
53
Q

what causes dyspnea r/t to CKD

A
  • fluid overload
  • pulmonary edema
  • pleural effusion
  • uremic pleuritis
54
Q

why would kussmaul’s breathing occur with CKD

A
  • due to metabolic acidosis
55
Q

describe physical assessment of resp symptoms of CKD

A
  • observe for SOB, dyspnea, cough (infection)

- ascultate for air entry & adventitious sounds

56
Q

what is a diagnostic test for resp signs of CKD

A
  • chest xray
57
Q

what are 6 GI signs of CKD

A
  • uremic fetor
  • stomatitis w ulterations
  • altered sense of taste (metallic)
  • NV, anemia
  • bleeding & ulceration
  • constipation
58
Q

describe physical assessment of GI symptoms of CKD

A
  • monitor I&O
  • monitor characteristics of emesis
  • observe/inspect mouth for ulceration, ammonia breath, abdomen
  • asucultate abdomen
  • palpate abdomen
59
Q

what are GU symptoms of CKD (6)

A
  • polyuria in early stages
  • with CKD progression: oligiura & anuria
  • proteinuria
  • casts
  • hematuria
  • pyuria
60
Q

what urine volume is anuria

A

<40 mL/day

61
Q

describe physical assessment for GU signs of CKD (3)

A
  • assess vital signs (increased BP)
  • monitor I and O
  • monitor urine characteristics
62
Q

what urine characteristics may occur in early CKD? late CKD?

A
  • early = dilute

- late = conc

63
Q

what is a diagnostic test for GU symptoms of CKD? what results will you see?

A 
urinalysis:
- proteinuria
- casta
- pyuria
- hematuria 
(depends on cause)
64
Q

list 2 integumentary symptoms of CKD

A
  • pruritus

- uremic frost

65
Q

what causes pruritis in CKD (3)

A
  • dry skin
  • calcium-phosphate deposits
  • sensory neuropathy
66
Q

what are risks associated w pruritis (2)

A
  • bleeding
  • infection
    due to scratching
67
Q

what causes uremic frost

A
  • urea crystalizing on skin (rare)
68
Q

describe physical assessment of the integ system for CKD

A
  • inspect for rashes & scratches

- inspect for signs of infection

69
Q

what are 3 possible diagnostic tests for the integ system

A
  • BG
  • increase BUN
  • CBC for infection
70
Q

what are 2 musculoskeletal symptoms of CKD

A
  • renal osteodystrophy

- insoluble calcification in vascular walls & soft tissues

71
Q

what is renal osteodystrophy

A
  • skeletal disorder

- alteration of bone morphology

72
Q

what is a risk of renal osteodystrophy

A
  • increased risk of fractures
73
Q

what causes calcifications in CKD

A
  • phosphate binding w calcium
74
Q

describe physical assessment for musculoskeletal signs of CKD

A
  • often asymptomatic
  • assess for complains of weakness, muscle/bone pain
  • observe for abnormal gait
75
Q

what are 4 potential diagnostic tests for musculoskeletal signs of CKD

A
  • alk phosphotase increased
  • xrays –> fractures
  • BMD tests
  • Ca and phos levels
76
Q

in general, what are 3 things you want to measure for physical assessment of CKD? why?

A
  • vital signs (fluid overload, infection?)
  • I and Os (anuria, oliguria)
  • daily weight
77
Q

in general, what are some things you want in observe/inspect for phys assessment of CKD

A
  • gait
  • LOC
  • paleness
  • rash
  • bruising
  • edema
  • signs of infection
  • bleeding
  • uremic fetor
  • dyspnea
  • urine color
78
Q

in general, what are 2 things you want to palpate during assessment of CKD

A
  • extremities for sensation & edema

- abdomen for discomofrt

79
Q

in general, what are 3 things you want to auscultate for assessment of CKD

A
  • lungs (crackles, consolidation)
  • heart
  • abdomen (bowel sounds)
80
Q

in general, what are 3 categories of diagnostics for CKD

A
  • blood work
  • imaging
  • urine tests
81
Q

what are 2 main types of blood work for CKD

A
  • electrolytes

- CBC

82
Q

what are 3 types of urine tests done for CKD

A
  • urinalysis
  • albumin/creatinine urine test (ACR)
  • creatinine clearance (24 hr)
83
Q

what is measured during urinalysis

A
  • pH
  • protein
  • glucose
  • blood
84
Q

what are 5 types of imaging test for CKD

A
  • abdominal xray
  • renal US
  • renal CT (dye)
  • renal MRI
  • renal biopsy
85
Q

what is a risk associated with getting a renal biopsy

A
  • risk of bleeding
86
Q

what is a risk of a renal CT (dye)?

A
  • must be processed thru the kidney & can be harmful
87
Q

what is dialysis

A
  • movement of fluid & molecules across a semi-permeable membrane from one compartment to another
88
Q

what is dialysis used for

A
  • to correct fluid & electrolyte imbalances

- remove waste products

89
Q

what stage of CKD is dialysis used for

A
  • stage 5
90
Q

what are 2 methods of dialysis

A
  1. hemodialysis

2. peritoneal dialysis

91
Q

what are 5 possible indications for dialysis

A

Acidemia (metabolic acidosis)
Electrolyte abnormalities with EKG changes (hyperkalemia)
Intoxication from meds or Infection r/t uremia
Overload of fluid (not responsible to diuretics)
Uremia complications

92
Q

how does dialysis help to treat infection

A
  • enhances WBC function to fight infection
93
Q

what uremia complications indicate use of dialysis (3)

A
  • pericarditis
  • encephalopathy
  • GI bleeding
94
Q

what is peritoneal dialysis? how does it work

A
  • insertion of a catheter thru the anterior abdominal wall into the perionteal
  • dialysis inside the body that uses the peritoneal membrane
  • put fluid into the body, let it sit for awhile (dwell), and then you drain it out
95
Q

list complications of PD (6)

A
  • abdominal/back pain
  • outflow problems
  • hernias
  • protein loss
  • pulmonary complications
  • infection
96
Q

what causes abdominal/back pain r/t PD (4)

A
  • low pH of solution
  • peritonitis
  • intraperitoneal irritation
  • catheter placement
97
Q

what is an outflow problem r/t PD

A
  • normally, 80% of fluid should be returned that is instilled
  • outflow problem = not enough fluid returned
98
Q

what can cause a hernia r/t PD

A
  • due to increased intraabdominal pressure w infusion
99
Q

what can cause protein loss during PD

A
  • the peritoneal membrane is permeable to some
100
Q

what can cause pulmonary complications during PD

A
  • repeated upward displacement of the diaphragm due to extra fluid = decreased lung expansion
101
Q

what two places coudl infection occur during PD

A
  1. at the exit site

2. peritonitis (inside the body)

102
Q

what are signs of an infection at the exit site during PD (3)

A
  • site redness, tenderness, drainage
103
Q

what are signs of periotonitis due to PD (7)

A
  • cloudy peritoneal effluent
  • diffuse abdominal pain
  • diarrhea
  • vomitting
  • abd distension
  • hyperactive bowel sounds
  • foul smell
104
Q

what is hemodialysis? how does it work?

A
  • dialysis outside the body
  • blood is brought out of the body & run thru a dialyzer which filters out toxins/waste products & clean blood is returned to body
105
Q

what are 2 types of hemodialysis vascular access sites

A
  1. fistula

2. graft

106
Q

what is a fistula?

A
  • joining of an artery to a vein
107
Q

how does a graft work for hemodialysis

A
  • a synthetic looped graft is inserted between the arery & vein
108
Q

list 2 nursing considerations for hemodialysis

A
  • fistula must be protected from trauma & compression (ex. tight clothing, sleeping on that side, etc.)
  • no blood pressure, venipuncture (drawing of blood), IV
109
Q

what are signs of good flow during hemodualysis

A
  • palpate for thrill

- listen for bruit

110
Q

list 5 complications of hemodialysis

A
  • infection —> sepsis
  • hypotension (bc fluid removed)
  • muscle cramps
  • loss of blood
  • disequilibrium syndrome
111
Q

what is disequilibrium syndrome

A
  • where rapid removal of urea leads to cerebral edema and increased intrcranial pressure
  • more common in people who are new to dialysis
112
Q

what should you assess pre-dialysis (3)

A
  • be aware of why they are having it
  • ensure vital signs are stable (bp esp)
  • review meds , some may be held
113
Q

which meds might be held when giving dialysis

A
  • any med that would be dialysed out
114
Q

what should you monitor post-dialysis (5)

A
  • monitor LOC, mental status
  • monitor vs
  • auscultate heart & lung sounds
  • observe vascular access
  • monitor urine & blood work

NURS 2514 (75 decks)

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