Week 4: Renal Flashcards
anemia
a deficiency in the number of erythrocytes (red blood cells [RBCs]), the
quantity or quality of hemoglobin (Hb), and the volume of packed RBCs (hematocrit
[Hct]), or a combination of these.
iron deficiency anemia
may develop from inadequate dietary intake, malabsorption,
blood loss, or hemolysis. Also, pregnancy contributes to iron deficiency because of the diversion of iron to the fetus for erythropoiesis, blood loss at delivery, and
lactation.
thalassemia
group of diseases that involve inadequate production of normal
hemoglobin and therefore decreased erythrocyte production.
megaloblastic anemias
group of disorders caused by impaired DNA synthesis
and characterized by the presence of large RBCs.
2 common forms of megaloblastic anemia
are cobalamin deficiency and folic acid deficiency.
aplastic anemia
disease in which the patient has peripheral blood pancytopenia
(decrease of all blood cell types) and hypocellular bone marrow.
chronic blood loss
bleeding ulcer, hemorrhoids, menstrual and postmenopausal blood loss
hemolytic anemia
condition caused by
the destruction or hemolysis of RBCs at a rate that exceeds production.
sickle cell disease
group of inherited, autosomal recessive disorders characterized by the presence of an abnormal form of hemoglobin in the erythrocyte.
care for pt with sickle cell disease
(a) preventing sequelae from the disease, (b) alleviating the symptoms of the disease, (c) minimizing end–target organ damage, and (d) promptly treating serious sequelae, such as acute chest syndrome. There is no specific treatment for the disease.
Extrinsic causes of hemolysis can be separated into three categories:
(1) physical
factors, (2) immune reactions, and (3) infectious agents and toxins.
infectious agents foster hemolysis in 3 ways
(1) by invading the RBC and
destroying its contents (e.g., parasites such as in malaria); (2) by releasing hemolytic
substances (e.g., Clostridium perfringens); and (3) by generating an antigen–antibody
reaction (e.g., Mycoplasma pneumonia).
Hemochromatosis
iron overload disorder. Although primarily caused by a
genetic defect, it occurs secondary to diseases such as sideroblastic anemia, and may
also be caused by liver disease and the multiple blood transfusions that are used to
treat thalassemia and SCD.
polycythemia
production and presence of increased numbers of RBCs. The
increase in RBCs can be so great that blood circulation is impaired as a result of the
increased blood viscosity (hyperviscosity) and volume (hypervolemia).
thrombocytopenia
reduction of platelets below 150 × 109/L or 150 000 per mcL.
hemophillia
X-linked recessive genetic disorder caused by defective or deficient coagulation factor. The two major forms of hemophilia, which can occur in mild to severe forms, are hemophilia A (classic hemophilia, factor VIII deficiency) and hemophilia B (Christmas disease, factor IX deficiency).
disseminated intravascular coagulation
serious bleeding and thrombotic
disorder.
It results from abnormally initiated and accelerated clotting. Subsequent decreases in
clotting factors and platelets ensue, which may lead to uncontrollable hemorrhage.
neutropenia
defined as a neutrophil count of less than 1 to 1.5 × 109/L, or 1 000 to 1 500/mcL. Normally, neutrophils range from 2.2 to 7.7 × 109/L. Severe neutropenia is defined as an ANC less than 0.5 × 109/L.
myelodysplastic syndome
group of related hematological disorders
characterized by a change in the quantity and quality of bone marrow elements.
Although it can occur in all age groups, the highest prevalence is in people over 80
years of age.
leukemia
broad term used to describe a group of malignant diseases affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen.
Acute myelogenous leukemia (AML)
characterized by uncontrolled
proliferation of myeloblasts, the precursors of granulocytes. Onset may be abrupt
and dramatic.
Acute lymphocytic leukemia (ALL)
most common type of leukemia in
children. In ALL, immature lymphocytes proliferate in the bone marrow; most are
of B-cell origin.
Chronic myelogenous leukemia (CML)
excessive development of
mature neoplastic granuloctyes in the bone marrow, which move into the
peripheral blood in massive numbers and ultimately infiltrate the liver and spleen.
Chronic lymphocytic leukemia (CLL)
characterized by the production and
accumulation of functionally inactive but long-lived, mature-appearing
lymphocytes. The lymphocytes infiltrate the bone marrow, spleen, and liver, and
lymph node enlargement is present throughout the body.
mainstay of the treatment for leukemia.
Cytotoxic chemotherapy
The overall nursing goals are that the client with leukemia will
(1) understand and
follow the treatment plan, (2) experience minimal adverse effects and complications
associated with both the disease and its treatment, and (3) feel comfortable and
supported during the periods of treatment, relapse, or remission.
Lymphomas
malignant neoplasms originating in the bone marrow and lymphatic
structures resulting in the proliferation of lymphocytes.
Hodgkin’s lymphoma,
malignant condition
characterized by proliferation of abnormal giant, multinucleated cells, called Reed-
Sternberg cells, which are located in lymph nodes.
Non-Hodgkin’s lymphomas (NHLs)
a heterogeneous group of malignant
neoplasms of primarily B- or T-cell origin affecting all ages. A variety of clinical
presentations and courses are recognized from indolent (slowly developing) to rapidly
progressive disease.
Multiple myeloma,
condition in which neoplastic
plasma cells infiltrate the bone marrow and destroy bone.
splenomegaly,
increased filtering and sequestering capacity,
lowering the number of circulating blood cells.
Autotransfusion,
consists of removing whole blood from a
person and transfusing that blood back into the same person. The problems of
incompatibility, allergic reactions, and transmission of disease can be avoided.
UTIs include
cystitis, pyelonephritis, urethritis
UTI symptoms
dysuria, frequent urination (more than every 2 hours),
urgency, and suprapubic discomfort or pressure. Flank pain, chills, and the presence
of a fever indicate an infection involving the upper urinary tract (pyelonephritis).
uti preventative measures
(1)emptying the bladder regularly and completely, (2) evacuating the bowel regularly,(3) wiping the perineal area from front to back after urination and defecation, and (4) drinking an adequate amount of liquid each day.
Pyelonephritis
inflammation of the renal parenchyma and collecting system
(including the renal pelvis). The most common cause is bacterial infection that begins
in the lower urinary tract.
pyelonephritis clinical s&s
manifestations vary from mild fatigue to the sudden onset of chills, fever,
vomiting, malaise, flank pain, and the bothersome lower urinary tract symptoms
(LUTS) characteristic of cystitis.
Chronic pyelonephritis
term used to describe a kidney that has become shrunken
and has lost function owing to scarring or fibrosis.
Urethritis
an inflammation of the urethra, most commonly from a sexually
transmitted bacterial or viral infection.
Urethral diverticula
outpouchings in the urethra that result from obstruction and
rupture of the periurethral glands. They are associated with childbearing, urethral
instrumentation, dilation, and infections.
URETHRAL DIVERTICULA s&s
dysuria, postvoid dribbling, frequency, urgency, suprapubic
discomfort or pressure, and dyspareunia.
interstitial cystitis
a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency/frequency and pain in the bladder and/or
pelvis.
glomerulo-nephritis
immune-related
inflammation of the glomeruli characterized by proteinuria, hematuria, decreased
urine production, and edema.
Clinical manifestations of glomerulo-nephritis
varying degrees of hematuria
(ranging from microscopic to gross) and urinary excretion of various formed
elements, including RBCs, WBCs, and casts.
Acute post-streptococcal glomerulo-nephritis (APSGN) s&s
generalized body edema, hypertension, oliguria, hematuria with a smoky or rusty
appearance, and proteinuria.
Goodpasture’s syndrome
a rare autoimmune disease characterized by the
presence of circulating antibodies against glomerular and alveolar basement
membranes.
Rapidly progressive glomerulo-nephritis (RPGN)
glomerular disease associated
with rapid, progressive loss of renal function over days to weeks.
Chronic glomerulo-nephritis
a syndrome that reflects the end stage of glomerular
inflammatory disease. It is characterized by proteinuria, hematuria, and slow development of uremic syndrome. Treatment is supportive and symptomatic.
Nephrotic syndrome
a clinical course that can be associated with a number
of disease conditions, including multisystem diseases such as diabetes or systemic
lupus erythematosus, infections, and neoplasms, and also certain drugs.
The five major categories of stones
(1) calcium phosphate, (2) calcium
oxalate, (3) uric acid, (4) cystine, and (5) struvite (magnesium–ammonium
phosphate).
Lithotripsy
(use of sound waves to break renal stones into small particles) is used to
eliminate calculi from the urinary tract. Outcome for lithotripsy is based on stone
size, stone location, and stone composition.
A stricture
an abnormal temporary or permanent narrowing of the lumen of a
hollow organ; in this context, of the ureter or the urethra.
Causes of urethral strictures
include trauma, urethritis, iatrogenic (following
surgical intervention), or a congenital defect.
Nephrosclerosis
a vascular disease of the kidney characterized by sclerosis of the
small arteries and arterioles of the kidney, resulting in renal tissue destruction. It may
be benign or malignant.
Renal artery stenosis
a partial occlusion of one or both renal arteries and their
major branches due to atherosclerotic narrowing or fibromuscular hyperplasia.
Renal vein thrombosis,
embolus occurring in the renal vein, may occur
unilaterally or bilaterally. Trauma, extrinsic compression (e.g., tumour, aortic
aneurysm), renal cell carcinoma, pregnancy, contraceptive use, and nephrotic
syndrome are associated with renal vein thrombosis.
Polycystic kidney disease (PKD)
by thin-walled cysts ranging in
size from several millimetres to several centimetres in diameter that fill the cortex and
medulla and destroy surrounding tissue by compression.
Systemic lupus erythematosus
a connective tissue disorder characterized by the
involvement of several tissues and organs, particularly the joints, skin, and kidneys. It
results in clinical manifestations similar to glomerulo-nephritis.
Systemic sclerosis
disease of unknown etiology characterized by
widespread alterations of connective tissue and by vascular lesions in many organs.
Risk factors for bladder cancer
cigarette smoking, exposure to dyes used in
the rubber and cable industries, chronic use of phenacetin-containing analgesics, and
chronic, recurrent renal calculi.
Urinary retention is caused by two different dysfunctions of the urinary system:
bladder outlet obstruction and deficient detrusor (bladder muscle) contraction
strength.
Acute kidney injury (AKI)
an abrupt decline in kidney function,
leading to a rise in serum creatinine or a reduction in urine output, or both.
azotemia
an accumulation of
nitrogen waste products [urea nitrogen, creatinine] in the blood
Acute tubular necrosis (ATN)
the most common intrarenal cause of AKI
and is primarily the result of ischemia, nephrotoxins, or sepsis. ATN is
potentially reversible if the basement membrane is not destroyed and the
tubular epithelium regenerates.
atn initiation
increase in serum creatinine and BUN and a
decrease in urine output.
atn maintenance
This phase may last from days to weeks. During this phase, patients may be anuric, oliguric (oliguria is characterized by urine output less than 400 mL/24 hr), or nonoliguric.
atn recovery
The recovery phase begins when the GFR increases, allowing the BUN and serum
creatinine levels to plateau and then decrease.
Almost all patients with uremia develop
dyslipidemia
Chronic kidney disease–mineral and bone disorder (CKD–MBD)
a term used
to describe the systemic components of this clinical syndrome that include
characteristic bone abnormalities, changes in mineral balance (calcium, phosphorus,
PTH, and vitamin D), and vascular and other soft tissue calcification.
Renal osteodystrophy
syndrome of skeletal changes that is a result of alterations
in calcium and phosphate metabolism, and includes osteomalacia and osteitis fibrosa.
overall goals are that a patient with CKD will
(1) demonstrate knowledge and
ability to comply with the therapeutic regimen, (2) participate in decision making, (3)
demonstrate effective coping strategies, and (4) continue with activities of daily living
within physiological limitations.
Dialysis
movement of fluid and molecules across a semipermeable membrane
from one compartment to another. Clinically, dialysis is a technique in which
substances move from the blood through a semipermeable membrane (dialyzer) and
into a dialysis solution (dialysate).
Peritoneal dialysis (PD)
method of removing waste products and excess fluid
from the blood using a natural semipermeable membrane, the peritoneum. Dialysis
fluid is infused into the peritoneal cavity, and excess fluid and waste products pass
across the membrane into the fluid, which is then drained and discarded.
complications of peritoneal dialysis
infection of catheter, abdominal pain, outflow problems, hernias, lower back problems,
bleeding, pulmonary complications (atelectasis, pneumonia, and bronchitis may occur from repeated upward displacement of the diaphragm), protein loss, and carbohydrate
and lipid abnormalities.
hemodialysis
method of removing waste products and excess fluid from the blood using a machine to pump the blood through an artificial semipermeable
membrane (dialyzer).
native arteriovenous fistula (AVF)
the preferred HD access, created by the
surgical connection of a vein and an artery, usually in the forearm. AVFs have the
best overall patency rates and least number of complications.
Arteriovenous grafts (AVGs)
made of synthetic materials and form a “bridge”
between the arterial and venous blood supplies. Grafts are placed under the skin and
are surgically anastomosed between an artery (usually brachial) and a vein (usually
cephalic).
Complications of Hemodialysis
hypotension, painful muscle cramps, blood loss, sepsis, disequilibrium syndrome
Continuous renal replacement therapy (CRRT)
alternative or adjunctive
treatment for AKI. It provides a means by which uremic toxins and fluids are
removed from a hemodynamically unstable patient, while acid–base status and
electrolytes are adjusted slowly and continuously.
Contraindications to kidney transplantation
disseminated malignancies, refractory or
untreated cardiac disease, chronic respiratory failure, extensive vascular disease,
chronic infection, and unresolved psychosocial disorders (e.g., nonadherence to
medical regimens, alcoholism, drug addiction).
