Week 9 Kidney Problems Flashcards
What is glomerulo-nephritis?
It is an immune related inflammation of the glomeruli
What is the cause of glomerulo-nephritis?
Caused by incident (infection, exposure to drug meds) or condition (lupus)
What are the signs and symptoms of glomerulo-nephritis and how are they caused?
- Generalized body edema due to poor function of glomeruli and body retains fluid
- BP increase due to retained fluid
- Hematuria in urine, proteinurea (looks smoky rust colour)
What would you find in a patients history if they have glomerulo-nephritis?
- Recent infection
- Lupus
- Scheraderma
What is patient recovery in glomerulo-nephritis
Complete and recover well.
There are times where it can go and and lots of glomerular die.
What is the patient population in acute poststreptococcal glomerulo-nephritis.
Most common in children and young adults
What is the organism in acute poststreptococcal glomerulo-nephritis?
Streptococci, group A-beta hemolytic streptococci
What is the acute poststreptococcal glomeruli-nephritis?
Decrease in filtration of metabolic waste products from blood and increase in permeability of glomerulus to larger protein molecules
What are the S&S of acute poststreptococcal glomerulo-nephritis?
- Generalized body edema - face, eyes, elbows, etc.
- High BP
- Hematuria
- Proteinurea
- Smoky rusty coloured urine
- Abd/flank pain
- Strep throat infection
- Body cannot filter metabolic waste
- Pt losing protein through urine
What kind of analysis should be done for acute poststreptococcal glomerulo-nephritis..?
Urine analysis
What is patient recovery in acute poststreptococcal glomerulo-nephritis?
95% Complete recovery
1% Develops renal failure
What is patient prevention in acute poststreptococcal glomerulo-nephritis?
- Early diagnoses and treatment
- Get strep throat and drink full course of antibiotics
- If patient does not feel better, kidneys might have gotten attacked
What is the treatment in poststreptococcal glomerulo-nephritis?
- Manage symptoms
- Treat edema with diuretics
- Anti-hypertensive - lower BP
- Restrict sodium intake and fluid
- Rest
- Weight Pt everyday, 1&0, Watch Cr and Bun
- Antibiotics might not work
What is nephrotic syndrome (high in glomerular permeability)?
Clinical issue associated with variety of disease. Sometimes related to kidneys but sometimes other disease.
What is the patient population in nephrotic syndrome?
Kids (1/3 have systemic disease) and adults
What are the issues in patient with nephrotic syndrome?
- Patient lose protein in urine edema (generalized)
- Low serum albumin
- Hypercoagubility
- Elevated serum cholesterol and triglyceride
- Nutrition status
- Altered immune responses
In patients with nephrotic syndrome, what are you accessing?
- I&O’s
- Weight
- Measure girth (ascites)
- Skin care (make sure it’s clean and dry, notice skin tears or sores, skin becomes thin)
In patients with its nephrotic syndrome, why do they get clots?
Because they become hypercoagulable, clot in renal vein thrombosis, clot in lungs (pulmonary embolism). Decrease in anti thrombin excess fibrinogen.
In patients with nephrotic syndrome, what affects nutrition status and what is the diet?
Can become malnourished; less protein in urine.
The body cannot keep protein inside.
Diet: Low to moderate protein, we can’t stop body from losing protein and small frequent meals.
In patients with nephrotic syndrome, altered immune systems increase the risk of what?
Infection
What is the nursing care for nephrotic syndrome?
Deal with the edema, duress the patient, weigh daily, I&O’s, skin, check abd.
What is the onset of acute kidney injury?
Sudden
What is the onset of chronic kidney disease?
Gradual, often over many years
What is the most common cause in acute kidney disease?
Acute tubular necrosis
What is the most common cause of chronic kidney disease?
Diabetic nephropathy
What is the diagnostic criteria of acute kidney injury?
Acute reduction in urine output and/or elevation in serum creatinine
What is the diagnostic criteria for chronic kidney disease?
GFR <60 mL/min/1.73m^2 for >3 mo and/or kidney damage >3 mo
What is the reversibility on acute kidney injury?
Potentially
What is the reversibility of chronic kidney disease?
Progressive ms irreversible
What is the mortality of acute kidney injury?
High (~60%)
What is the mortality of chronic kidney disease?
19-24% (patients on dialysis)
What is the primary cause of death for acute kidney injury?
Infection
What is the primary cause of death in chronic kidney disease?
Cardiovascular disease
How do patients get AKI?
Having a primary disease and develops AKI
Describe a patient who has CKD.
Patients are called medically fragile. Their body is generally alive but they easily get sick and die.
What are the causes of acute kidney injury/acute renal failure in pre, intra, and post renal?
Pre-renal: Reduced blood low to kidney
Intra-renal: Direct damage to kidney
Post-renal: An obstruction (kidney stones block flow I’m kidney)
In AKI/ARF what is an example of pre-renal?
- Pt. Came in that was stabbed & 12 hours with low BP
- Reduce blood pressure (internal or external)
- Sustained BP & hypovolemia
In SKI/ARF what is an example of intra-renal?
- Severe crash injury and myoglobin went up
- Nephrotoxic medication (vancomycin)
- Trauma to the kidney
In AKI/ARF what is an example of post-renal obstruction?
Kidney stones block urine flow in the kidney
What are the S&S’s of AKI/ARF?
- Physical assessment
- Fluid balance, amount of urine output, weight
- bun & Crea
- Acid base balance
- Lab work
What are the examples of S&S’s: Physical assessment in AKI/ARF?
(H2T) Volume overload, edema, auscultate lungs (red flag: crackles)
What are the examples of S&S’s: Fluid balance in AKI/ARF?
Amount of urine output and weight
What are the examples of S&S’s: BUN & Crea in AKI/ARF?
Increased
In AKI/ARF what does fluid move load levels look like I’m weight, urine output, BUN&Cr, and Ph and metabolic acidosis?
Increase weight
Decrease urine output
Increase BUN&Cr
Decrease Ph and metabolic acidosis
In AKI/ARF what does the lab work look like?
Na (normal or decrease) - tubular in kidney cannot reserve because it’s not working, K+ (high).
Ca (low), PO4 (high)
How do we recognize acute renal injury (ARI)?
- Develops hours to days.
- Depends on the cause.
- Older Pt. Are much susceptible, less functioning nephrons
What is the treatment goal of AKI/ARF?
Treating precipitating (pre, intra, postrenal) cause, manage symptoms, prevent complications
What are the examples of of precipitation cause, manage symptoms, prevent complications in AKI/ARF?
- Fluid balance
- Electrolyte balance
- Diet /nutrition
- Review medication
- May need cardiac monitor/telemetry
What is the treatment goal: fluid balance of AKI/ARF?
Lots of IV fluid depends on cause
What is the treatment plan: electrolyte balance in AKI/ARF?
Draw blood work, BUN, Cr, Na, K, PO4, Ca
What is the treatment plan: diet/nutrition in AKI/ARF?
Low sodium diet & adequate calories. Involve dietitian if needing tube feed,
What is the treatment plan: review medications in AKI/ARF?
Review any meds that can make kidney worse and avoid contrast, NSAIDS
In AKI/ARF (in treatment goal) if K+ is too high what to do?
Get patient into telemetry > risk for lethal rhythm and ectopics.
If K is really high:
Give glucose IV & insulin IV.
K exilate or diverse them or emergency dialysis.
What is the treatment plan: may need cardiac monitoring\telemetry in AKI/ARF?
Due to increase of K+
Why should you compare assessments made over time in AKI/ARF?
To see if patient is improving or worsening (check for S&S’s of infection)
If severe complications are or may occur in AKI/ARF, what to do?
The patient will be transferred to the ICU and will likely undergo a type of renal replacement therapy (only some in ICUs) for a period of time (days to couple of weeks).
If severe complications in AKI/ARF continue what can it progress to?
Chronic renal failure - dialysis for life or renal transplant
Why is the cause of chronic kidney disease?
Diabetic neophropathy —> progressive disease, irreversible
What is the treatment for CKD?
Peritoneal dialysis (at home), hemodialysis, kidney transplant
What kind of hemodialysis for CKD?
Vascath or AV fistula (long term use, no opening)
In CKD what do patients take to manage symptoms?
Medications and supplements
In CKD what are the problems to manage?
- Fluid volume status
- Diet/nutrition
- Fatigue
- Anemia
- Pruritus
- Hi Phosphate
- Hypertension
- Drug dosages
What are the examples for problems for manage: fluid volume status in CKD?
Weight, I&O’ balance
Signs of fluid volume excess - SOB, decrease saturation, crackles in chest
Serum K level - Can impact heart
What are the examples of problems to manage: diet/nutrition in CKD?
Restrict fluid and protein intake (BUNN& Creatinine is the end product of protein metabolism and their BUN & Cr is already high. Increase carbs & fats.
What are the examples of problems to manage: Anemia in CKD?
Erythropoietin, iron because kidney is not working
What are the examples of problems to manage: pruritus in CKD?
Always irritable due to waste products
What are the examples of problems to manage: Hi phosphate (PO4)?
Kidney cannot filter this and it just builds up
What are the examples of problems to manage: hypertension in CKD?
Fluid overload, ace inhibitors, beta-blockers, etc.
What are the examples of problems to manage: drug dosages in CKD and why?
Digoxin, metformin, antibiotics, opioids because of kidney is unable to filter the drug.
Statins —> decrease cholesterol
In RN care for dialysis how many times do you monitor the patient?
3-4 times per week, at least 2-4 hrs procedures.
What should you know in a patients with dialysis?
- Baseline
- Temperatures
- Edema
- Skin condition
- Auscultate lungs
- Electrolyte checks
- Monitor for changes in BP
In patients with dialysis, what do you do if the BP is low?
250ml Bolus given
In RN care when should you check electrolytes on a patient with dialysis?
Check before and after
In RN care why do muscle cramps occur in patient with dialysis?
Fast change in electrolytes
In RN care what should you monitor in a patient with dialysis?
- BP
- Electrolytes
- Muscle cramps
- Energy/fatigue/mood
- ‘Disequilibrium syndrome’
- Risk of sepsis
- ‘medically fragile’
In RN care for dialysis why should you monitor for disequilibrium syndrome?
- Fast changes in extra cellular fluid
- N&V, restless, jerking movement, seizures
In RN care for dialysis patients what technique should you use for risk of sepsis when monitoring?
Aseptic technique when dialysis RN accesses vascular access site, tubings, set up.
A nurse wears a mask and is sterile.
In RN care for dialysis what do they mean the patients are medically fragile ?
Patients feels worse and may choose to stop dialysis. —> death in couple of weeks.
Ambulate patient, dressing change before dialysis, do things before treatment (Pt will be tired)
Where to do Peritoneal dialysis
Don at home.
How many times for peritoneal dialysis?
4 times a day
What time is peritoneal dialysis is done?
Usually done at night
In peritoneal dialysis describe the exchange cycle.
- Dialysis solution sits 4 hours them drained.
- Worry about infection
Describe the Peritoneal dialysis transplant
A kidney transplant has to be matched
