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NURS 3512 > Week 9 Kidney Problems > Flashcards

Week 9 Kidney Problems Flashcards

1
Q

What is glomerulo-nephritis?

A

It is an immune related inflammation of the glomeruli

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2
Q

What is the cause of glomerulo-nephritis?

A

Caused by incident (infection, exposure to drug meds) or condition (lupus)

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3
Q

What are the signs and symptoms of glomerulo-nephritis and how are they caused?

A
  1. Generalized body edema due to poor function of glomeruli and body retains fluid
  2. BP increase due to retained fluid
  3. Hematuria in urine, proteinurea (looks smoky rust colour)
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4
Q

What would you find in a patients history if they have glomerulo-nephritis?

A
  1. Recent infection
  2. Lupus
  3. Scheraderma
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5
Q

What is patient recovery in glomerulo-nephritis

A

Complete and recover well.

There are times where it can go and and lots of glomerular die.

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6
Q

What is the patient population in acute poststreptococcal glomerulo-nephritis.

A

Most common in children and young adults

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7
Q

What is the organism in acute poststreptococcal glomerulo-nephritis?

A

Streptococci, group A-beta hemolytic streptococci

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8
Q

What is the acute poststreptococcal glomeruli-nephritis?

A

Decrease in filtration of metabolic waste products from blood and increase in permeability of glomerulus to larger protein molecules

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9
Q

What are the S&S of acute poststreptococcal glomerulo-nephritis?

A
  1. Generalized body edema - face, eyes, elbows, etc.
  2. High BP
  3. Hematuria
  4. Proteinurea
  5. Smoky rusty coloured urine
  6. Abd/flank pain
  7. Strep throat infection
  8. Body cannot filter metabolic waste
  9. Pt losing protein through urine
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10
Q

What kind of analysis should be done for acute poststreptococcal glomerulo-nephritis..?

A

Urine analysis

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11
Q

What is patient recovery in acute poststreptococcal glomerulo-nephritis?

A

95% Complete recovery

1% Develops renal failure

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12
Q

What is patient prevention in acute poststreptococcal glomerulo-nephritis?

A
  1. Early diagnoses and treatment
  2. Get strep throat and drink full course of antibiotics
  3. If patient does not feel better, kidneys might have gotten attacked
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13
Q

What is the treatment in poststreptococcal glomerulo-nephritis?

A
  1. Manage symptoms
  2. Treat edema with diuretics
  3. Anti-hypertensive - lower BP
  4. Restrict sodium intake and fluid
  5. Rest
  6. Weight Pt everyday, 1&0, Watch Cr and Bun
  7. Antibiotics might not work
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14
Q

What is nephrotic syndrome (high in glomerular permeability)?

A

Clinical issue associated with variety of disease. Sometimes related to kidneys but sometimes other disease.

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15
Q

What is the patient population in nephrotic syndrome?

A

Kids (1/3 have systemic disease) and adults

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16
Q

What are the issues in patient with nephrotic syndrome?

A
  1. Patient lose protein in urine edema (generalized)
  2. Low serum albumin
  3. Hypercoagubility
  4. Elevated serum cholesterol and triglyceride
  5. Nutrition status
  6. Altered immune responses
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17
Q

In patients with nephrotic syndrome, what are you accessing?

A
  1. I&O’s
  2. Weight
  3. Measure girth (ascites)
  4. Skin care (make sure it’s clean and dry, notice skin tears or sores, skin becomes thin)
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18
Q

In patients with its nephrotic syndrome, why do they get clots?

A

Because they become hypercoagulable, clot in renal vein thrombosis, clot in lungs (pulmonary embolism). Decrease in anti thrombin excess fibrinogen.

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19
Q

In patients with nephrotic syndrome, what affects nutrition status and what is the diet?

A

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.

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20
Q

In patients with nephrotic syndrome, altered immune systems increase the risk of what?

A

Infection

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21
Q

What is the nursing care for nephrotic syndrome?

A

Deal with the edema, duress the patient, weigh daily, I&O’s, skin, check abd.

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22
Q

What is the onset of acute kidney injury?

A

Sudden

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23
Q

What is the onset of chronic kidney disease?

A

Gradual, often over many years

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24
Q

What is the most common cause in acute kidney disease?

A

Acute tubular necrosis

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25
Q

What is the most common cause of chronic kidney disease?

A

Diabetic nephropathy

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26
Q

What is the diagnostic criteria of acute kidney injury?

A

Acute reduction in urine output and/or elevation in serum creatinine

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27
Q

What is the diagnostic criteria for chronic kidney disease?

A

GFR <60 mL/min/1.73m^2 for >3 mo and/or kidney damage >3 mo

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28
Q

What is the reversibility on acute kidney injury?

A

Potentially

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29
Q

What is the reversibility of chronic kidney disease?

A

Progressive ms irreversible

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30
Q

What is the mortality of acute kidney injury?

A

High (~60%)

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31
Q

What is the mortality of chronic kidney disease?

A

19-24% (patients on dialysis)

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32
Q

What is the primary cause of death for acute kidney injury?

A

Infection

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33
Q

What is the primary cause of death in chronic kidney disease?

A

Cardiovascular disease

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34
Q

How do patients get AKI?

A

Having a primary disease and develops AKI

35
Q

Describe a patient who has CKD.

A

Patients are called medically fragile. Their body is generally alive but they easily get sick and die.

36
Q

What are the causes of acute kidney injury/acute renal failure in pre, intra, and post renal?

A

Pre-renal: Reduced blood low to kidney
Intra-renal: Direct damage to kidney
Post-renal: An obstruction (kidney stones block flow I’m kidney)

37
Q

In AKI/ARF what is an example of pre-renal?

A
  • Pt. Came in that was stabbed & 12 hours with low BP
  • Reduce blood pressure (internal or external)
  • Sustained BP & hypovolemia
38
Q

In SKI/ARF what is an example of intra-renal?

A
  • Severe crash injury and myoglobin went up
  • Nephrotoxic medication (vancomycin)
  • Trauma to the kidney
39
Q

In AKI/ARF what is an example of post-renal obstruction?

A

Kidney stones block urine flow in the kidney

40
Q

What are the S&S’s of AKI/ARF?

A
  1. Physical assessment
  2. Fluid balance, amount of urine output, weight
  3. bun & Crea
  4. Acid base balance
  5. Lab work
41
Q

What are the examples of S&S’s: Physical assessment in AKI/ARF?

A

(H2T) Volume overload, edema, auscultate lungs (red flag: crackles)

42
Q

What are the examples of S&S’s: Fluid balance in AKI/ARF?

A

Amount of urine output and weight

43
Q

What are the examples of S&S’s: BUN & Crea in AKI/ARF?

A

Increased

44
Q

In AKI/ARF what does fluid move load levels look like I’m weight, urine output, BUN&Cr, and Ph and metabolic acidosis?

A

Increase weight
Decrease urine output
Increase BUN&Cr
Decrease Ph and metabolic acidosis

45
Q

In AKI/ARF what does the lab work look like?

A

Na (normal or decrease) - tubular in kidney cannot reserve because it’s not working, K+ (high).

Ca (low), PO4 (high)

46
Q

How do we recognize acute renal injury (ARI)?

A
  • Develops hours to days.
  • Depends on the cause.
  • Older Pt. Are much susceptible, less functioning nephrons
47
Q

What is the treatment goal of AKI/ARF?

A

Treating precipitating (pre, intra, postrenal) cause, manage symptoms, prevent complications

48
Q

What are the examples of of precipitation cause, manage symptoms, prevent complications in AKI/ARF?

A
  1. Fluid balance
  2. Electrolyte balance
  3. Diet /nutrition
  4. Review medication
  5. May need cardiac monitor/telemetry
49
Q

What is the treatment goal: fluid balance of AKI/ARF?

A

Lots of IV fluid depends on cause

50
Q

What is the treatment plan: electrolyte balance in AKI/ARF?

A

Draw blood work, BUN, Cr, Na, K, PO4, Ca

51
Q

What is the treatment plan: diet/nutrition in AKI/ARF?

A

Low sodium diet & adequate calories. Involve dietitian if needing tube feed,

52
Q

What is the treatment plan: review medications in AKI/ARF?

A

Review any meds that can make kidney worse and avoid contrast, NSAIDS

53
Q

In AKI/ARF (in treatment goal) if K+ is too high what to do?

A

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.

54
Q

What is the treatment plan: may need cardiac monitoring\telemetry in AKI/ARF?

A

Due to increase of K+

55
Q

Why should you compare assessments made over time in AKI/ARF?

A

To see if patient is improving or worsening (check for S&S’s of infection)

56
Q

If severe complications are or may occur in AKI/ARF, what to do?

A

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).

57
Q

If severe complications in AKI/ARF continue what can it progress to?

A

Chronic renal failure - dialysis for life or renal transplant

58
Q

Why is the cause of chronic kidney disease?

A

Diabetic neophropathy —> progressive disease, irreversible

59
Q

What is the treatment for CKD?

A

Peritoneal dialysis (at home), hemodialysis, kidney transplant

60
Q

What kind of hemodialysis for CKD?

A

Vascath or AV fistula (long term use, no opening)

61
Q

In CKD what do patients take to manage symptoms?

A

Medications and supplements

62
Q

In CKD what are the problems to manage?

A
  1. Fluid volume status
  2. Diet/nutrition
  3. Fatigue
  4. Anemia
  5. Pruritus
  6. Hi Phosphate
  7. Hypertension
  8. Drug dosages
63
Q

What are the examples for problems for manage: fluid volume status in CKD?

A

Weight, I&O’ balance

Signs of fluid volume excess - SOB, decrease saturation, crackles in chest
Serum K level - Can impact heart

64
Q

What are the examples of problems to manage: diet/nutrition in CKD?

A

Restrict fluid and protein intake (BUNN& Creatinine is the end product of protein metabolism and their BUN & Cr is already high. Increase carbs & fats.

65
Q

What are the examples of problems to manage: Anemia in CKD?

A

Erythropoietin, iron because kidney is not working

66
Q

What are the examples of problems to manage: pruritus in CKD?

A

Always irritable due to waste products

67
Q

What are the examples of problems to manage: Hi phosphate (PO4)?

A

Kidney cannot filter this and it just builds up

68
Q

What are the examples of problems to manage: hypertension in CKD?

A

Fluid overload, ace inhibitors, beta-blockers, etc.

69
Q

What are the examples of problems to manage: drug dosages in CKD and why?

A

Digoxin, metformin, antibiotics, opioids because of kidney is unable to filter the drug.
Statins —> decrease cholesterol

70
Q

In RN care for dialysis how many times do you monitor the patient?

A

3-4 times per week, at least 2-4 hrs procedures.

71
Q

What should you know in a patients with dialysis?

A
  • Baseline
  • Temperatures
  • Edema
  • Skin condition
  • Auscultate lungs
  • Electrolyte checks
  • Monitor for changes in BP
72
Q

In patients with dialysis, what do you do if the BP is low?

A

250ml Bolus given

73
Q

In RN care when should you check electrolytes on a patient with dialysis?

A

Check before and after

74
Q

In RN care why do muscle cramps occur in patient with dialysis?

A

Fast change in electrolytes

75
Q

In RN care what should you monitor in a patient with dialysis?

A
  • BP
  • Electrolytes
  • Muscle cramps
  • Energy/fatigue/mood
  • ‘Disequilibrium syndrome’
  • Risk of sepsis
  • ‘medically fragile’
76
Q

In RN care for dialysis why should you monitor for disequilibrium syndrome?

A
  • Fast changes in extra cellular fluid

- N&V, restless, jerking movement, seizures

77
Q

In RN care for dialysis patients what technique should you use for risk of sepsis when monitoring?

A

Aseptic technique when dialysis RN accesses vascular access site, tubings, set up.
A nurse wears a mask and is sterile.

78
Q

In RN care for dialysis what do they mean the patients are medically fragile ?

A

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)

79
Q

Where to do Peritoneal dialysis

A

Don at home.

80
Q

How many times for peritoneal dialysis?

A

4 times a day

81
Q

What time is peritoneal dialysis is done?

A

Usually done at night

82
Q

In peritoneal dialysis describe the exchange cycle.

A
  • Dialysis solution sits 4 hours them drained.

- Worry about infection

83
Q

Describe the Peritoneal dialysis transplant

A

A kidney transplant has to be matched

NURS 3512 (10 decks)

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