Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
128 Cards in this Set
- Front
- Back
Define chronic kidney disease
|
kidney damage or decrease in GFR for 3 or more months
|
|
What is the most accurate indicator of fluid loss or gain?
|
the patients WEIGHT
|
|
What does fluid vol deficit look like?
|
weight loss >5%, dec skin turgor, dry mucus membranes, oliguria/anuria, inc hematocrit, BUN inc out of proportion to creatinine level, hypothermia
inc HR, dec BP, inc urine specific gravity |
|
What do you do for fluid volume deficit?
|
fluid replacement, orally or patenterally
|
|
What does fluid volume excess look like?
|
weight gain >5%, edema, crackles, shortness of breath, dec BUN, dec hematocrit, distended neck veins
|
|
What do you do for fluid volume excess?
|
fluid and sodium restrictions, diuretics, dialysis
|
|
What does sodium deficit look like?
|
Nausea, malaise, lethargy, headache, adbdominal pain, cramps, apprehension, sz
<135 |
|
What do you do for sodium deficit?
|
diet, normal saline, or hypertonic saline solutions
|
|
what does sodium excess look like?
|
dry sticky mucous membraines, thirst, rough dry tough, fever, restlessness, weakness, disorientation
>145 |
|
What do you do for sodium excess?
|
fluids, diuretics, dietary restrictions
|
|
What does potassium deficit look like?
|
anorexia, abdominal distention, paralytic ileua, muscle weakness, ECG changes, dysrhythmias
<3.5 |
|
What do you do for potassium deficit?
|
diet, oral or parenteral potassium replacement
|
|
What does potassium excess look like?
|
diarrhea, colic, nausea, irritability, muscle weakness, ECG changes
>5.0 |
|
What do you do for potassium excess?
|
dietary restrictions, diuretics, IV glucose, insulin, and sodium bicarb, cation exchange resin, calcium gluconate, dialysis
|
|
What does calcium deficit look like?
|
abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's, tingling of fingers or around mouth, ECG changes
<8.6 |
|
What do you do for calcium deficit?
|
diet, oral or patenteral calcium salt replacement
|
|
What does calcium excess look like?
|
deep bone pain, flank pain, muscle weakness, depressed deep tendon reflex, constipation, N/V, confusion, impaired memory, polyuria, polydispsia, ECG changes
>10.2 |
|
what does bicarbonate deficit look like?
|
headache, confusion, drowsiness, inc resp rate and depth, N/V, warm flushed skin
|
|
What do you do for bicarbonate deficit?
|
bicarbonate dialysis, dialysis
|
|
What does bicarbonate excess look like?
|
depressed resp, muscle hypertonicity, dizziness, tingling of fingers and toes
|
|
What do you do for bicarbonate excess?
|
fluid replacement if vol is depleted, ensure adequate chloride
|
|
What does protein deficit look like?
|
weight loss, emotional depression, pallor, fatigue, flabby muscles
|
|
what do you do for protein deficit?
|
diet, dietary supp, hyperalimentation, albumin
|
|
What does magnesium deficit look like?
|
dysphagia, muscle cramps, hyperactive reflexes, tetany, pos Chvostek's or Trousseau's, tingling of fingers, dysrhthymia, vertigo
|
|
What do you do for magnesium deficit?
|
diet, oral or parenteral magnesium replacement
|
|
What does magnesium excess look like?
|
facial flushing, N/V, warm sensation, drowsiness, depressed tendon weakness, resp dep, cardiac arrest
|
|
What do you do for magnesium excess?
|
calcium gluconate, meachanical ventilation, dialysis
|
|
What does phosphorous deficit look like?
|
deep bone pain, flank pain, muscle weakness and pain, paresthesia, apprehension, confusion, SZ
|
|
What do you do for phosphorus deficit?
|
diet, oral or parenteral phosphorus supplemental therapy
|
|
What does phosphorus excess look like?
|
tetany, tingling of fingers, muscle spasm, calcification of soft tissue
|
|
What do you do for phosphorous excess?
|
diet restriction, phoshphate binders, NS, IV D5W, insulin
|
|
What geratric considerations are there for renal fx?
|
high incidence of atherosclerosis, HYN, HF, DM, cancer, poly pharmacy, kidneys are less able to respond to acute chances, atypical signs of fluid and electrolyte imbalance
|
|
What are the clinical manifestations of glomerulus injury?
|
proteinuria, hematuria, dec GFR, Na+ excretion alterations
|
|
What is acute glomerulonephritis?
And what can cause it? |
inflammation of the glomerular capillaries
impetigo, strep, viral infections, etc |
|
What are the s/s of acute glomerulonephritis?
|
hematuria (cola colored urine b/c of rbc), edema, azotemia (urea and nitrogenous wastes in the blood), proteinuria, HYN, anemia, headache, dyspnea, malaise, flank pain, FVE
|
|
How do they diagnose glomerulonephritis?
|
kidney biopsy
|
|
What are complications of acute glomerulonephritis?
|
Chronic glomerulonephritis, ESRD, HF, hypertensive encephalophathy, pulmonary edema
|
|
How is acute glomerulonephritis managed?
|
treatment of symptoms, kidney fx preservation, corticosteroids, restricted protein and sodium, high carb, lab tests monitored, fluid restrictions
|
|
What causes chronic glomerulonephritis?
|
repeated bouts of acute glom., hypertensive nephrosclerosis, hyperlipidemia, chronic tubulointerstitual injury, glomerular sclerosis, SLE, DM glomerulosclerosis, amyloidosis
|
|
What are the s/s of chronic glomerulonephritis?
|
renal failure, retinal hemorrhage, yellow-gray pigmentation, peripheral neuropathy, cardiomegaly, etc
|
|
What will the urinalysis reveal?
|
specific gravity at 1.010, proteinuria, urinary casts, electrolyte imbalances, hypoalbuminemia
|
|
What happens when GFR <50%?
|
hyperkalemia (dec excretion of potassium), metabolic acidisos (dec excretion), anemia (dec in erythropoiesis), hypoalbuminemia with edema (protein loss), inc serum phosphorous (dec excretion), dec serum Ca+, mental status change, impaired nerve conduction, cardiac enlargement, pulmonary edema
|
|
What does the ECG display with hyperkalemia?
|
tall, tented T waves
|
|
How is chronic glomerulonephritis managed?
|
antihypertensives, dialysis, prompt treatment of UTI, high cal/protein diet, strict i/o, daily weight, F/E imbalance watched, cardiac monitored, follow up labs often
|
|
What is nephrotic syndrome?
|
any condition that damages the golmerular membrane and results in increased permeability of plasma proteins
a cluster of clinical findings of: proteinuria (>3.5 g/day) hypoalbuminemia edema hyperlipidemia |
|
What causes nephrotic syndrome?
|
chronic glomerulonephritis, DM with glomerulosclerosis, amyloidosis, SLE, multiple myeloma, renal vein thrombosis
|
|
What are s/s of nephrotic syndrome?
|
pitting edema (eyes, extremities, abdomen), headache, irritability, malaise
|
|
What are complications of nephrotic syndrome?
|
infection, thromboembolism, pulmonary emboli (renal vein), ARF (hypovolemia), atherosclerosis(hyperlipidemia)
|
|
How does one diagnose and manage nephrotic syndrome?
|
renal biopsy, labs, diuretics, corticosteroids, cyclosporine, low sodium protein and chol diet
|
|
What is nephrosclerosis?
|
decreased blood flow to renal arteries due to diabetes, HYN, atherosclerosis and cause ESRD
|
|
What are two main types of nephrosclerosis?
|
Malignant- assoc with malignant HYN (180/130)
Benign- assoc with atherosclerosis and HYN |
|
How do you treat nephrosclerosis?
|
malignant- dialysis
benign- aggressive antihypertensive therapy |
|
What is acute renal failure?
|
reversible clinical syndrome where there is a sudden loss of kidney fx (dec GFR)
Kidneys cannot remove wastes and perform regulatory fx |
|
What are the s/s of ARF?
|
inc serum creatinine and BUN, could be a change in urine vol
|
|
What are the risk factors for ARF?
|
hypovolemia, hypotension, dec CO and HF, obstruction of the kidney or lower UTI, bilateral obstruction of renal arteries or veins
|
|
What is meant by prerenal failure and what can cause it?
|
impaired blood flow that leads to hypoperfusion of kidney and dec in GFR
vol depletion, dec CO, vasodilation Many have <20 of Na+ in urine |
|
What is intrarenal failure and what causes it?
|
actual damage to the glomeruli or kidney tubules
acute tubular necrosis (prolonged ischemia, nephrotogic agents, infectious process) May have >40 Na+ plus casts and cellular debris |
|
What is postrenal failure and what causes it?
|
pressure rises in kidney tubules and GFR eventually decreases
obstruction somewhere distal to kidneys |
|
Describe the four phases of ARF
|
initiation
oliguria- could lead to hyperkalemia duiresis recovery- 3-12 months |
|
What are the s/s of ARF?
|
dehydration, lethargy, CNS changes, drowsiness, headache, muscle twitching, sz
|
|
What are the abnormal findings of ARF?
|
low specific gravity of urine, abnormal sodium levels, inc BUN/creatinine ratio, hyperkalemia, metabolic acidosis, inc phosphorous, and low Ca+ (elevated ph causes a decrease in Ca), anemia (dec erythropoeitin)
|
|
How does one manage ARF?
|
avoid fluid excess, dialysis, watch for hyperkalemia, med dosage must be reduced, high carb/no potassium or phosphorous diet, dec metabolic rate, promote pulm fx, no foley, meticulous skin care.
|
|
What are the s/s of fluid excess?
|
dyspnea, tachycardia, distended neck veins, crackles
|
|
What can you do if patient is hyperkalemic?
|
(>5.5, tall tented T wave)
Kayexalate- exchanges sodium ions for potassium ions (causes explosive diarrhea that stains) IV D50%, insulin, Ca+ replacement, albuterol, dialysis |
|
What is chronic Renal failure or ESRD?
|
progressive, irreversible, deterioration of renal fx
inability to maintaine metabolic and F/E balance resulting in uremia or azotemia |
|
What causes ESRD?
|
DM, HYN, chronic glomerulonephritis, pyelonephritis, obstruction of UT, lesions, vascular d/o, infections, meds and toxic agents
|
|
What is the path of ESRD?
|
end product of protein metabolism cannot be excreted and builds up in the blood
Uremia develops |
|
What are the s/s of ESRD?
|
CV- HYN, HF, pulmonary edema, pericarditis, general edema, hyperkalemia, hyperlipidemia
Integ- pruritus, uremic frost GI -N/V, anorexia, hiccups, ammonia breath Neuro- confusion, muscle twitching, peripheral neuropathy, restless leg, sz Pulm- crackels, shortness of breath, tachypnea, kussmaul resp MS- muscle cramps, dec muscle strength, bone pain, foot drop Neuro- |
|
Explain GFR
|
amount of plasma filtered through the glomerul/unit of time
creatinine clearance: serum vs urine is compared to to calculate ability to clear GFR dec-creatinine clearance dec |
|
What is the more sensitive indicator of renal fuction?
|
SERUM CREATININE
|
|
What is normal GFR?
|
GFR 125 ml/min/1.73 m2
|
|
What is stage 1 ESRD?
|
GFR >90 ml/min/1.73 m2
|
|
What is stage 2 ESRD?
|
GFR = 60-89 ml/min/1.73 m2
|
|
What is stage 3 ESRD?
|
GFR = 30-59 ml/min/1.73 m2
|
|
What is stage 4 ESRD?
|
GFR = 15-29 ml/min/1.73 m2
|
|
What is stage 5 ESRD?
|
GFR < 15 ml/min/1.73 m2
|
|
What risks are associated with ESRD?
|
sodium and H2O retention (edema, HF, HYN), loss of Na+ (hypotension, hypovolemia), metabolic acidosis (unable to excrete NH3- and reabsorb HCO3-), anemia (inadequate erlythropoietin), increase phosphate and decrease in calcium leading to calcium leaving the bones (calcification of blood vessels), decrease in active Vit D
|
|
What is uremic bone disease?
|
renal osteodystrophy- calcification of blood vessels from complex changes in calcium, phosphate and parathyroid hormone
|
|
What are the complications of ESRD?
|
hyperkalemia, pericarditis, pericardial effusion, pericardial tamponade, HYN, anemia, bone disease, vascular calcification
|
|
How does one manage ESRD?
|
dialysis, phosphate binding agents (avoidance of antacids- magnesium toxicity), antihypertensive agents, fluid restrictions (500 ml> then yesterday urine output), low sodium, potassium and protein diet, diuretics, Epogen (erythropoeitin), ionotrops, sz meds, iron
|
|
What is suggested preventative care for renal patients
|
vacinnations: flu, pneumo, Hep A, Hep B
TB screen LDL monitored (<100 or <70 for DM, CVD) screen for malignancy glycated hemoglobin A1C (blood sugar over 3 months) < 7% good skin care asepsis techni for central line |
|
When is acute dialysis used?
|
high levels of serum potassium, fluid overload, pulmonary edema, increasing acidosis, pericarditis, severe confusion, to remove toxins or meds
|
|
When is chronic or maintainence diaylsis used?
|
presence of uremic signs and overall body systems (N/V/lethargy, confusion, anorexia), hyperkalemia, fluid overload not responsive to diuretics, lack of well-being
|
|
What is the objective of hemodialysis?
|
extract toxic nitrogenous substances from the blood and to remove excess water
|
|
How are toxins and wastes removed from the blood?
|
By diffusion- they move from an area of higher concentration in the blood to an area of lower concentration or the dialysate
The semipermeable membrane impedes diffusion of large molecules like RBC and proteins |
|
How is excess water removed from the blood?
|
osmosis- water moves from an area of higher solute concentration (blood) to an area of lower solute concentration (dialysate bath)
|
|
What does ultrafiltration do?
|
moves water under high pressure to an area of lower pressure through negative pressure or suctioning force to the dialysis membrane
usually necessary to achieve fluid balance |
|
How is the body's buffer system maintained?
|
dialysate bath is made up of bicarbonate or acetate which metabolizes into bicarbonate
heparin is also added to keep blood from clotting |
|
What are the advantages of ultrafiltrate dialyzers?
|
reduced neuropathy, increased efficiency (shortened treatment time), reduced need for heparin
|
|
What is the optimal rate of dialysis?
|
300-550 mL/min
|
|
What vascular access is used temporarily?
|
subclavian, internal jugular, femoral vein
no longer then 3 weeks |
|
What access sites are used long term?
|
double lumen into internal jugular vein, av fistula, av graft
|
|
How many days does it take for the av fistula to heal? What is the patient encouraged to do?
|
14 days
exercises to increase size of vessel to accomodate large-bore needle |
|
When is an av graft used and what are the complications of them?
|
when patients have compromised vascular systems, usually in arm, leg, or chest
infection and thrombosis are common |
|
What is the highest priority?
|
protection of the access line
do not use arm to draw blood or BP |
|
What are complications of hemodialysis?
|
atherosclerosis CVD (HF, CHD, angina, stroke, PVD), lipid metabolism disturbances, GI ulcers, calcium disturbances (fx), fluid overload, malnutrition, infection, neuropathy, pruritis, sleeping disturbances, hypotension, painful muscle cramping, blood loss if lines seperate, dysrhythmias, air embolism, dialysis disequilibrium (fluid shift)
|
|
What are s/s of hypotension?
|
N/V, diaphoresis, tachycardia, dizziness
|
|
what is exsanguination?
|
drain of blood (occurs if line separeate or dialysis needle dislodges
|
|
What is dialysis disequilibrium?
|
cerebral fluid shifts
s/s-headache, N/V, restlessness, dec LOC, SZ |
|
List nursing management for dialysis patient
|
weight, strict I/O, s/s of uremic syndrome, electrolyte imbalance, cardiac & resp status, BP, with hold BP meds, avoid meds with potassium and magnesium, asepsis, good skin care, nutrition
|
|
What is proper nutrition for dialysis patient?
|
dec protein intake, fluid restriction, sodium restriction, potassium restriction
|
|
What is CRRT?
|
continous renal replacement therapy, use of hemofilter
used for thoses too clinically unstable for traditional hemodialysis |
|
What is CVVH?
|
continuous venovenous hemofiltration, continuous slow fluid removal without arterial access
|
|
What is CVVHD?
|
continuous venvenous hemodialysis, use of hemofilter and ultrafiltration without arterial access
|
|
What is the goal of peritoneal dialysis?
|
to remove toxic substances and metabolic wastes and re-establish normal fluid and electrolyte balance
|
|
How does peritoneal dialysis vary from hemodialysis?
|
sterile dialysate fluid is introduced in intervals into peritoneal cavity via abdominal catheter
Urea, creatinine, and metabolic end products are removed by diffusion and osmosis from high conc to lower conc |
|
What is used as the filter for peritoneal dialysis?
|
peritoneal membrane that covers abdominal cavity is the semipereable membrane
|
|
What is the rate at which urea and creatinine are removed?
How does this differ from hemodialysis? |
ureas is cleared at 15-20 ml/min, creatinine is removed slower
takes 36-48 hour to achieve what hemodialysis can achieve in 6-8 hours |
|
Which patients are better candidates for peritoneal dialysis?
|
those susceptible to rapid fluid, electrolyte and metabolic changes
DM, CVD, HF, pulmonary edema, severe HYN |
|
Before peritoneal dialysis?
|
vitals signs, weight, serum electrolyte levels, empty bladdera and bowel, may give antibiotic and heparin and potassium chloride, insulin maybe needed, meds added before, diasylate warmed to body temp
|
|
How does peritoneal dialysis work?
|
dialysis infused by gravity (5-10 mins to infuse 2-3 L), drainage for 10-30 minutes, cycle is repeated
|
|
What if excess water is needed to be removed?
|
hypertonic dialysate is used with high dextrose concentration (1.5-4.25%)
|
|
what are acute complications of peritoneal dialysis?
|
-peritonitis (cloudy dialysate, abd pain, rebound tenderness, hypotension) treatment is antibiotics, catheter removal
-acute malnutrition, delayed healing (large loss of proteins) -leakage -bleeding |
|
What are long term complications of peritoneal dialysis?
|
hypertriglyceridemia, incr BP, incr fluid volume, abd hernias, pain, anorexia
|
|
When is acute intermittent peritoneal dialysis used?
|
unstable patient with uremic signs, fluid overload, acidosis, hyperkalemia
|
|
What are nursing considerations for intermittent peritoneal dialysis?
|
aseptic techn, VS, weight, I/O, fluid balance, dialysate concentration, skin turgor, turning patient, comfort, resp, bleeding, peritonitis, leakage
|
|
Things to consider for all dialysis patients
|
protect vascular access, check site for clotting/infection, give IV therapy as slow as possible, strict I/O, corticosteroid or parental nutrition may inc toxic accumulation and require daily dialysis, continually check for fluid overload, HF, pulm edema, cardiac tamponade, electrolyte levels, good skin care, hypertension, low WBC counts
|
|
State preoperative considerations for kidney surgery
|
fluids are encouraged, if infection antibiotics, conagulation studies
Resp fx, VS, pain, urinary retention |
|
State postoperative considerations for kidney surgery
|
hemorrhage and shock, fluid and blood replacement, abdominal distenstion and paralytic ileus, DVT, pneumonia
|
|
What makes kidney transplants more successful
|
if the kidney comes from a live donor, performed before dialysis is initiated
|
|
What is the nursing management of a kidney transplant patient
|
pulmonary hygiene, pain managment, early ambulation, immunosuppressive therapy, infection prevention, urinary output, vascular access clotting
|
|
What are s/s of transplant rejection, infection or adverse effects of immunosuppressive regimen:
|
dec urinary output, weight gain, malaise, fever, resp distress, tenderness, anxiety, depression, changes in BP, eating, drinking
|
|
What do kidney patients have a higher risk for?
|
CVD and cancer
|
|
What are the clinical manifestations of renal tumors?
|
painless hematuria, pain, mass in the flank, dull/colicky pains, unexplained weight loss, increasing weakness, anemia
|
|
What are the risk factors for renal cancer?
|
gender (men), tobacco use, occupational hazards, obesity, unopposed estrogen therapy, polycystic kidney disease
|
|
What are the treatments for renal cancer?
|
surgery: radical nephrectomy, laparoscopic nephrectomy, partial nephrectomy
Renal artery embolization Radiation Chemo |
|
What are the two types of renal trauma?
|
blunt trauma 80%
penetrating trauma 10% |
|
What are clinical manifestations of renal trauma?
|
pain, renal colic, hematuria, swelling, ecchymoses, hemorrage, oliguria, hemorrhagic shock
|