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206 Cards in this Set
- Front
- Back
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what is chronic kidney disease?
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umbrella term that is used to describe kidney damage or a decrease in the glomerular filtration rate for three or more months
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what is end stage renal disease?
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progressive irreversible deterioration in renal function that results in retention of uremic waste products
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What is azotemia?
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concentration of urea and other nitrogenous wastes in the blood
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What is continuous ambulatory peritoneal dialysis? or CAPD?
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method of peritoneal dialysis whereby a pat performs 4 or 5 complete exchanges or cycles througout the day
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What is continuous cyclic peritoneal dialysis? or CCPD?
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method of peritoneal dialysis in which a peritoneal dialysis machine automatically performs exchanges usually while pt is asleep
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What is continuous renal replacement therapy? or CRRT?
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variety of methods used to replace normal kidney function by circulating the patients blood through a filter an dreturning it to the patient
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What is continuous venovenous hemodialysis? or CVVHD?
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a form of continuous renal replacement therapy that results in removal of fluid and waste products; venous blood cirulates through a hemofilter and returns to the patient
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What is continous venovenous hemofilration? or CVVH?
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a form of continuous renal replacemtn therapy that primarily results in removal of fluid; venous blood circultates through a hemofilter and returns to the patient
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What is glomerulonephritis?
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inflammation of the glomerular capillaries
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What is hemodialysis?
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procedure during which a patients blood is circulated through a dialyzer to remove waste products and excess fluid
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What is polycystic kidney disease?
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fluid filled cycts form in the epithelial cells f the nephron
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Can these cysts form anywhere else in the body?
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yes, liver brain heart bv. they can be benign or malignant
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If the cyst ruptures what happens?
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it's painful and toxic
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What causes PKD?
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develop due to kidney cell proliferation, altered secretion and abnormal cell matrix biology
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where do these cysts develop?
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can develop anywhere in the nephron and become progressively larger and more widely distributed
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How do these cycts affect the kidney?
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glomular and tublar membranes are damaged, as the disease progresses the process of filtration absorption and secretion are less effective. this is what causes the grossly enlarged kidney
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What are the s/sx or PKD?
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pain in back and lower sides, HA, UTI, hematuria, cysts in kidneys and other organs, heart valve abnormailities, renal calculi
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If a cyst ruptures in the brain what could happen?
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could cause sudden death
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Should you do deep palpatations on someone who has PKD?
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No, deep palpatations are painful and can cause them to rupture
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What is the treatment for PKD?
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rx for infections, pain
surgery to remove dialysis or transplantation to replace fx of failed kidney |
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Is there a cure for PKD?
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no cure
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What is hydronephrosis?
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obstruction high in the urerter, obstruction causes a problem with urine outflow
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What is hydroureter?
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obstruction lower in urterer
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What is a urethral stricture?
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scar somewhere in or around the urethra
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What other diseases can contribute to an urethral stricture?
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in males, sexually transmitted diseases are a problem, the scar tissue causes urine outflow problems
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What are the three infectious kidney diseases?
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pyelonephritis, renal abscess, renal tuberculosis
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What is pyelonephritis?
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inflammation of the renal pelvis
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Why is pyleonephritis so serious?
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even when it is treated, causes scarring and hurts the nephrons
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Where does the pylelonephritis usually come froM/
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bacteria from the bladder
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What are the s/sx of acute pyelonephritis?
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back, side, and groin pain, urgency frequency or burning urination, fever, chills, n/v, pyuria and blood in urine, costovertebral angle tenderness
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Why is actue pyleonephritis so serious?
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risk for septicemia and becoming septic b/c all bacteria is filtered through kidney
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What is the second leading cause of chronic renal failure?
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Chronic pyelonephritis
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What causes chronic pyelonephritis?
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ongoing inflammation causes fibrosis and scarring and loss of nephrons
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What is teh end result of longstanding UTI's with reinfection?
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chronic pyelonephritis
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What other condition is often diagnosed incidentally during evaluationa dn treament of HTN?
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chronic pyelonephritis
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What are the signs and symptoms of chronic pyleonephritis?
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fatigue, ITCHING, HTN, nauseas inability to conserve Na, poor appetite, weight loss
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How does chronic pyelonephritis develop?
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very slowly it's insidious
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How do NSAIDS affect pyleonephritis?
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cause reflux which can cause nehpritis
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What are the important nursing interventions for chronic pyelonephritis?
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identify, treat, and recheck UTI infection, control BP, encourage fluide intake of 2 l to prevent fuluid vol deficit, limit protein
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What is an acid ash diet?
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Diet consists of mainly meat, eggs, fish and cereals with a minimum of fruit and veggies and milk
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What does an acid ash diet do?
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when a meal is catabolized it leaves an acid residue which is excreted in the urine
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What condition is an acid ash diet prescribed for?
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chronic pyelonephritis
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What should we teach pts about managing pyelonephritis?
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be cautious about Rx's and stay hydrated
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What is a renal abscess?
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a collection of fluid and cells caused by an inflammatory response to bacteria
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What is a hallmark sign of a renal abscess?
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fever that can't be accounted for, they are already on antibiotics
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What is renal tuberculosis?
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infection of the kidney with mycobacterium can be spread from pulmonary tb
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What are the manifestations of renal tb?
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frequency, dysuria, hematuria, proteinuria, flank pain, pyuria, and HTN
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What are the immunologic renal disorders?
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acute glomerulonephritis, chronic glomerulonephritis, and nephrotic syndrome
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What is the third leading cause of ESRD?
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glomerulonehpritis
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Does glomerulonephritis affect one or both kidneys?
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inflammatory in nature and affects both kidneys
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In ACUTE glomerulonephritis, what usually causes this?
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post infectious strep
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What are the manifestations of renal tb?
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frequency, dysuria, hematuria, proteinuria, flank pain, pyuria, and HTN
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What are the immunologic renal disorders?
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acute glomerulonephritis, chronic glomerulonephritis, and nephrotic syndrome
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What is the third leading cause of ESRD?
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glomerulonehpritis
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Does glomerulonephritis affect one or both kidneys?
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inflammatory in nature and affects both kidneys
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In ACUTE glomerulonephritis, what usually causes this?
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post infectious strep
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What are the manifestations of renal tb?
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frequency, dysuria, hematuria, proteinuria, flank pain, pyuria, and HTN
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What are the immunologic renal disorders?
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acute glomerulonephritis, chronic glomerulonephritis, and nephrotic syndrome
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What is the third leading cause of ESRD?
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glomerulonehpritis
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Does glomerulonephritis affect one or both kidneys?
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inflammatory in nature and affects both kidneys
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In ACUTE glomerulonephritis, what usually causes this?
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post infectious strep
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What condition in acute glomerulonephritis should you never see in healthy kidneys?
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protein and rbc's leave the bllodstream and enter the urine due to the glomerular damage
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What are the manifestions of acute glomerulonephritis?
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heaturia, proteinuria, azotemia, renal na and water rention and dependent edema
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In acute glomerulonephritis what causes the urine to be dark?
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blood cells in urine
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what kind of protein is spilled into the urine with agn?
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albumin
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what is azotemia?
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return of excessive amts of nitrogenious products
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what causes vomiting with agn?
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uremic acid
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why do these pts gain weight?
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excessive na and water retention
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what condition would we want to watch for?
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orthopenea - due to edema (difficulty breathing)
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What lab value helps us understand whether or not the kidney is filtering?
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creatine
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What is is a normal GFR?
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usually 120 for clearance
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What would the diagnosis be for a GFR of 50?
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acute glomerulonephritis
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what is the treatment for agn?
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antibiotics, diuretics, na and water restriction, anti HTN therapy and protein and K restriction
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What drugs wouldn't be given to this kind of pt?
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ACE or any other med that takes a hold of K
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What kind of therapy would be offered for this kind of pt?
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plasma pharesis or dialysis to eliminate antibodies
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What is chronic glomerulonephritis?
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AKA chronic nephritic syndrome
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What happens in chronic glomerulonephritis?
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continuing or persistent hematuria resulting in slow progressive deteriortation of renal fx
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is this a fast or slow developing in chronic glomerulonephritis?
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usually slow develops over a period of 20-30 years
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What is the end result of chronic glomerulonephritis?
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HTN, small kidneys and renal failure
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What is the med mgmt of chronic glomerulnephritis?
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low protein, na and k, and meds for BP
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What happens to these pts eventually in chronic glomerulpehpritis?
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eventually req dialysis or transplant
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What will show up in a UA with a pt who has chronic glomerulonephritis?
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proteinuria and GFR is reduced
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What three electrolytes show up as elevated in a chronic glmerulonephritis?
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HyperKalemia, Hyperphosphatemia and HYPOcalcemia
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What two lab values indicate renal failure?
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creatinine and BUN
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What is teh normal range for serum creatinine?
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.6-1.2mg/dL
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What is the normal range for BUN?
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7-18 mg/dL
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What is the BEST indicator for renal function?
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renal biopsy
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What is a better indicator than serum creatinine?
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creatinine clarance 24 hours
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What is a characteristic of nephrotic syndrome?
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massive protein loss
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what causes nephrotic syndrome?
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a condition of increased glomerular permability causes mass protein loss, edema and hypoalbuminemia
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What does hypoalbuminemia stimulate?
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liver activity resulting in hyperlipidemia and hypercoagulability
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what are the complications of nephrotic syndrome?
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infection, thromboembolism, pulmonary emboli, acture renal failure, accelerated atherosclerosis
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What do we do for pts with nephrotic syndrome?
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diuretics, ACE1(decreases bp, decreases protein loss by kidney) cyclosporine, corticosteroids, antineoplastic agents, immunosuppressants
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What is the body doing to itself in nephrotic syndrome?
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destroying itself
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What do we monitor for in nephrotic syndrome?
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teach diet therapy, prevention of infection. montior for pulmoneary edema, electrolytes, i/o, dialy weights adequate dietary intake
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what pulmonary s/sx should we watch for with nephrotic syndrome?
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SOB, crackles, cough- productive
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what are the complications of nephrotic syndrome?
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infection, thromboembolism, pulmonary emboli, acture renal failure, accelerated atherosclerosis
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What do we do for pts with nephrotic syndrome?
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diuretics, ACE1(decreases bp, decreases protein loss by kidney) cyclosporine, corticosteroids, antineoplastic agents, immunosuppressants
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What is the body doing to itself in nephrotic syndrome?
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destroying itself
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What do we monitor for in nephrotic syndrome?
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teach diet therapy, prevention of infection. montior for pulmoneary edema, electrolytes, i/o, dialy weights adequate dietary intake
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what pulmonary s/sx should we watch for with nephrotic syndrome?
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SOB, crackles, cough- productive
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What is nephrosclerosis?
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problems of changes in the nephron blood vessels
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What happens in the kidney that is similar to the heart?
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decrease in blood flow causes wall thickening, lmen narrowing leads tochronic hypoxic kidney
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HTN, atherosclerosis and DM are all associated with what condition?
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nephrosclerosis
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what is the second leading cause of ESRD?
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hypertension
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If we get control of HTN, what happens in kidney disease?
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delays outcome of chronic problems
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What is nephrosclerosis?
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problems of changes in the nephron blood vessels
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What happens in the kidney that is similar to the heart?
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decrease in blood flow causes wall thickening, lmen narrowing leads tochronic hypoxic kidney
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HTN, atherosclerosis and DM are all associated with what condition?
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nephrosclerosis
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what is the second leading cause of ESRD?
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hypertension
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What is nephrosclerosis?
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problems of changes in the nephron blood vessels
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What happens in the kidney that is similar to the heart?
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decrease in blood flow causes wall thickening, lmen narrowing leads tochronic hypoxic kidney
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If we get control of HTN, what happens in kidney disease?
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delays outcome of chronic problems
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HTN, atherosclerosis and DM are all associated with what condition?
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nephrosclerosis
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what is the second leading cause of ESRD?
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hypertension
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If we get control of HTN, what happens in kidney disease?
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delays outcome of chronic problems
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What is the medical mgmt of these patients?
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aggressive antihyperteniseve therapy with ACE inhibiotrs either alone or with other drugs
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What is renovascular disease?
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pathologic processes affecting the renal arteries resulting in severe lumen narrowing and drastic reduction of blood flow to the renal parenchyma
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What is the primary cause of renal artery stenosis?
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atherosclerosis or fibrommusclular hyperplasia
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what is diabetic nephropathy?
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microvascular damage to the kidney
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what is the leading cause of ESRD?
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diabetes mellitus
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In autonomic neuropathy whats causes the infection?
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bladder loses its tone, urine stays in causing the infection to spread to kidneys
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What is scary about renal carcinoma?
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manifestations are mild. painless hematuria, dull back pain, weight loss, weakness, anemia
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What is the treatment for tumors?
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radical hephrectomy, renal artery embolization
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what is the pharmacologic treatment of tumors
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chemo, radiation, immunotherapy, hormonal therapy
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What is the difference between acute and chronic renal failure?
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ACUTE- many body systems
chronic - EVERY body system |
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What hormone does the kidney stimulate?
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erythropoeitin, which causes RBC production in bone marrow
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what stimulates the need for they kidneys to give erythroopoetin?
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loss of 02
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What is acture renal failure?
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rapid decrease in renal fx, leading to the accumulation of metabolic waste in they body
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What causes acture renal failure?
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inadequate kidney perfusion, damge to glomeruli, obstruction
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what happens in hypoperfusion?
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oliguria, and ischemia from hypoperfusion which leads to tubular cell injury
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What is BUN?
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protein
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What is creatinine?
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waste
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A GFR of what indicates renal disease? what indicates renal failure?
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less than 90- disease, less than 50 failure
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What is prerenal azotemia?
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anything above the kidney
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what is intrarenal ARF?
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inside kidney, IV dye, infection
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what is postrenal AFR?
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obstructionin flow of urine below kidney
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What can cause prerenal azotemia?
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hemorrhage, shock, sepsis, volume deplection severe dehydration, PE, CHF
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Can you cure prerenal azotemia?
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yes, once what is causing problem is treated it goes away
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what are the signs and symptoms of prerenal azotemia?
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SHOCK- hypotension, tachycardia, lethargy) decreased i/o, cardiac output, central venous pressure
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what is the recovery time for intrarenal failure?
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recovery is min of two weeks, normal renal function may take 3-12 month
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what kind of therapy can cause nephron damage?
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chemotherapy cells filter through kidney clogs nephron damages kidney
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what are some nephrotoxic agents that contribute to ARF?
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antibiotics ei: vanco, aminogylcosides, NSAIDS, HTN meds, heavy metals
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What are the s/sx of ARF?
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oliguria, or anuria, edema, HTN, tachycardia, SOB, jugular distention elevated CVP
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What can a pt have after dialysis?
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chest pain
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What are the three phases of ARF?
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oliguric, diuretic, and convalescent
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What happens in the oliguric phase?
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urine is less than 400 mL/24 hrs and indicates extensive severe damage to renal tubules
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What are the characteristics of oliguric phase?
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^ in BUN and creatinine, hyper Kalemia, metabokci acidosis, hyperphospatemia, hypermagnesmia, HYPOcalcemia
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What happens in diuretic phase?
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kidneys are getting better, begin to heal, decrease in BUN and creatinine, weight loss from edema
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What is the convalescent phase?
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BUN and creatinine return to normal, urine is 1-2 L daily, may take up to 12 mos.
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What type of ARF will need a biopsy?
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intrarenal
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What is the drug therapy for ARF?
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diuretics, fluid challenges, Ca channel blockers
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What kind of diet is used for ARF?
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low protein, K, and Na
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How about dialysis for ARF?
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usually only after drugs don't work and only 1-3 times may be needed to spur kidney to work
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What are the requirements for dialysis?
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persistent hyper Kalemia, uremic encephalopathy, uncompensated metabolic acidosis, fluid retention unresponsive to diruretics
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What is chronic renal failure?
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progressive irreversible kidney injury
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What is prognosis for crf?
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mortality is 100% without dialysis or transplant, terminates in ESRD
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what are treatments for CRF?
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based on treating underlying disease like diabetes or HTN
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What happens in CRF?
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healthy nephrons compensate for enlarging and increasing clearance capacity
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what constitutes CRF in regards to nephrons?
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75-80% are damaged
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What is stage 1 in CRF?
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called diminshed renal reserve, renal function decreases 50%, health kidney compensates, decreases ability to conc. urine
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What kind of changes in BP would you see in stage 1 CRF?
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around 130/80, so don't always pay attention to it
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What is stage II?
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renal insufficiency, renal fx decreases by 75%, metabolic waste begins accumulating, affected nehprons no longer compensate
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What stage do you see an increase in BUN and creatinine?
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stage II
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how do we control stage II?
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dietary changes and mgmt of s/sx start to control protein, Na, K, and glucose lvls
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What is stage III?
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end stage renal disease renal function is down by 90%
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What else do we see in stage III or ESRD?
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excessive amts of nitrogenous wastes, HYPOcalcemia worsens, erythropoietin lvls depressed, K and metabolic acidosis may be life threatening
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What are the manifestations of ESRD?
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fluid volume overload, jugular vein distention, bounding pulses, rales in lungs, perpheral edema, HTN, osteodystrophy
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Why fluid overload in ESRD?
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kidneys can't excrete water and Na
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Why jugular vein distention in ESRD?
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constant renin release
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Why bounding pulses?
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vol. overload due to CHF
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Why perpherial edema in ESRD?
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blood glucose lvls increase
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why is osteodystrophy in ESRD?
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unique to renal failure b/c of ractions to Ca and phos aren't normal
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what are the metabolic alterations in ESRD?
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ura and creatinine are elevated, sodium is retained in exchange of H and bicarb, K and acid balance are increased, Ca and Phosphate are in imbalance
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What does hyper phosphatemia cause?
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tachycardia, anorexia, nausea and vomiting
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What does Hypocalcemia cause?
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numbness seizures carpopedal spasms
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What does hyperKalemia cause?
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bradycardia, irritability in HR, dysrhythmias, elevated T wave on EKG
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how do we treat hyperKalemia?
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kayalate
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what is the nutritional treatment of CRF?
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protein restriction, K restrict, phosphorus restrict, specialized vitamins, individualized diet plan, fluid mgmt
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What is the drug therapy for ESRD?
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antihypertensives, diruetics, vit d supplement, phosphate binders, erythopoietin, vita b comlex vita, calcimimetic agents
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how are phosphate binders taken?
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with first bite of food, only rx that can be left at bedside
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are tums an antacid or phosphate binder?
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if given to a renal patient they are a binder
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when do we give erythropoietin?
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after dialysis
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what kind of antihypertensives are given?
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ACE, ARBS, and CCB's
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why do we use renal replacement therapies?
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to remove waste products and fluids
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what is the most common form of dialysis?
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hemodialysis
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what is special about dialysis grafts?
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they heal faster for access
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what about fistulas?
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they last longer than grafts
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can you get a bp on an arm with a graft or fistula?
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NO, never bp, venous access or draw blood. this is their life line
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What do you assess for dialysis?
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feel the thrill, hear the bruit
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what if there isn't a bruit?
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no dialysis
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what are the primary complications of hemodialysis?
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hypotension, dysrhythmias, muscle cramps, hypovolemic shock, orthostatic hypotension
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what causes the muscle cramps in hemodialysis?
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take off k too fast
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what is disequalibrium syndrome?
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happens to new pts induction day of dialysis
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what are the s/sx of disequalibrium syndrom?
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n/v, ha, decreased LOC, siezure, coma
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what causes this syndrome?
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rapid movement of water into brain cells, hypoosomolality as solutes are removed from blood
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what other complications can occur in dialysis?
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hemorrage - need pressure drgs, HIT due to amt of heparin used
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why use peritoneal dialysis?
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a little more freedom, must be compliant and use sterile technique
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Why else use peritoneal dialysis?
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no anticoagulant therapy is necessary
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what about diets in peritoneal dialysis?
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no restrictions aren't as great esp with proteins
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what are the advantages of PD?
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self mgmt, dont' have to be anticoagulated, less restrictive diet, avoidance of venipuncture, less risk of bp problems less restrict of fluids
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what is the advantage of renal transplant?
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no more dialysis, but a lifetime of immunosuppressant drugs, very expensive
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what are the s/sx of organ rejection?
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oliguria, edema, fever, weight gain, swelling or tenderness, but hallmark sign is increasing BP
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what is an acute rejection?
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lose kidney
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what is a chronic rejection?
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mgmt with drugs might be able to keep kidney
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what are the manifestions of kidney infection of a transplant?
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fever/chills, shaking tachypnea, tachycardia, increase/decrease in WBCs
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