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54 Cards in this Set

  • Front
  • Back
Factors that affect GFR
Autoregulation of blood flow
Pressure in Bowman's capsule
Oncotic pressuer
Sign of glomerular damage
protein in urine
Function of the kidneys
Control fluid and electrolytes
maintains optimal fluid volume
filter waste products for elimination
Participates in acid base regulation
Hormone Function of Kidneys
Erythropoietin for RBC prod.
renin to regulate BP
Activates Vit D
How does ADH work
Hyupothalamus senses low blood volume and increases serum osmolality and notifies pituitary gland
Pituitary secretes ADH into bloodstream
ADH causes kidneys to retain H2O
H2O retention increases BP and decreases serum osmolality
How aldosterone works
Causes kidneys to retain sodium and H2O
Ace Inhibitors
reduce the production of angiotension II
ARBS
Inhibit angiotension II receptors. Because of the intraglomerular effects, the rate of proteinurea decreases ans slows the progression of renal disease.
Renoprotective drugs
ACE and ARBS
How Erythropoietin works
Kidney detects a low arterial O2 tension, kidneys secrete erythropoietin which travels to the bone marrow which stimulates increased production of RBC's
Assessment
Family and personal history
chief compaint from pt
recent changes in weight or appetite
HTN, DM, PCKD, Tumors, infections, stones, chronic swollen extremities
Med Assessment
Current meds usage, antibiotics (aminoglycosides - gentamycin), antihypertensives, diuretics, illicit drug use
Physical Assessment
Recent strenuous exercise (rhabdomyolysis)
Stressors
Change in employment, illness, financial proglems, sexual function
Labs
proteinuria, albumuria
General Appearance
Sallow skin color, rashes, bruising or discoloration, any edema
Affect
General alertness, LOC, concentration, throught process and memory changes,
Lungs
Ascultation for adventitious signs (crackles) fluid
Extremities
Edema pedal and pretibial
Auscultation
Listen for bruit over each renal artery
Inspection
inspect abdomen, flank both supine and sitting
Palpation
Renal palpation identifies masses and areas of tenderness, lightly palpate all abdominal quadrants
Percussion
Distended bladder sounds dull when percussed
Quinolones
Cipro, 7 days, 750 ml/day, avoid taking antacids 1 hour before and 2 hrs after, caution asthma, avoid use in pregnancy or under 18, interferes with cartilage
Penicillins
Amoxil, Augmentin (3 days) Increased effect with ASA, decreased effect with erythromycin, assess for allergies, may decrease effectiveness of oral contraceptives
Cephalosporins
Duricef, Suprax, Assess for allergies, monitor renal and liver, advise to injest buttermilk or yogurt to decrease risks for superinfection with long term use
Antispasmotic
Anaspaz, Cystospaz used to treat urinary spasms or urinary incontinence
Contraindications for Anaspaz
Gi obstruction, glaucoma, myasthenia gravis, prostatic hypertrophy
Pyridium
Med that helps to decrease bladder related pain or discomfort, causes urine to change a harmless orange-red.
Serum Creatinine
0.6 - 1.2 indicatesw increased renal nephron damage, renal insufficiency, renal failure, atrophy of muscles
BUN
Normal 7 - 18 varies with age. Increased level indicates dehydration, renal failure, liver failure, high protein diet
Signs of increased BUN
Confused and disorientation, may have oliguria
Decreased BUN
overhydration, malnutrition
BUN/Creatinine ratio
Normal10:1 ratio. Elevated ratio with hypovolemia (dehydration), Elevated BUN and creatinine is seen with renal disease, multiple trauma with elevated creatinine but normal BUN
GFR
also known as creatinine clearance. Best indicator of renal function, renal function decreases, creatinine clearance decreases
Renal insufficiency
GFR < 60 for at least 3 months
Chronic renal failure
GFR 15-30
End-Stage renal disease
GFR < 15
Abnormal color
dark amber, pale, bloody, dark red or brown, cloudy
Abnormal odor
Foul smell may be infection or dehydration
Abnormal Proteins
Increased could mean infection, stress, glomerular disease
Abnormal Specific gravity
Increased: dehydration, renal disease, CHF, DM
Decreased: FI, fluid overload
Abnormal Urinalysis
pH, Ketones, RBC, WBC
IVP
Intravenous Urography or intravenous pyelography
IVP Procedure
Assess for allergies to seafood, 2-3 liters 24 hours before test, fast 8 hours, dye will have transient burning sensation, continue fluids and hydration after test
IVP problems
Barium enema or GI or gallbladder series can itnerfere with imaging
Metforman (glucophage)
Hold med before IVP 48 hrs before procedure and not restarted until urine output is wellestablished.
Computed Tomography (CT Scan)
Provides inforamtion on tumors, cysts, abscesses, masses, obstructions, blood vessel abnormalities. Bowel prep, light evening meal, NPO after midnight
Renal Angiography
Check for alergies to seafood, 2-3 liters hydration and NPO 8 hrs prior, baseline labs, baseline VS and peripheral pulses
Renal Angiography during test
Transient discomfort, flushing, burning, nausea, take off metal objects
Post care of renal angiography
15 minutes direct pressure to artery, lie flat for 6 hours, VS, peripheral chekcs, watch for bleeding, paresthesia, 2-3 liters fluid post.
Renal Biopsy
Kidney sample is obtained percutaneousily
Pre-test Renal Biopsy
H&H, coagulation, renal function, Urine C&S, VS, fast several hours before, IV, Instruct, Informed consent
Post Test renal biopsy
Supine position after and bedrest 8 - 24 hrs to minimize bleeding, observe for rise and fall of BP, anorexia, development of full ache in abdomen, watch for flank pain, usually bleeding into muscle or colicky pain (clot in ureter), VS q 15 min for 1 hours then decrease if stable, bright red blood up to 24 hours