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45 Cards in this Set

  • Front
  • Back
What conditions are major predispositions for chronic kidney disease


Account for approximately 60% of persons who develop chronic kidney disease
Who is most likely to say "what are you doin here?"

(especially when you show up to the library on a weekend)
Chronic kidney disease is defined as either the presence of?
Kidney Damage

Glomerular filtration rate
<60 mil/min for 3 months or longerq
What test is the best for diagnosing chronic kidney disease?
24 hr urine clearance (the best measure of GFR)
What is the normal glomerular filtration rate (GFR)

reflected by urine creatinine clearance
End-stage renal disease (ESRD) occurs when?
GFR< 15ml/min
Clinical manifestations of CKD
Polyuria- losing concerntrating abilities of kidneys

Oliguria/ Anuria- diminished and absent

Clinical manifestations of CKD Metabolic?
Increase BUN and creatinine

Impaired glucose use, insulin resistance

Elevated Triglycerides
Clinical manifestations of CKD Elyte / acid-base
Elevated K, NA, CA, po4, Mg

Metabolic acidosis
What is the result of increased Mg?
Absence of reflexes, decreased mental status, and hypotension
How is the blood affected by CKD?
Decrease in erthyropoeitin production in the kidneys --> decreased RBCs
What are respiratory manifestations of CKD?
Kussmaul breathing (respiratory acidosis), dyspnea, pulmonary edema, infection
Clinical manifestations of Nazarene women?
Long jean skirts

Lack of make-up

Long hair (Tammy-Faye style)

(Unless you are Kara, then you have none of these)
What are the clinical manifestations of CKD in the GI?
Stomatitis from increased acid along the entire GI tract

Mucosa inflamed from excessive urea
What is uremic frost?
Crystalization of urine on the skin (only extreme cases)
What is ecchymosis?
Widespread bleeding under the skin
What is the nutritional therapy for CKD?
Basically, reduction in everything (protein, water, Na, K, Po4
Meds for CKD
See pages 153-54 in syllabus
How do you identify persons at risk for CKD?
Hx of renal disease
Repeated urinary tract infection
what are the most common causes of death in the elederly ESRD pt?
CV disease (MI, stroke)

Withdrawal from dialysis
What is peritoneal dialysis?
Catheter inserted through anterior abdominal wall
1) Instill fluid
2) Dwell
3) Drain (pull out waste)
What does it mean if the excahanged fluid is cloudy after peritoneal dialysis?
Probable infection
What is an arteriovenous fistula?
Connection of an artery to a vein

Most preferable access for hemodialysis

Causes vein to dialate, necessary to accomodate large needle
What is an arteriovenous graft?
Similar to arteriovenous fistula, only synthetic
What should be assessed prior to hemodialysis?
Fluid statue, vascular access, temp, skin condition, weight
What is the maximum amount of weight that can be gained between dialysis treatments?
1 - 1.5 Kgs
What is disequillibrium syndrome?
Cerebral edema that can occur during HD becasue of imbalance between blood and CNS

Most likely to occur during first treatment
How many patients on HD die each year?
22%, usually infection or cardiac
What is continuous renal replacement therapy (CRRT)?
Slow and continuous fluid exchange in hemodynamically unstable pt.

Continuous 1 on 1 care in ICU
What is the cause of stress incontinence?
Sudden increase in intraabdominal pressure.

Relaxed muscles (after menopause, atrophy of urethra)
What is the cause of urge incontinence?
Uncontrolled contraction or overactivity of muscles

CNS disorders, bladder disorders, cancer, etc...
How do you treat urge incontinence?
Treat underlying cause

Anticholenergic drugs, Detrol LA, Ditrapan, Vesicare, Enablex
Overflow incontinence?
Leakage from overfull bladder

Caused by outlet obstruction or underactive muscle
Reflex incontinence?
No warning, freq voiding

From spinal cord lesion above S2
What types of incontinence are drugs most effective in treating
Urge and reflex

Nzot as effective in stress
Pelvic Sling?
Type of surgery used to treat incontinence
The inability to empty the bladder despite micturation or the accumulation of urine in the bladder becausse of an inability to urinate?
Urinary retention
What is the noraml amount of post-void retention?
50-75 ml

100-200 ml is considered a problem
Acute urinary retention?
Total inability to urinate

Medical emergency
What are the 2 causes of urinary retention?
1) Bladder outlet obstruction

2) Decreased detrusor contraction strength
Drugs used to treat urinary retention?
Detrol, VESIcare


Avodart, Proscar
What are the 4 routes of catheterization?

Ureteral (not common)


3 specific postop needs following urinary tract surgery?
1) Output- q 1-2 hrs

2) Respiratory- reluctant to Turn, Cough, Deep Breathe, Incentive Spirometry,

3) Abdominal distention- restrict po intake until bowel sounds present
Incontinent urinary diversion?
Illeal conduit (most common)

Ureteres--> Colon segment --> stoma (ostomy)
Continent urinary diversion?
similar to illeal coduit, but catherizable