Nursing 202

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Glomerulonephritis

1. Inflammation of glomerulus of kidney characterized by: (Select all that apply)

Back 1

• Proteinuria, Hematuria, Flank Pain, Headache

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2. During nursing assessment and history, you would ask:

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• Have you had a sore throat in the past 2-3 weeks?

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3. Glomerulonephritis, if caught Early:

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• 90% of children will recover; 70% of adults will recover

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4. Most Acute Glomerulonephritis is caused by:

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• Infection (ie: Streptoccocal) or related to other systemic disease (Primary & Secondary)

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5. Uremia is indicated by: (Select all that apply)

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• Nausea, Vomiting, Anorexia, Lethargy

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6. What diagnostic test is the BEST indicator of Kidney Function from urine/blood:

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• Creatinine Clearance Test (24 hour to assess GFR)

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7. Acute Glomerulonephritis patient urine will have characteristic:

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• Color (Redish Brown, “Coke” Colored, Smokey)

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8. Acute Glomerulonephritis treatment:

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• Bed rest to decrease tissue catabolism breakdown so kidneys don’t work so hard

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9. Acute Glomerulonephritis diet teaching:

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• ↓ Protein

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10. Acute Glomerulonephritis expected finding with bedrest:

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• ↑ Urine Output

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11. Acute Glomerulonephritis will restrict K+ & Protein to prevent:

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• Hyperkalemia & Uremia due to ↑ BUN

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12. Glomerulonephritis patient teaching:

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• Routine checkups for kidney function MUST continue even when Pt. feeling better

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13. Clinical manifestations of Chronic Glomerulonephritis (CGN):

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• No symptoms for many years

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14. Oliguria leads to:

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• ↑ K+ from potassium retention
• Hyperphosphatemia with ↓ Ca+
• Metabolic Acidosis develops with Loss of Bicarbonate
• Respiratory compensation with Kussmaul’s (↑Rate & ↑Depth of Breathing)

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15. Signs of Renal Failure:

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• HTN, Oliguria, Electrolyte Imbalance, Uremia

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Lupus

1. What is the genetic link between Lupus, RA, Psoriatic Arthritis:

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• RUNX-1 protein (rheumatoid factor)

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2. Only way to Diagnose Systemic Lupus Erythematosus (SLE):

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• Complete Medical History
• Physical Exam (Evidence of Multi-System Organ: Skin, Joints, Kidney, Lung, Nervous, etc.)
• Blood Tests (CBC, RUNX-1, Antinuclear Antibody (ANA), Erythrocyte Sedimentation Rate (ESR), Immunoglobulins, Venereal Disease Syphilis (VDRL), etc.)
• There is no single exam to diagnose SLE
• CBC may reveal Pancytopenia=↓ in ALL cells RBC, WBC, etc.

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3. Pt.’s should be taught that:

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• Stress causes a high-incidence of exacerbations (flare-ups)

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4. 1st Sign of Lupus:

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• Skin involvement (“Butterfly Rash” – red, dry, scaly skin on Face, Sun-Exposed Upper Body)
• Can also be Lesions (Discoid=Coinlike) & Alopecia

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5. Lesions especially evident when client exposed to sunlight & UV light – Pt. Teaching:

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• Wear Hat, Clothing, Sun Screen, Avoid prolonged Sun/UV/Fluorescent Exposure

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6. There are 11 Signs associated with Lupus:

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• Must have at least 4 to be diagnosed

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7. Majority of deaths in SLE are caused by:

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• Renal (50% will have renal disease)

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8. Lupus is treated with:

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• High-Doses of Steroids (ie: Prednisone & other Corticosteroids)

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9. Other Drugs/Treatments to treat SLE:

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• Plaquenil - Hydroxychloroquine (Anti-Malarial helps ↓ Inflammation)
• Imuran – Azathioprine (Immunosuppressant)
• Cytoxan – Cyclophosphamide (Immunosuppressant)
• Cortisone (Topical)
• Plasmapheresis (Plasma Exchange for autoimmune disorders)

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10. Discoid Lupus Erythematosus (DLE) is characterized by:
(immediate family member best)

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• Affects only small % & Skin (Discoid=individual round “Coinlike” lesions)
• “Scarring” Lesions

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11. Systemic Lupus Erythematosus (SLE) is characterized by:

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• Chronic, Progressively Worsens (Onset Acute or Insiduous=Steady)
• Inflammatory connective tissue disorder
• Spontaneous remissions and exacerbations (flare-ups)
• Systemic – usually non-scarring

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12. SLE “Risk Factors” from the following Medications:

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• Hydralazine – Apresoline (HTN Drug)
• INH – Isoniazid (TB Drug)
• Procainamide – Pronestyl (Abnormal Heart Rhythm Drug)
• Chlorpromazine – Thorazine (Anti-Psychotic Drug)
• (Anti-Seizure Meds) Phenytoin/Dilantin, etc.

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13. Classic CNS symptoms of Lupus:

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• Fever (unknown origin)
• Fatigue
• Weight Loss
• Malaise

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14. Cardiovascular symptoms of Lupus:

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• Pericarditis, Vasculitis, Raynaud’s

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15. Diagnosis of DLE:

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• Skin Biopsy (because it’s not systemic)

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16. Teach Pt. in Acute Setting:

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• Monitor skin changes daily

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17. Teach Pt. to monitor which MAJOR SIGN of flare-up with SLE:

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• Fever/Body Temp. (can become seriously ill during this time)

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Acute Renal Failure (ARF)

1. 3 Main Causes/Complications leading to acute renal failure:

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• Complications of poorly controlled Diabetes (1st most common)
• Complications of uncontrolled HTN (2nd most common)
• Complications of Glomerulonephritis (3rd most common)

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2. Kidney’s Function:

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• Excretion of Waste, Water, Salt-Balance, Acid-Base Balance, Hormone Secretion

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3. When going from Oliguric Phase to Diuretic Phase, a Pt. is:

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• Risk for HypOvolemia & Electrolyte Imbalance

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4. What food would the nurse say is alright for ARF Pt. to have:

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• A Scoop of Ice Cream (High-Calorie)

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Chronic Renal Failure (CRF)

1. 2 Signs of “EARLY” CRF:

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• Hyposthenuria (loss of urine concentrating ability)
• Polyuria (↑ Urine Output b/c kidneys not reabsorbing water)

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2. What disease is the LEADING cause of death in clients with ESRD:

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• Cardiac Disease (check for Edema, Assess HR & Rhythm)

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3. When fewer than 10%-20% of Nephrons are working: (More than 80-90% Impaired)

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• ↓ GFR leads to ESRD

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4. You would treat Cardiac Tamponade (Emergency leading to death):

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• Requires removal of peridcardial fluid by needle, catheter, or tube into pericardium

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5. Don’t Give ? with CRF

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Magnesium (Mg)

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6. Advantages of giving Epogen (Procrit – Alphapoeitin) for Anemia in CRF:

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• ↓ Need for transfusions
• ↑ Well-Being of Pt.
• Pt. tolerates Dialysis better (that’s why given before)

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7. The medications to administer for constipation of CRF:

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• Metamucil (Psyllium) for constipation (Best Safe Choice)
• Senna, Ducosate/Colace
• DO NOT USE!!! (Mylanta, Maalox, Milk of Magnesia, Aluminum Citrate, Magnesium Citrate)

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8. HyperKalemia in CRF causes:

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• Paresthesia
• Tall, Peaked T-Waves on ECG (K+ >5.5 mEq/L)

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9. Dietary teaching for for CRF:

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• Need High-Value Protein (ie: eggs) – need amino acids to repair but restrict to <40 Gm/day
• Restrict K+, Na+, Phosphorous
• Encourage High Complex Carbohydrates & Fat (to prevent catabolism & supply calories)

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10. Metabolic Changes for Sodium (Na+) in CRF:

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• Early = HypOnatremia
• Late = HypERnatremia

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11. Potassium (K+) will become Hyperkalemia:

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• When 24 hr. Urine falls below 500 mL

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12. Hyperkalemia will cause what signs/symptoms:

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• Dysrrythmias
• Muscle Cramps

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13. Hyperkalemia will be treated with:

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• Kayaxelate
• D5W
• Insulin

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Dialysis

1. 3 Criteria for getting Dialysis:

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• Fluid Overload NOT RESPONDING to Diuretics
• Uncontrolled Hypertension
• Uremic Manifestations

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2. Best Methods for Hemodialysis Vascular Access:

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• 1st Choice – Fistula (surgically joining artery to vein & takes 4-6 weeks to heal)
• 2nd Choice – Graft
• Other choices: Subclavian, Internal, Jugular, Femoral (↑ risk for infection)

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3. A Nurse would assess for the following with dialysis:

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• Weights (dry weight – before & after)
• BP (careful of Orthostatic Hypotension)
• Meds to be withheld
• Assess site (if redness/swelling & suspect infection – send for culture)
• Check for Clots (usually in venous return – determine amount of Heparin to use)

Front 53

4. Tenckhoff Catheter – Peritoneal Dialysis (PD) – 1 Exchange:

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• Infuse Dialysate
• Dwell Time
• Outflow/Drain Time

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Renal Transplant

1. Pt. teaching:

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• Take Imuran / Azathioprine FOR LIFE (Immunosuppressant/Anti-rejection)

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2. Administer what medications for ACUTE inflammation/swelling:

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• Prednisone & Solu-Medrol (Methylprednisolone)

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3. Rejection of Kidney Transplant:

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• Acute Rejection (1-3 weeks post-surgery – RAPID ONSET)
• Chronic Rejection (3 month GRADUAL progression of signs/symptoms)

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4. Biggest Barrier to receiving a Transplant:

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• Lack of available/viable donors