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