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Renal key points
Test 2 Med surg 2910
| Question | Answer |
|---|---|
| What is the functional unit of the kidney | nephron |
| what are the seven conditions that must be assessed in a renal patient | fluid volume, presence of edema, lung sounds, anemia, electrolyte imbalance, urine output, nutritional deficiency |
| What is the normal value for serum Na+ | 135-145 mEq/L |
| what is the normal value for serum K+ | 3.5-5.0 mEq/L |
| What is the normal value for serum Ca++ | 8.6-10.2 mg/dL |
| What is the normal GFR | 100-125 mL/min |
| What is the normal serum creatnine | 0.6-1.3 mg/dL |
| What is the normal BUN | 8-25 mg/dL |
| What are 3 blood components that shouldn't be found in urine | Red blood cells, glucose, and protein |
| What is the earliest sign of kidney damage | persistent proteinuria (greater than 3 months) |
| What is the definition of glomerular filtration rate | the amount of blood filtered each minute by the glomeruli |
| what are 3 factors that determine the GFR | total surface area for filtration, permeability of filtration membrane, net filtration pressure |
| How is net filtration maintained | osmotic and hydrostatic pressure |
| What is given to help increase RBC production | Erythropoetin is given 2-3X a week to keep Hgb level 10-12 |
| What happens when Hgb gets too high | causes increased blood viscosity and accelerates HTN |
| What is the function of Vitamin D | to absorb calcium in the GI tract |
| What is the kidney's function in vitamin D production | convert to it's active form |
| What is polycystic kidney disease | kidney enlargement due to fluid filled cysts |
| What is PKD caused by | genetic disorder |
| What are symptoms of PKD | bright red or cola colored urine, chronic infections, and bleeding. often have intracrainial aneurysms |
| What are important assessments for PKD | headache and level of consciousness |
| When is acute glomerulonephritis most common | after streptococal skin or throat infection |
| What are symptoms of AGN | urine has a smokey or rusty appearance, salt and water retention, mild to moderate HTN |
| What are important assessments for AGN | Assess for fluid overload and hyperkalemia |
| What are some nursing interventions for AGN | diet limited in protein, diuretics, and antibiotics |
| What is the etiology of Chronic glomerulonephritis | due to other diseases such as lupus or diabetes causing impaired renal function and HTN |
| What is the treatment for acute glomerulonephritis | aimed at symptoms, protein and phosphate restriction |
| What is Neprotic syndrome | glomerulus excessively permeable to protein manifested by HTN, edema, hypalbuminemia, massive proteinuria and hyperlipidemia |
| What are critical assessments for Nephrotic Syndrome | Level of consciousness, DVT, daily weight, abdominal girth, I & O, skin assessment for edema |
| What are potential risks of nephrotic syndrome | infection malnutrition |
| What do nurses use to assess renal blood flow | blood pressure and urinary output |
| What do you assess for in renal trauma | hypovolemia, shock, urinary output of20-25ml/hr maintain a map of at least 70 |
| How is MAP calculated | (systolic + diastolic x 2)/3 |
| What are the reasons for altered urinary output | decreased fluid intake and excessive fluid loss |
| What is the RIFLE classification for | Acute kidney injury using serum creatnine and GFR |
| What can cause pre-renal AKI | heart failure, hypovolemia, decreased peripheral vascular resistance, decreased reanal blood flow, anything that causes decreased cardiac output |
| What is the most common type of intrarenal AKI | Acute tubular necrosis |
| What are the causes of post renal AKI | decreased mechanical outflow of urine from the kidney kidney stones |
| What is the most common cause of post-renal AKI | Benign prostatic hypertrophy |
| What are the 3 phases of AKI | oliguric, diuretic, and recovery |
| What is oliguria | urine output of 400 ml or less in 24 hours |
| What is anuria | urine output of 50 ml or less in 24 hours |
| What are the symptoms of oliguric phase | decreased GFR, accumulate metabolities (creatnine, urea, K+) and fluid excess |
| What are the symptoms of diuretic phase of AKI | uurine output gradually increases to 1-3 liters a day-assess for decreased sodium and potassium and dehydration |
| What are the indications of the recovery phase of AKI | return to normal renal function, extemely vulnerable for 6-12 months |
| What are the neurological effect of AKI and CKI | accumulation of nitrogenous waste products which cause slow peripheral nerve conduction causing neuropathy |
| What neurological assessments are needed with CKI | level of consciousness, seizures, itching, tingling and numbness of extremities |
| What is the only cure for PKD | Transplant |
| What percent resting cardiac output do the kidneys receive | 20-25% |
| What is important to teach patients during recovery phase of AKI | Do not use nephrotoxic agents like nsaids |
| What is basis for most cardiovascular symptoms of AKI and CRF | Fluid volume excess and electrolyte imbalances |
| What are symptoms of uremic pericarditis | audible friction rub and fever |
| what does increased potassium cause | arrythmias |
| why assess acute kidney patients for pneumonia | increased risk due to pericardial effusion, decreased loc and decreased cough reflex |
| What are GI effects of AKI and CRF | increased capillary fragility, mucosal irritation and GI bleeding |
| What are 3 effects of AKI on blood cells | platelet function is impaired low WBC Anemia |
| Why are skeletal disorders common with kidney disease | decreased calcium absorption which activates PTH which stimulates bone demineralization |
| What effect does kidney disease have on the skin | uremic toxins cause itching and dry skin |
| Why do kidney patients take phosphorus binders | cannot excrete phosphorus |
| When do kidney patients take renalgel or PhosLo | with meals because phosphorus is absorbed within one hour of intake |
| What causes increased potassium level in AKI | decreased excretion and increased cellular release through tissue breakdown and acidosis |
| What does EKG show with increased potassium levels | tall peaked T waves with widening of QRS complex and ST segment depression |
| What are the 3 most common treatments for increased potassium | IV glucose Insulin hemodyalisis |
| What are the 2 mechanisms of fluid overload in kidney disease | retention of Na+ and water renin-angiotensin-aldosterone system |
| What is the purpose of dialysis | to remove waste products and excess fluid |
| What nursing interventions are necessary before giving Kayexalate | check bowel sounds |
| When does aggresive treatment begin for AKI | When Potassium level reaches 6 mEq or arrythmias are identified |
| What 3 mechanisms are involved in dialysis | diffusion, osmosis, and ultrafiltration |
| What medications should be held or adjusted before hemodialysis | water soluble meds and blood pressure meds |
| What is the most common complication of hemodialysis | hypotension |
| What are common complaints from patients undergoing hemodialysis | feeling lightheaded, dizzy, chest pain from ischemia, and nausea and sometimes muscle cramps |
| How are the common complaints from dialysis treated | decrease the blood pump rate and give 0.9% NS |
| Why are patients undergoing hemodialysis more prone to seizures | rapid removal of fluid from the vascular bed |
| What are muscle cramps during hemodialysis caused by | hypotension, rapid removal of Na+ and water, and neuromuscular irritability |
| What causes dialysis disequilibrium syndrome | rapid changes in the composition of extracellular fluid, can cause cerebral edema |
| When is dialysis disequilibrium syndrome most often seen | during initial treatments when BUN is high |
| What is the leading cause of death in renal failure | infection |
| What percentage of chronic hemodialysis patients are positive for Hepatitis C | 8-10% |
| Why are dialysis patients more prone to bleeding | platelet dysfunction and heparinization during dialysis treatment |
| When is Continuous Renal Replacement(CRRT) therapy used | critically ill patients who are hemodynamically unstable and more susceptible to hypotension |
| What is different about CRRT | more gradual removal of fluid, done over 24 hours to several days |
| What is Quintin catheter | temporary vascular access for hemodialysis |
| What is a fistula or graft used for | permanent access for hemodialysis |
| What can't be done on extremities with dialysis access is | no BP, No IV lines, and no venipuncture |
| What is used as the dialyzing surface for peritoneal dialysis | peritoneum |
| What is a catheter for peritoneal dialysis called | Tenchoff Catheter |
| What are the 3 phases of peritoneal dialysis | inflow, dwell and drain |
| What is the inflow phase | 1-2 liters of dialysate are infused over 10 minutes |
| When is the inflow phase slowed down | when patient complains of pain |
| What must be done to stop air from entering abdomen | tubing must be clamped |
| How long is dwell time in peritoneal dialysis | 20-30 minutes to 8 hours |
| How long is drain time in peritoneal dialysis | 15-30 minutes |
| How can drain be facilitated | gently massaging abdomen or changing position |
| How is ultrafiltration controlled | glucose in dialysate which acts as an osmotic agent |
| What are 2 methods of peritoneal dialysis | Automated or continuous ambulatory |
| What are clinical manifestations of exit site infection | redness, tenderness and drainage |
| What are complications of exit site infection | peritonitis and abcess |
| What is usual organism that caused peritonitis in PD patients | staph epi or staph aureus |
| What is primary clinical manifestation of peritonitis in PD patients | cloudy peritoneal drainage |
| When is removal of peritoneal catheter necessary | after repeated infections or adhesions |
| When is protein loss more significant | peritonitis |
| What are pulmonary complications of peritoneal dialysis | decreased lung expansion due to displacement of diaphram |
| When is PD contraindicated | recent abdominal trauma, recent abdominal surgery, peritonitis, and significant lung disease |
| Why do PD patients have carbohydrate and lipid abnormalitiies | increased absorption of glucose which increases insulin secretion with increased hepatic production of triglycerides |
| What is an advantage of PD | dietary intake is more liberal and can be done at home |
| How can dialysis help manage diabetes in kidney patients | regular insulin can be added to dialysate |
| When does acute kidney transplant rejection occur | within days to months(usually within first 6 months) |
| What are signs and symptoms of transplant rejection | oliguria, weight gain, fever, increased BUN and creatnine, and tenderness at graft site |
| How is rejection treated | immunosuppressants, corticosteroids, and monoclonal antibodies |
| What are signs and symptoms of chronic rejection of kidney transplant | occurs over months to years and is irreversible Treatment is supportive causes fibrosis and scarring |
| What are transplant patients at increased risk for | malignancies,CVD, corticosteroid related complications |
| What is Stage 1 Kidney disease characterized by | Damage with normal or Increased GFR (>90) |
| What is Stage 2 Kidney disease characterized by | Damage with mildly decreased GFR (60-89) |
| What is Stage 3 Kidney disease characterized by | Moderately decreased GFR (30-59) |
| What is Stage 4 Kidney disease characterized by | Severly decreased GFR (15-29) |
| What is Stage 5 Kidney disease characterized by | Kidney failure-needs RRT to sustain life |
| What are the 4 leading causes of Kidney Disease | DM, HTN, Glomerulonephritis, and Cystic kidney disease |
Created by:
garrisonl
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