Patho - RENAL
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List the five functions of the kidney.
- Urine Formation and Elimination
- Electrolyte Balance
- Acid-Base Balance
- BP Regulation
- Blood Component Production
True or False?
Acute renal failure is one of the few instances of organ failure that is completely reversible.
Which four groups of patients have approximately 90% mortality rate from acute renal failure?
Which of the following are the leading causes of death from acute renal failure?
b. Fluid volume overload
d. Major hemorrhage
Define acute renal failure.
- the inability of the kidney to
- –Excrete various end products of cell metabolism in adequate or normal amounts
- –Failure to regulate fluid, electrolyte, and acid-base balance
- –Failure to regulation RBC production
Define renal insufficiency
–Decline in renal function to about 25% of normal. Levels of BUN and Creatinine are mildly elevated
- –Syndrome of renal failure that includes elevated BUN and Cr levels accompanied by fatigue, anorexia, nausea, vomiting,
- pruritus and neurological changes.
–Increase in the serum levels of urea and creatinine.
List 7 risk factors for the development of Acute Renal Failure and state why they are a risk factor
- Cardiopulmonary bypass
- Aortic or renal vessel surgery
- Procedures that require large volumes of blood transfusions
- Biliary Surgery
- OB complications
- Preexisting renal disease
- Anesthetic agents
- Radiologic dyes
- Crush injuries – Rhabdomyolysis
- Hypotension Blood transfusion reactions
- Nephrotoxic agents
Identify the three groups of causes of acute renal failure and give three examples of each.
What are the three stages of acute renal failure and what are two findings of each?
- Oliguric Stage
- Diuretic Stage
- Recovery Stage
List 7 clinical manifestations of acute renal failure.
- Proteinuria, WBC and RBC
List five body systems altered by acute renal failure and list 2 ways that systems is impaired.
What is the major focus of care of the client with acute renal failure?
- Maintain Vital Body Functioning
- Keep the body’s chemical status within reasonable limits to give the kidneys an opportunity to recover their function.
List 5 Treatments/nursing care needs of the client with acute renal failure.
- Fluid Intake
- Restrict intake of K & Na
- Correction of pH Imbalances
- Correction of Electrolyte Imbalances
- Protection from Infection
- Positioning, Turning and Skin Care
- Observation for Neurological Changes
- Medication Adjustment
- Daily Weights
- Daily Lab Values
- Hourly Vital Signs and Cardiac Monitoring
- Hourly I & O
- Respiratory Care
- Oral Care Monitoring for Bleeding Disturbances
- Assist with Cares
- Psychosocial Support
- Determination of the Cause and attempt to eliminate it
What is peritoneal dialysis and how does it differ from hemodialysis?
Which of the following are ways that the nurse could prevent acute renal failure from developing?
a. Avoid hypertension
b. Avoid hypovolemia
c. Be aware of nephrotoxic drugs the client is getting
d. Accurate I and O
All of them
True or False? The prognosis of acute renal failure will vary with the cause of the renal failure, the extent of the renal failure and the early management of the renal failure.
List 5 indications that the client with acute renal failure will need dialysis.
- Uncontrolled Hyperkalemia
- Severe Acidosis
- Azotemia – BUN approaching 200
- Fluid Overload - CHF - Pulmonary Edema
- Removal of Nephro toxic Agents
- Uremic Symptoms
How do Chronic Renal Failure and Acute Renal Failure differ?
Continued improvements in _______________, ___________________, and _______________________ have improved the outcome for persons with renal disease.
List 10 Causes of Chronic Renal Failure.
- Congenital Disorders of the Kidney • Agenesis: absence of the organ due to failure to develop• Hypoplasia: when the kidneys do not develop to normal size• Alterations in the kidney position and form- this can lead to kinking of the ureters and obstruction of urine flow
- B. Obstructive Disorders of the Kidney • Developmental defects• Renal calculi• Normal pregnancy• BPH• Scar tissue resulting from infection and inflammation• Tumors• Neurologic disorders – SCI and Diabetic neuropathy
- C. Urinary Tract Infections
- D. Disorders of Glomerular Function• The Nephrotic Syndrome• Glomerulonephritis • Diabetic Glomerulosclerosis – major complication of DM• Hypertensive Glomerular Disease
- E. Tubulointerstistial Disorders• Renal Tubular Acidosis• Renal Cystic Disease – Polycystic Kidney Disease• Pyelonephritis• Drug-related Nephritis
- F. Neoplasms• Adult Kidney Cancers• Wilms Tumor
All forms of renal failure are characterized by marked reduction in the _______________________________________.
All forms of renal failure are characterized by marked reduction in the glomerular filtration rate.
The progression of chronic renal failure occurs in three stages. Name them.
- Renal Impairment
- Renal Insufficiency
- End-stage Renal Disease
Regardless of the cause of chronic renal failure there is a progressive deterioration of ____________________, _________________, and _________________ function of the kidney.
Regardless of the cause chronic renal failure causes a progressive deterioration of glomerular filtration, tubular reabsorption, and endocrine functions of the kidney.
Match the Following
A. Renal Impairment
B. Renal Insufficiency
C. End-Stage Renal Disease
__ GFR 20-40% of normal
__ GFR 40-50% of normal
__ GFR 10-15% of normal
__ Earliest sign in this stage is polyuria
__ The mass of the kidneys is reduced
__ Treatment in this stage is wither transplantation or dialysis.
There is a reduction in the capillaries and scarring in the glomeruli
Only a few remaining nephrons that function
In this stage the kidneys have difficulty in the elimination of the waste products of metabolism
__ the nephrons undergo changes to compensate for the damaged nephrons
- B - GFR 20-40% of normal
- A - GFR 40-50% of normal
- C - GFR 10-15% of normal
- A- Earliest sign in this stage is polyuria
- C - The mass of the kidneys is reduced
- C - Treatment in this stage is wither transplantation or dialysis.
- C - here is a reduction in the capillaries and scarring in the glomeruli
- C - Only a few remaining nephrons that function
- C - In this stage the kidneys have difficulty in the elimination of the waste products of metabolism
- A - the nephrons undergo changes to compensate for the damaged nephrons
Clinical manifestation of chronic renal failure can be divided into 2 areas – Name them.
- Alterations in Fluid and Electrolyte Balance
- Alterations in Various Body Systems
____________________ is a term used to describe the clinical manifestations seen with end-stage renal failure.
List 5 alterations in fluid and electrolyte balance in chronic renal failure.
- Low - Na
- Low Vit - D
- Low - Ca
- high – phosphorous
- High K - or - Hyperkalemia
Why will persons with CRF develop hyperparathyroidism?
Few symptoms of uremia occur until ______ of the nephrons are destroyed.
With deteriorating renal function the serum PO4 with rise. This will cause an inverse change in what other electrolyte?
What impact does chronic renal failure have on Vitamin D? What impact does this have on the body in chronic renal failure?
Why is the patient in metabolic acidosis with CRF?
_________________ is an early sign of CRF that usually develops before other symptoms are evident. Define it.
The most profound hematological alteration that occurs in CRF is __________________ . Why does this occur?
Why are chronic renal failure patient at risk for bleeding?
__________________ is a common complication of CRF due to the decrease in the efficiency of the immune system.
What are the three cardiovascular abnormalities seen in CFR?
- i. Hypertension
- ii. CHF & Pulmonary Edema
- iii. Pericarditisi
- v. Cardiac Arrhythmias
Cardiac arrhythmias usually seen in CFR are the result of an increase in _______.
What are the 3 common GI disturbances in CRF?
- ii. Nausea
- iii. Vomiting
- iv. Metallic taste in the mouth
- v. Gastric Ulceration and Bleeding
- vi. Hiccoughs
What are the 2 common neurological disorders seen in CFR? Describe them.
- Peripheral Neuropathies
- Uremic Encephalopathy
CRF can lead to which respiratory problem?
- Osteodystrophy - defective bone development; usually attributable to renal disease or to disturbances in calcium and phosphorus metabolism
- Osteo - Bone
- dystrophy - any degenerative disorder resulting from inadequate or faulty nutrition
How is CRF evaluated or diagnosed?
- Physical Findings
- Kidney Biopsy
What are the 2 treatment stages in CRF? Describe them.
What are the factors that should be taken into consideration regarding the effect of CRF on the elimination of drugs?
- Slows the elimination of medication thus lengthening the 1/2
- life and duration
What are the two damaging effects of urinary obstruction and why?
- • Stasis of urine
- • The development of backpressure
List 4 predisposing factors for urinary obstruction.
- A. Congenital defects in the urinary tract structures
- B. Pregnancy
- C. BPH
- D. Tumors
- E. Kidney stones
- F. Trauma
Where is pain located with urinary obstruction?
- Depends on where the obstruction is located can present flank
- pain, or groin pain. Chronic obstruction can be asymptomatic.
How is urinary obstruction diagnosed and treated?
- Depends on underlying etiology. Possible treatments include 1. Antibiotics 2. Surgery (Ex: Removal of obstruction) 3. Prevention !!!!
- a. Decreased use of foleys
- b. Teaching (Females wipe from front to back, for ex.)
- c. Bladder training for the neurogenic bladder
- d. Hygiene measures (ex: incontinence)
- e. Hydration (If no restriction in fluid intake)Antibiotics Surgical Removal of Obstruction Fluids
What are special considerations regarding UTI in
- Females - Anatomy, Pregnancy increase risk, Introduciton of org. due to invasive procedures
- Elderly - Reduced fluid intake, incontinence, Introduciton of org. due to invasive procedures
- Children - too busy to empty bladder, hygiene
- Males - Not as common unless introduciton of org. due to invasive procedures
What are the common organisms that can cause UTI?
E. Coli, Klebsiella, Proteus, Pseudomonas, or Staphylococcus.
List the predisposing Factors for UTI and give examples of each.
- 1. Urinary stasis - renal pelvis, bladder
- 2. Obstruction - renal calculi, prostatitis, congenital urinary defects. Obstruction of urine flow produces stasis of urine which increases the incidence of infection.
- 3. Presence of a foreign body - foley, stones in bladder
- 4. Neurogenic bladder - due to retention, stasis
- 5. Disease of blood vessels - ischemia - >damage to bladder structures
- 6. Underlying conditions a. Pregnancy b. Sickle-cell trait c. Hypertension d. Diabetes mellitus
- 7. Being a woman, due to shorter urethra
Discuss the clinical manifestations seen with UTI
- Pain may help the clinician locate the source of UTI
- a. May be asymptomatic for years. If symptoms present they usually occur in acute conditions.
- b. May be due to distention of the renal capsule
- c. Kidney: costovertebral pain
- d. Ureter: pain occurs in the back and radiates to the abdomen, upper thigh, testes, and/or genitalia
- e. Bladder: Pain is due to over distention of an infected bladder.
- Symptoms include
- I. tenesmus (ineffectual or involuntary straining with urination) II. dysuria (painful urination)
- f. Urethra: dysuria, burning with urination.
What are three things you can teach you clients to do in order to prevent UTI?
- b. Teaching (Females wipe from front to back, for ex.)
- Force fluids - flushes bacteria, prevents stasis of urine
- 2. Encourage frequent voids, q 2-3 hrs. Empty bladder completely
- 3. For women with repeated UTI’s
- a. wash in shower or stand in tub to clean genitalia
- b. if associated with sexual intercourse; void before and immediately after intercourse.
- 4. Encourage follow-up. There is a marked tendency for UTI’s to recur, especially with pregnancy
Define the following:
Polycystic Kidney Disease
- *Cystitis - infection predominate at bladder
- *Pyelonephritis - Infection predominate at Kidney
- *Glomerulonephritis - an acute, subacute or chronic
- condition characterized by inflammation of the capillary loops in the glomeruli of the kidney.
- *Polycystic Kidney Disease - (PKD) is a form of renal cystic disease. It is the result of a hereditary trait and is one of the most common hereditary diseases in the United States affecting 600,000 people.
Discuss the Pathology of Pyelonephritis.
- An infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys. May be acute or chronic. - Pathology
- The ascending pathway is the most common route for the spread of the infection, but it may also be spread by the bloodstream.
- 1. Inflammatory process – patchy (irregular) in location.
- 2. Swelling of the renal parenchyma
- 3. Patchy distribution of acute infections
- 4. Swelling and scarring of infected tissue occurs
- 5. Abscess formation and tubular necrosis
- 6. Kidney atrophy where scar tissue forms
- 7. Renal failure if untreated - rare.
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