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Renal threshold for glucose?
How many ml/min do nephrons filter in a healthy kidney (GFR)?
What should you suspect of men with recurrent UTIs?
What regulates blood flow, GFR & BP?
What controls sodium & water reabsorption?
What stimulates RBC production in bone marrow?
If you have poor kidney function what would you suspect your H & H levels to be?
What is the best indicator of overall kidney function?
Normal Levels of Serum Creatinine in Men & Women?
Normal value for BUN?
1.005 - 1.030
(decreased means dilute - increased means concentrated)
If an older adult has a decreased LOC what should you suspect?
When is the best time to do an urinalysis?
First void of the morning
What phosphorus and calcium levels would you suspect to see in a patient with poor kidney function?
Increased Phosphorus & Low Calcium
Billirubin in a urinalysis would sugest what?
Leukoesterase & Nitrates in the urine - what should you suspect?
Why are older people at an increased risk for UTI?
They have a tendency to retatin urine
What is a baby's chance of getting PKD if one parent has an Autosomal Dominant gene?
Which is worse: Autosomal Dominant or Recessive PKD?
What is ACUTE PAIN r/t in PKD?
What is CHRONIC PAIN r/t in PKD?
What is the main manifestation to be concerned about with PKD?
What type of diet should you adopt if you have PKD?
High Fiber & 2500 ml/day & Low Sodium Diet
What % of kidney function must be lost before Serum Creatinine increases?
What are some manifestations of PKD?
- Increased abdomen size
- Flan pain
A patient with PKD develops a severe headache.. What should you suspect?
S/S of a Berry Aneurism r/t PKD?
- Neurologic/Vision chances
What is often the first manifestation of PKD?
Where would you expect to see pain in someone with Hydroureter?
Low - scrotal pain for men
Where would you expect to see pain in someone with Hydronephritis?
High - flank pain
Nephrosotomy post-op care?
-first 12-24 hrs red-tinged blood is normal
-If drainage decreases and patient has back pain OR leaking urine/blood from site - Notify Physician
Acute Pyelonephritis is related to what?
Chronis Pyelonephritis is related to what?
recurrent UTIs (scarring/ inflammation)
S/S of Acute Pyelonephritis?
- Fever, chills, malaise, fatigue
- flank pain, abdominal discomfort
- tachcardia, tachypenea
- S/S of UTI (urgency, frequency, dysuria)
S/S of Chronis Pyelonephritis?
S/S of renal failure - hypertension, nocturia, hyperkalemia, acidosis and inability to conserve sodium
Where would you expect to see edema on someone with Acute GN?
preorbital (face & hands)
Where would you expect to see edema in someone with Chronic GN?
dependent edema (feet & legs)
S/S of Glomerulonephritis?
(SOA, crackles, edema, S3 Gallop)
What causes fluid overload in GN?
Sodium & Water retention
What is Chronic GN due to?
Disease processes such as LUPUS or diabetes
What is Acute GN usualy due to?
Infection - ask about recent infections, tattoo, piercings
Treatment of Acute GN?
- Personal Hygeine
What determines the extent of kidney damage?
How do you collect Creatinine Clearance?
- -Discard first specimen & note time
- -Collect for 24 hrs.
- -Void at end of 24 hrs. and save specimen
- -keep on ice or in refrigerator
- -tell everyone
Renal Scan patient instructions?
- -obtain informed consent & weight
- -drink 2-3 glasses of water prior to procedure
- -void before procedure
- -increase fluids after procedure
Post Procedure Renal Biopsy?
- check pressure dressing
- supine postion & strict bed rest
- monitor for bleeding!!!!
- report complications (abdominal pain, decreased bowel sounds, guarding)
- No heavy lifting or activity for 1-2 weeks
What is the first manifestation of Diabetic Nephropathy?
Albuminuria (.3 g/dl)
Other patient care for Diabetic Nephropathy?
- Avoid nephrotoxic agents & dehydration
- assess need for insulin
What is a common manifestation of Renal Cell Carcinoma due to the parathyroid hormone produced by tumor cells?
What is hypertension due to in Renal Cell Carcinoma?
increased blood levels of RENIN
What does increased HCG levels cause in Renal Cell Carcinoma?
decreased libido (sex drive) :'(
Post-Op care following Renal Cell Carcinoma Surgery?
Assess for signs of bleeding in bed linens, H&H, BP, distended abdomen, hypotension, etc.
BUN level is directly related to what?
What are the 4 main causes of CRF?
- Kidney Disease
What are EARLY signs of CRF?
- Decreased ability to concentrate urine (polyuria & nocturia)
- Elevated Cr & BUN
Metabolic Changes you would expect to see with CRF?
- Metabolic Acidosis (kussmaul respirtations)
CRF Cardiac Changes:
Excess volume, excess sodium, renin-angiotensin-aldosterone
CRF Cardiac Changes:
Anemia, hypertension, fluid overload, uremic toxins
CRF Cardiac Changes:
Chest pain, pericardial friction rub, increased HR, fever
CRF Cardiac Changes:
Bradycardia, decreased pulse pressure, muffled heart sounds
Hematologic changes with CRF?
- Anemia (decreased erythropoietin)
- Bleeding (impaired platelet function)
GI changes with CRF?
- Halitosis (increased ammonia)
- uremic colitis
- GI bleed
Integumentary changes with CRF?
Uremic Frost (crystallized urea on the skin)
Normal Phosphorus level?
Normal potassium level?
3.5 - 5
Normal Calcium level?
9 - 10.5
Normal Hemoglobin levels?
Normal Hematocrit levels?
Fluid restriction in pt. with CRF?
Urine output + 500-700 ml/day
Diet restrictions/additions in a patient with CRF?
Decrease potassium, sodium & phosphorus
Increase Calcium & Iron
How much weight gain over 2 days should be reported in a patient with CRF?
5 pounds over 2 days
Do you give diuretics to ssomeone with ESKF?
After undergoing Hemodialysis what must the patient be aware of?
Risk for bleeding r/t Heparin
Be cautious for 4-6 hours afterwards!
What is the antidote for Heparin in Hemodialysis?
Care of AV Fistulas & Grafts?
- Avoid venipunctures and taking BP in that extremity
- Feel for Thrill
- Auscultate for Bruit
- Assess distal pulses
- Asses bleeding & infection
- Never use site to administer IV fluids
Do not sleep on or do any heavy lifting with affected arm!
Hemodyalisis: Which port is blood drawn through?
Hemodyalisis: Which port is blood returned through?
What should you asses for during Hemodialysis?
Dialysis Disequilibrium Syndrome
Dialysis Disequilibrium Syndrome S/S?
- Decreased LOC
- Nausea & Vomitting
- Cerebral Edema r/t decreased blood volume & BUN
Treatment of Dialysis Disequilibrium Syndrome?
Anticonvulsants due to the risk of seizures
How does Peritoneal Dialysis work?
Peritoneal Dialysis: Sanguinous drainage?
Bleeding - stop infusion & call MD
Peritoneal Dialysis: Brown Drainage?
Bowel Perforation - stop infusion & call MD
Peritoneal Dialysis: Urine colored drainage?
Bladder Perforation - stop infusion & call MD
Peritoneal Dialysis: Cloudy drainage?
Infection - collect a sample
Peritoneal Dialysis: Pre-dialysis care?
- Measure abdominal girth
- Assess VS & lung sounds
- Record weight
- Monitor BUN, Cr, electrolytes, H&H
- Empty Bladder
Peritoneal Dialysis: Post Dialysis Care?
- Time meals with outflow!!
- monitor BUN, Cr, electrolytes, H&H