Alterations in Renal Function

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foxyt14
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234800
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Alterations in Renal Function
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2013-09-18 17:29:16
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N172 Renals
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Renals
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  1. List medications that can cause nephrotixicity
    • Antibiotics ("mycins")
    • Aspirins
    • Cephalosporins
    • Cyclosporins
    • Ibuprofen
    • Rifampin
    • Sulfonamides
  2. Specific drugs of concern that cause nephrotoxicity
    • Digoxin
    • metformin/glyburide
    • Gentamicin
    • Vancomycin
  3. Top 3 ways a person develops chronic renal failure
    • #1 Diabetes
    • #2 Hypertension
    • #3 Glomerulonephritis
  4. Why does diabetes cause CRF?
    when you have diabetes for awhile the glomeruli will be under a lot of pressure and will become sclerotic and thick causing a decrease in GFR
  5. How does a person get Glomerulonephritis? and how does it cause CRF?
    it happens from strep throat

    which causes an immunologic response triggering inflammation and proliferative changes to the glomerulus resulting in scarring and a decrease in the ability of the glomerulus to filter blood
  6. What's pyelonephritis?  What can it cause?
    upper UTI problem....CRF
  7. What is polycystic kidney disease?  What can it cause?  Mainly in who?
    grapelike cluster of cysts that destroys renal tissues by compressing it

    genetically transmitted....seen in kids
  8. What is nephrosclerosis?  What can it cause?
    it is a thickening (hypertrophy) of the renal arteries, arterioles and glomerulus caused by elevated BP
  9. What meds cause CRF?
    • Contrast Media
    • Aminoglycosides
    • NSAIDS
    • Crack
    • Heroine
  10. What's the goal ofcollaborative management for clinical manifestations experienced by a patient with CRF?
    • to preserve the existing kidney function
    • treatment of cardiovascular disease
    • prevention of complications
    • provide comfort for the patient
  11. Why does a person get dialysis?(2)

    Indicators that it is needed?(2)
    • for correction of fluid and electrolyte imbalances
    • removal of waste products for a person in kidney failure

    • removal of uremia
    • GFR is <15
  12. What is peritoneal dialysis?
    the peritoneum is used as the semi permeable membrane
  13. What is hemodialysis?
    it is an exchange of fluid and electrolytes and toxins from blood to a bath that circulates through an artificial kidney and returned to the venous circulation
  14. What is important to remember when you are caring for a patient with a fistula/graft for dialysis?
    • No BP on that arm
    • No blood draws from that extremity
    • No injections in that extremity
    • No IV's in that extremity
  15. When a person has a AVF or AVG (Arterial Venous Fistula/Graft) what do you want to listen for?
    bruit and thrill.....we want a bruit
  16. Pre Dialysis checks....
    • PA
    • Assess access site
    • Compare post and pre dialysis weights
    • Labs and MD Dialysis order
  17. How often do you check VS on a person who is getting dialysis?
    every 30-60 minutes.....watching for changes in a persons BP
  18. Post Dialysis checks
    • observe for fluid volume deficit
    • VS-watching temperature
    • assess for bleeding at AVF/AVG
  19. Home daily care for the patient with a Peritoneal catheter
    • wash site with soap and water
    • change dressing (daily)
    • check site for infection
    • showers are best
  20. Daily care for a patient with a peritoneal catheter when they are in the hospital
    • AESEPTIC dressing change with masks for patient and me
    • check site for infection
    • check VS
    • check WBC count
  21. General Care for the patient with a peritoneal catheter for dialysis
    • blood draw prior to treatment
    • PA of VS, temp, breath sounds
    • Weigh
    • Check I&O's
    • Any patient teaching?
  22. Labs I am looking at when a person has a peritoneal catheter for dialysis
    • BUN
    • Creatinine
    • Sodium
    • K
    • phosphate
    • **Look at before treatment
  23. Advantages of PD
    • Less complicated
    • Fewer dietary restrictions
    • Less cardiovascular stress
  24. Which type of dialysis is preferred for a patient with Diabetes?
    PD
  25. Which dialysis can you do at home?
    BOTH
  26. Disadvantages of PD
    • Bacterial or chemical peritonitis
    • Infections
    • Hyperglycemia is common
    • Surgically inserted
  27. Who's contraindicated to have a PD?
    a person who has had multiple abdominal surgeries, trauma or has an unrepaired hernia
  28. Advantages of Hemodialysis
    • Rapid fluid, urea and creatinine removal
    • Effective K removal
    • Less protein loss
    • Lowers serum triglycerides
  29. Disadvantages of Hemodialysis
    • Vascular access problems
    • Dietary and fluid restrictions
    • Heparinization may be necessary
    • Surgery is required to place devise
  30. What are two complications that can occur with hemodialysis?
    Hypotension and added blood loss causing anemia
  31. If you are looking to slow the progression of kidney failure what should you be on top of?
    • early detection of heart problems
    • dehydration
    • infections
    • nephrotoxins
    • urinary tract obstructions
    • glomerulonephritis
    • renal artery stenosis
  32. If you treat this.....you will slow the progression of kidney disease
    cardiovascular disease....HTN
  33. Name the risk factors for developing CKD
    • Diabetic
    • HTN
    • >60
    • Cardiovascular Disease
    • Family History
    • Exposure to Nephrotoxic Drugs
    • African American/Native American
  34. Name the 4 hormones that are counter-regulatory to insulin
    • Cortisol
    • Epinephrine
    • Glucagon
    • Growth Hormone
  35. Why doesn't management of diabetes in the older adult require as tight of glucose control as in a young diabetic?
    cuz it takes 10-20 years for long term effects to occur
  36. When do you take Prandin and Starlix to avoid hypoglycemia?
    30 minutes prior to eating
  37. If GFR is 60 what is Creatinine Clearance?
    60....they are equal
  38. What is  your next step if you find protein in a persons urine?
    Get a 24 hr. creatinine clearance test ordered
  39. KUB
    xray of the kidneys
  40. When I do any  diagnostic procedure with contrast what do I need to watch for?
    nephrotoxicity....hard on kidneys.  Check the patients BUN and Creatinine before and after
  41. Which diagnostic procedures use contrast media?
    • CT
    • Urogram/IVP
  42. What does a renal biopsy determine?
    reason for the renal dysfunction....tumor?
  43. What's a Renal Arteriogram?
    its an evaluation of renal blood flow by putting dye in to the renal arteries
  44. What is a cystoscopy used for?
    it removes stones or tumors.....goes up the urethra
  45. 3 main functions of the kidneys
    • erythropoetin
    • renin
    • prostaglandins
  46. Major functioning unit of the kidneys....
    Nephron
  47. What will kill a persons Nephron?
    artherosclerosis
  48. How often is HD done and how much is pulled out each time?
    • 3 x a week
    • 250-400mL/min
  49. How often is PD done?
    7x week...and it is more effective
  50. Which is better....AVF or AVG?

    When can each be accessed after placement surgery?
    AVF is better cuz it lasts longer and is from our own tissues

    Access AVF 4-6 weeks after placement....but better to wait 3 months

    Access AVG 2-4 weeks after placement.
  51. What gauge needle is used for AVF and AVG?
    14-16 gauge
  52. Bruits you......

    Thrill you....
    • hear
    • feel
  53. What meds will you hold prior to administering dialysis
    • BP
    • water soluable vitamins
    • diaretics
  54. Danger of PD
    Peritonitis
  55. Priority nursing care for a person with a stone
    • hydration
    • treat for pain
    • find out what kind of stone it is
  56. If you have an Incontinent Urinary Diversion procedure done you will....
    have a visible stoma and a bag

    Simplest form of diversion
  57. What is Continent Urinary Diversion?
    when the ureters are attached to the bowels

    will self cath every 4-6 hours....so now bag
  58. Describe Orthotopic Bladder Substitution
    a segment of the bowel is reshaped to become a neobladder with ureters and a urethra is surgicacally attached
  59. Positives and negatives for Orthotopic Bladder Substitution
    Pt. can naturally micturate

    But may need to self cath some times

    May have problems with incontinence....especially women cuz short urethra
  60. Pre Op Care for a person getting a urinary diversion done
    • address fears about body image
    • address concerns about sex
    • arrange a visit by ostomate or ET nurse when getting Incontinent Urinary Diversion
  61. What will kidney transplant rejection look like?
    • Person will have an increase in fluids and electrolytes (similar to levels prior to surgery)
    • HTN/Increased BP
  62. Describe Acute Kidney Transplant Rejection

    How do you treat it.
    • happens 1 week to 2 years after the transplant from T cell immune response and will see:
    • Anuria
    • low grade fever
    • tender kidney
    • lethargy
    • fluid retention
    • Rise in serum creatinine
    • Oliguria
    • Azotemia

    • Increase immunosuppressive drugsMethylprednisolone
    • OKT3 Monoclonal antibody
  63. Describe Chronic Kidney Transplant Rejection
    Can happen months to years post transplant and it involves both humoral and cellular immune response

    • Will see progressive azotemia
    • Proteinuria
    • HTN
  64. What are some other kidney transplant complications besides rejection?
    • Infection
    • Cardiovascular
    • Malignancies/Tumors
    • Reoccurrence of original Renal Disease
    • Corticosteroid related complications
  65. What cancer do you see oftenly in a person who has had a kidney transplant?
    Lymphoma
  66. What are corticosteroid complications?
    • bone/joint problems
    • osteoperosis
    • peptic ulcers
    • cataracts
  67. What is very important to tell a person who is on nephrotoxic meds?
    STAY HYDRATED
  68. When does a hyper-acute infection occur after a transplant?  What are the S/S?  How will you treat this?
    within 48 hrs of the surgery

    • fever
    • HTN
    • Pain at transplant site

    Remove kidney stat....back on dialysis and list
  69. Azotemia
    very high levels of nitrogen, urea and creatinine
  70. What is the most common problem after a kidney transplant?

    How do you prevent it?
    Infection

    • Promote hand hygiene
    • Monitor for signs of local and systemic infection (pneumonia/sepsis)
  71. Nephrolithiasis
    stones in the kidneys
  72. Urolithiasis
    stones in the urinary tract outside the kidneys
  73. Who's most likely to get kidney stones?
    White man
  74. What causes kidney stones?
    • increase in urine levels of calcium and acids
    • warm climates (dehydration)
    • diet
    • family history
    • sedentary life style
  75. What disorders increase your risk for kidney stones?
    • Gout
    • cystinuria
    • Renal acidosis
  76. What should you keep in mind with your diet if you get kidney stones?
    • drink 2-3 L/day
    • watch intake of proteins
    • watch intake of tea and fruit juices
    • watch intake of calcium
    • watch intake of oxalate
  77. What leads to lithiasis
    • supersaturation (high concentration of insoluble salt in urine
    • pH of urine
  78. How do stones get formed?
    when crystals are in a supersaturated concentration they unite to form a stone
  79. If your urine is alkalitic (high pH) what will happen?
    calcium and phosphate will be less soluble
  80. If your urine is acidic (low pH) what will happen?
    uric acid and cysteine will be less soluble
  81. How do Struvite stones get made?  Who gets them?
    bacteria invades and causes the urine to become aklalitic and they form

    Females....UTI's
  82. What's the problem with Staghorn stones?
    They are large and cant come out on their own....so cause renal hydronephrosis
  83. A person who has an autosomal recessive disorder which causes an increase excretion of cystine has
    Cystinuria
  84. Symptoms for a person with calculi affecting kidney calices/pelvis
    few symptoms unless obstructing urine flow

    dull, aching flank pain
  85. Symptoms for a person with calculi affecting the bladder
    • Gross hematuria
    • dull suprapubic pain with exercise or post voiding
  86. Symptoms for a person with calculi affecting the ureter
    • Ureter spasm...SEVERE flank pain
    • N/V
    • Pallor
    • Cool
    • Clammy Skin
  87. How do you treat a person with a calcium oxalate stone?
    • increase hydration
    • *give cellulose phosphate
  88. How do you treat a person with Struvite stone?
    • Admin antimicrobial (from UTI?)
    • Surgically remove
    • make urine acidic
  89. How do you treat a person with a Uric Acid stone?
    reduce purines in diet

    Sardines, mussels, venison....meats
  90. How do you treat a person with a Cystine stone?
    • increase hydration
    • give potassium citrate to maintain alkaline urine
  91. Pain meds for stones
    • Opioids
    • Toradol (NSAIDS)
  92. Spasmolytic med for stones
    Ditropan
  93. Antibiotics for stones
    • Garamycin
    • Keflex
  94. Name some oxalates
    • dark roughage
    • spinach
    • tomatoes
    • beets
    • nuts
    • chocolate
  95. What kind of urine do you promote for clients with uric acid or cystine stones?

    calcium or urinary tract infections?
    • Alkaline
    • Acid
  96. How large of a stone can we pass?
    2mm
  97. Extracorporeal Shock Wave Lithotripsy
    • ESWL
    • sound waves/laser used to break the stone in to fragments to be excreted in the urine
  98. After a person has had an ESWL procedure make sure.....
    • strain the urine
    • increase fluids
    • monitor VS
  99. Precutaneous Ultrasonic, Laser and Electrohydraulic Lithotripsy all will  be done by...
    poking a hole in the person.

    Give prophylaxis antibiotics
  100. What is common after Lithotripsy procedures?
    Hematuria
  101. Risk factors for Renal Cancer
    • Smoker
    • Men (2 xs often)
    • Obesity
    • HTN
  102. If you have acquired cystic disease of the kidney associated with ESRD....what else are  you at risk for?
    Renal Cancer
  103. Risk factors for Bladder Cancer
    • 60-70 y/o
    • Man
    • Cigarette Smoker
    • Women being treated for cervical cancer
  104. If you have chronic, recurrent renal calculi and chronic lower UTI's, you have an increased risk for.....
    Bladder Cancer
  105. Who's at risk for prostate cancer?
    • African American
    • Male
    • Over 65
    • Family History of
  106. What system stages Renal Cancer
    Robsons I-V
  107. When is a radical nephrectomy done and describe
    • Stage I and II
    • removal of kidney, adrenal gland, part of the ureter and draining lymph nodes
  108. When does a person with renal cancer have radiation?
    when it is inoperable for palliative care
  109. Where does renal cancer met to?
    • bones
    • lungs
  110. After a nephrectomy what should the patient know?
    protect your only kidney that's left....watch the sports you play and may need to change your occupation
  111. After a nephrectomy what will a person have in place?
    an NG tube to decompress
  112. Post care after Nephrectomy
    • Urine output
    • Respiratory
    • Pain
    • Abdominal Distention
    • Kidney fxn
  113. Transurethral Resection with Fulgurtation for Bladder cancer
    Best for superficial lesions and pt who are poor operative risk

    Tumor is removed by a blade
  114. Laser Photocoagulation for bladder cancer
    destroys the mass....but cant stage it then

    Can be done multiple times if it comes back
  115. Open Loop Resection for Bladder Cancer with Fulguration
    used for large superficial tumors
  116. Post op management for Bladder Cancer
    • Drink lots of water for 1st week
    • NO ETOH
    • urine should be pink
    • Analgesic admin
  117. What will happen 7-10 days after a bladder tumor resection or ablation?
    the patient will see dark red or rust colored flecks in the urine (SCABS)
  118. Follow up with Dr. after bladder cancer surgery
    Q3-6 months for 3 years
  119. Staging used for prostate cancer...and it is based on what?
    Gleason

    size and if it has spread
  120. Radical prostatectomy
    removal of entire prostate gland, seminal cesivles and part of the bladder neck
  121. Primary therapeutic approach for prostate cancer
    deprivation of androgens cuz it is an androgen dependent cancer

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