1750: Kidney Disease

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  1. What do kidneys control?
    • Waste
    • Water
    • Regulates electrolytes
    • pH (acid/base balance)
  2. What is the most accurate indicator of fluid loss or gain in an acutely ill Pt?

    What should you consider?

    1 kg = 1 L = 2.2 lbs.

    Consider use of same scale, same clothes, same time (mornings).
  3. What are some causes of Acute Kidney Failure or Acute Kidney Injury?
    • Hypovolemia
    • HypoTN
    • Reduced cardiac output & HF.

    • Obstruction of:
    • kidney or lower UT
    • renal arteries or veins
  4. When can acute cause injury?
    • Obstruction of one of the three:
    • renal artery
    • renal vein
    • ureter
  5. Acute injury is all about FLOW problems.


    What are the usual causes of each?
    Pre: not enough bloow flow to kidney (low volume, bad pump, vasodilation)

    Intra: clog in kidney (trauma, nephrotoxic agents,infection)

    Post: clog in UT (stone, tumor, BPH, clots).
  6. What is the most common cause of ARF?

    What are the priority interventions?

    • Interventions:
    • Maintain fluid volume
    • Cardiac output
    • Renal output
  7. Which nursing actions are instituted for the client with kidney trauma?
    Observe for HTN and check for hematuria.
  8. ARF/AKI

    What is is ARF?

    What is it characterized by (indicated by regarding electrolytes)?


    Does Osmol. increase/decrease?
    Rapid decline in renal function.

    Charaterized by 50% or greater increase in serum Creatinin.


    Osmolality will decrease
  9. RIFLE classification for AKI.

    Explain the acronym.
    R (risk): Increased serum Cr. 1.5x baseline OR GFR decreased 25%

    I (injury) Increase serum Cr 2x baseline OR GFR decreased >50%

    F (failure) Increase serum Cr 3x baseline OR GFR decreased 75%; PROBLEM

    L (loss) AKI > 4 weeks

    E (ESKD) End Stage Kidney Disease > 3 mos.
  10. What are some causes of Chronic Kidney Failure?

    (think of Charles)
    • Diabetes Mell (35% of adult cases)
    • HTN
    • Chronic glomerulonephritis
    • Pyelonephritis 
    • Obstruction of UT
    • Hereditary lesions
    • Vascular disorders
    • Medications or toxic agents
  11. Acute Nephritic Syndrome.

    What are some manifestations?

    How do you manage it?
    Man: hematuria, edema, azotemia (excess of urea or nitrogen products in blood), proteinuria, & HTN.

    • Med mgmt: 
    • supportive care
    • dietary mods
    • treat cause if appropriate-antibiotics
    • corticosteroids
    • immunosuppressants
  12. Acute Nephritic Syndrome.

    What is the nursing management?
    • Assessment
    • Maintain fluid balance (restrict)
    • Fluid & dietary restrictions 
    • Pt education
    • Follow-up care
  13. Chronic Glomerulonephritis.

    • Repeated acute glomerular nephritis
    • HTN nephrosclerosis
    • Hyperlipidemia
  14. Chronic Glomerulonephritis.

    What are some abnormal lab test results?
    • Urine w/ fixed specific gravity
    • Casts
    • Proteinuria
    • Electrolyte imbalance
    • Hypoalbumineamia
  15. Chronic Glomerulonephritis.

    What is the nursing process?
    • Assessment
    • Potential fluid & electrolyte imbalance
    • Cardiac status
    • Neurologic status
    • Emotional support
    • Education in self-care
  16. Nephrotic Syndrome.

    What is it?

    Results in?

    What is the med management?
    Any condition that damages the membrane.

    • Results in:
    • Hypoalbuminemia & edema

    • Med management:
    • drug & dietary therapy
  17. Kidney Failure.

    What happens during kidney failure?

    Is AKF or KF Reversible? If not, what happens to BUN?
    Kidneys cannot remove wastes or perform functions.

    Yes, but Chronic is not and results in azotemia.
  18. Kidney Failure.

    Nursing Process: Assessment
    • Fluid status
    • Nutritional status
    • Pt knowledge
    • Activity tolerance
    • Self-esteem
    • Potential complications
  19. Kidney Failure.

    What are some collaborative problems & complications of kidney failure?
    • Hyperkalemia
    • Pericarditis
    • Pericardial effusion and tamponade
    • HTN
    • Anemia - d/t kidney's inability to make erythropoeitin. 
    • Bone disease & metastatic calcifications
  20. Kidney Failure.

    Nursing Process: Planning/goals
    • Maintain ideal body wt (IBW)
    • Adequate nutritional intake
    • Increased knowledge
    • Improve self-esteem
    • Absence of complications
  21. FVE: fluid volume excess
    • Assess for s/sx of fluid volume excess
    • I&O & daily wts
    • Limit fluid 
    • Identify sources of fluid
    • Explain to Pt/family about fluid restrictions
    • Encourage oral hygiene
  22. What are some treatments for Chronic Kidney Disease and Acute Kidney Injury?
    • Remove/fix cause of kidney damage
    • Nutrition management
    • Medication to: treat cause and/or effect of damage.
    • Dialysis
    • Kidney transplant
  23. How is a fistula made?
    Suture of an artery and vein to enlarge the vasculature and puncture for dialysis.
  24. Care of the hospitalized Pt on dialysis:

    What must you check on the puncture site?

    What must you not use the access site for?
    • Protect vascular access
    • Check for patency.
    • Signs of potential infections.

    *Do not use for BP or blood draws.

    Monitor fluid balance, IV therapy, accurate I&O, IV admin. pump, cardiac/resp. status.

    S/sx of uremia, electrolyte imbalance.
  25. What class of drugs must be held prior to dialysis?
    Cardiovascular medications.
  26. Care of the hospitalized Pt on dialysis:


    Dietary considerations?
    Skin care?
    Monitor all meds & doses 

    Address pain & discomfort

    Infection & control measures

    Dietary considerations: Na+, K+, protein, fluid, nutritional needs

    Skin care: pruritus, keep skin clean & well moisturized, trim nails, avoid scratching.

    CAPD catheter care
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1750: Kidney Disease
2015-04-12 23:36:53
Kidney Disease EXAM II

Kidney Disease
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