Exam 3 Renal
Normal Creatinine
0.6-1.2
Hypospadias and Epispadias
congenital defect where the urinary meatus is below/above its normal location
Calcium, phosphate, and bone changes CKD
Reduced renal phosphate excretion, decreased renal synthesis of 1,25-(OH)2 vitamin D3, and hypocalcemia Fractures
normal BUN
10-20
How often is hemodialysis done?
3 times a week
uteropelvic junction obstruction
Dilated renal pelvis without ureteral dilation is observed in patients with
anemia meds
Iron Epogen (erythropoietin)
CKD also causes:
Osteoporosis less calcium
renal agenesis
absence of one or both kidneys
what do we keep CKD patients at hemoglobin
10, don't want to make blood too thick
The nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? 1."There will be a decrease in the inactive forms of vitamin D in your body." 2."There will be a decrease in the active metabolite of vitamin D in your body." 3."There will be an increase in the conversion of skin cholesterol into vitamin D." 4."There will be an increase in the vitamin D associated intestinal absorption of calcium."
2."There will be a decrease in the active metabolite of vitamin D in your body."
what bacteria is HUS associated with
Escherichia coli damages red blood cells and endothelial cells
phosphate binders
Examples: Phos-Lo, Aluminum hydroxide Take with meals, not if NPO Watch for signs of aluminum toxicity
what age group and gender are utis common in children
7-11 year old girls
Acute Post-Streptococcal Glomerulonephritis
Occurs after a throat or skin infection with certain strains of group A alpha-hemolytic streptococci Experience a sudden onset of hematuria, edema, hypertension, and renal insufficiency Antigen-antibody complexes and complement are deposited in the glomerulus The immune complexes initiate inflammation and glomerular injury
A nurse writes a goal of preventing renal calculi in a care plan for a client with paraplegia. Which information most likely caused the nurse to write this goal?
Accelerated bone demineralization
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem?
Acute kidney injury
what causes VUR
Caused by a congenital abnormality or ectopic insertion of the ureter into the bladder
Hemolytic Uremic Syndrome (HUS)
Characterized by hemolytic anemia, thrombocytopenia, acute renal failure HUS is the most common cause of acute renal failure in children
Immunoglobulin A (IgA) Nephropathy
Berger's disease - just like in adults! Glomerulonephritis from autoimmune issue Antibody complexes get stuck, just no strep here
what is the most common cause of renal failure in children
HUS
Nephroblastoma (Wilms tumor)
Wilms tumor is an embryonal tumor of the kidney Wilms tumor arises from the proliferation of abnormal renal stem cells Inherited and sporadic forms Usually found by parent due to abdominal swelling
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder?
Diabetes mellitus
VUR diagnostics
Diagnosed by a voiding cystourethrogram (VCUG) and an intravenous pyelogram (IVP)
The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? Select all that applies.
Elevated creatinine level Decreased hemoglobin level Decreased red blood cell count
extrophy of the bladder
Herniation of the bladder through the abdominal wall
A client is admitted to the hospital with severe renal colic caused by a ureteral calculus. Later that evening the client's urinary output is much less than the intake. When it is confirmed that the bladder is not distended, what should the nurse suspect developed?
Hydroureter
A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client?
Hypertension, fluid overload
Chordee
a downward curvature of the penis, often associated with hypospadias
A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication?
It combines with phosphorus and helps eliminate phosphates from the body
A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment?
Lack of weight-bearing activity promotes bone demineralization.
Anemia CKD
Lethargy, dizziness, and low hematocrit are common
how does CKD cause anemia
Loss of nephrons results in decreased synthesis of erythropoietin (EPO) EPO stimulates red bone marrow to increase production of RBCs under hypoxic conditions
normal hemoglobin levels
Male: 13-18 g/100mL Female: 12-16 g/100mL
Nephrotic syndrome
Massive protein loss in urine Caused by damage to the small blood vessels in the kidneys Rare in kids but can become a chronic illness Idiopathic
Acid-Base balance CKD
Metabolic acidosis when GFR 30%-40%
A client presents to the emergency department with shortness of breath, bloody sputum, weight gain, generalized edema, and a blood pressure of 150/110. The nurse reviews the client's laboratory results and determines that the client has impaired renal function. Which diagnosis will the nurse most likely observe written in the client's electronic medical record?
Nephrotic syndrome
vesicoureteral reflux (VUR)
Retrograde flow of urine from the bladder into the ureters Reflux encourages infected urine from the bladder to be swept up into the kidneys Leads to frequent pyelonephritis
Sodium and water balance with CKD
Sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss Concentration and dilution ability diminishes
HUS manifestations
Sudden onset of pallor, bruising or purpura, irritability, and oliguria Slight fever, anorexia, vomiting, diarrhea (with the stool characteristically watery and blood stained), abdominal pain, mild jaundice, and circulatory overload Seizures and lethargy indicate CNS involvement renal failure comes quickly
how does e. coli affect endothelium
The endothelial lining of the glomerulus becomes swollen and occluded with fibrin clots The damaged red cells are removed from the circulation by the spleen, causing acute hemolytic anemia The microcirculation develops numerous thrombi
potassium balance CKD
Tubular secretion increases early Once oliguria sets in, potassium retained
Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?
Urination is not painful
what is uremia
buildup of waste products in the blood
what supplements should you take for CKD
calcium and vitamin D supplements
UTI in kids
caused by E. coli, the most common pathogen, ascends the urethra in cystitis or the ureter in pyelonephritis Cystitis Acute and chronic pyelonephritis
primary enuresis
child has never been continent
polycystic kidney disease
condition in which the kidney contains many cysts and is enlarged
who has extreme levels of hyperkalemia
dialysis patients
endocrine and reproduction CKD
infertility
glomerulonephritis
inflammation of the glomeruli of the kidney
Daytime enuresis
loss of urine during the day hours
nighttime enuresis
loss of urine during the night hours
embryonal cancers
manifest before age 5 or 6
What type of acidosis does someone with CKD have
metabolic acidosis
neurologic alterations CKD
neuropathy tingling in hands and feet
secondary enuresis
onset of wetting after established urinary continence
pulmonary effects of CKD
pulmonary edema crackles
flank pain indicates
pyelonephritis
plasmapheresis
removal of plasma from withdrawn blood by centrifuge
hypoplastic or dysplastic kidneys
small kidney with decreased number of nephrons
hyrdoureter
the distention of the ureter with urine that cannot flow because the ureter is blocked
horseshoe kidney
the two kidneys are joined together across the midline of the body at the lower ends need to be separated
why do they keep CKD patients a little anemic
to make sure the blood isnt too thick
cardiovascular effects CKD
too much fluid in the body, raises BP
Integumentary CKD
uremia itchy and dry skin