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