Renal 2

hematuria, school, streptococcal, immune complex, discoloration, diuretics, rare

Glomerulonephritis Proteinuria, blank, htn, blank-ages; males Primary, blank infection Blank occludes glomeruli Edema, urine blank, lethargy Antihypertensive, blank Good, recurrence blank

sterile, arteries, ureter, 3-4, flank, pain

Donor Nephrectomy NHBD or Cadaveric: Blank autopsy in OR. Preserve blank, venous vessels, & blank. After removal, kidneys are preserved until time for implantation. Living Donor: Surgery (_____blank to blank hours_______). _Blank incision______. More post op blank than recipients. -laparoscopic -Psychological adjustment and post-op nursing care

healthier, cold ischemia, ischemia-reperfusion

Organs from living donors have the highest rate of graft survival due to blank donors, shorter blank times, and less blank injury. Nursing actions before surgery include teaching about the procedure and care after surgery, in-depth patient assessment, coordination of diagnostic tests, and development of treatment plans.

hyperacute, 48 hr, temp, BP, pain, removal

Blank Rejection Onset: within blank after sx. Inc blank. Inc blank. Blank at transplant site. Rx: Immediate blank of the transplanted kindey.

1.5-1.9, 0.3, 48, 0.5, 6, 2-2.9, 12, 1, 4, 35, anuria, 0.3

AKI Stage 1: Cr: blank to blank x baseline or more than blank mg/dL inc over blank hrs UO: less than blank mL/kg/hr for blank-12 hours Stage 2: Cr: blank to blank x baseline UO: less than 0.5 mL/kg/hr for more than blank hours Stage 3: Cr: blank x baseline or more than blank mg/dL or initiation of RRT or pt less than 18 dec GFR to less than blank mL/min UO: less than 0.5 mL/kg/hr for more than 12 hours or blank for more than 12 hours or less than blank mL/kg/hr for more than 24 hours

hemofiltration, critically ill, double, pump, air embolus, lower, hemodiafiltration, pump, longer, venous, stable BP

AKI Continuous Venovenous Blank (CVVH): (ultrafiltration) Blank patients. Blank-lumen venous catheter is used & powered by a blank (inc risk for blank → alarms that detect air). Need anticoagulation (blank doses). Continuous Venovenous Blank (CVVHD): Uses blank, HD membrane & dialysate solution & same venous access as CVVH. Removes waste products. Performed for blank periods (dec pressure in blank system) → More blank.

slow cont, 12-24, azotemia, uremia, sustained low-efficiency, 12-24, blood flow, hypotension

AKI Blank ultrafiltration (SCUF) (cont and intermittent approaches): Slow removal of fluid over blank to blank hrs. Useful when blank or blank is not a concern. Blank dialysis (SLED): Prolonged dialysis over blank to blank hours. Lower blank & dialysate flow rates. Removes particles and water. Better tolerated by unstable or critically ill patient/fewer episodes of blank.

rejection, acute, scan, biopsy, corticosteroids, lymphocyte, monoclonal, A, cancer, death, noncompliance

Complications Blank: Leading cause of graft loss. Hyperacute, blank (most often), & chronic rejection. Diagnosis: ___Renal blank, s/s, renal blank____. Rx: Immunosuppressive therapy. Blank. Anti-blank preparations. Blank antibodies. Cyclosporin blank. Blank of lymphatic system = complication of immunosuppressants. Risk: viral, fungal, bacterial, protozoal infections → ___blank___. Blank → ___loss of graft kidney_____________________________.

radiology, tunneling, moderate, IJ, 6-8, SQ, aseptic, third

A long-term dialysis catheter may be placed in the blank department using a blank technique under blank sedation. Under ultrasound or fluoroscopic guidance, the physician makes a small incision where the blank vein passes behind the clavicle. A blank to blank -cm tunnel is created away from the site of the incision. A long-term hemodialysis (HD) catheter is inserted through the tunnel and into the jugular vein. Keeping a segment of the catheter within the blank tissues before entering the jugular vein reduces the risk for infection. This central catheter is used only for dialysis and requires blank dressing changes. Dialysis catheters have two lumens—one for outflow and one for inflow. This allows the patient's blood to flow out and, once dialyzed, to be returned through the inflow lumen. Some catheters have a blank lumen to sample venous blood or give drugs and fluid during dialysis.

suplena, Novasource, dec, dec, dec, inc, hour, 500-1000, CVP, fluid overload, tachycardia, poor perfusion

AKI Interventions Kidney-specific supplements (enteral): Nephro, blank Renalcal, blank Renal. Blank Na, blank K, blank P. blank calories. -UO every blank after sx until stable, during fluid resuscitation, high risk for AKI. Fluid challenges: blank to blank mL/hr. Monitor blank. -Dependent and generalized edema. Dec pulse ox, confusion, inc RR and dyspnea = blank. Blank, thready peripheral pulses, dec cognition = risk for AKI r/t blank, SpO2 below 88%.

cytotoxic T, thrombosis, necrosis, acute, inc immunosuppressive, reversed, CT, biopsy

A reaction occurs between the tissues of the transplanted kidney and the antibodies and Blank-cells in the recipient's blood. These substances treat the new kidney as a foreign invader and cause tissue destruction, blank, and eventual kidney blank. Blank rejection is the most common type with kidney transplants. It is treated with blank therapy and often can be blank. Rejection is diagnosed by symptoms, a blank or renal scan, and kidney biopsy. Blank can be used to determine if oliguria is the result of AKI or rejection.

infection, immunity, 10, overload, BP, smoky, rusty, face, uremia, hematuria, proteinuria, multisystem

Ac. Glomerulonephritis Cause: Blank (passage if protein and blood in urine). Cues: Excessive blank response within kidney tissues. Onset: blank days from infection. Source of infection. Skin, upper resp tract, recent travel, illness, invasive procedure, sx, systemic disease. Fluid blank/pulm edema s/s: Fluid and Na retention Inc (mild to moderate) blank. (Diff breathing, SOB, crackles, S3, neck vein distention) Urine appearance: blank, reddish-brown, blank, cola colored -Edema (blank, eyelids, hands) -Dysuria/oliguria -Blank (n/v/a, fatigue) Lab Cues: UA (____blank and blank________). 24-hr urine tests. Cultures. BUN. Creatinine. Titers. -Primary: infectious -Secondary: blank disease -Recover completely and quickly possible

biopsy, corticosteroids, cytotoxic, UO, 500, potassium, daily, dialysis, antibodies

Ac. Glomerulonephritis (Cont.) Rx: Blank= precise diagnosis Antibiotics. Blank (moon face). Blank drugs. Diuretics. Fluid & electrolyte imbalance: sodium & fluid restrictions. HTN and edema. Fluid intake = blank + blank-600 mL. Blank and protein restrictions. Blank wt. and BP. Notify: inc wt or BP. Blank: Uremia s/s. (n/v/a, fatigue) Plasmapheresis: Remove blank. Complications.

intercellular, tubular, slough, repair, sediment, intrarenal, necrosis, ischemia, nephrotoxin

Activated immunity and damage from kidney toxins (nephrotoxins) cause blank changes of the blank system in kidney tissue. Inflammatory proteins and immune-mediated complexes can damage cells and tissues in the kidney. With extensive damage, tubular cells blank and nephrons lose the ability to blank themselves. The presence of tubular debris and blank in urine from kidney tissue damage (blank failure or acute tubular blank) is related to systemic blank, reduced kidney perfusion, or blank exposure.

early morning, concentrated, acidic, formed elements, RBC, casts, 24, protein, 500, 3, dec, dilution, inc, elimination, Cr, 24, Crcl, 50

Acute Glomerulonephritis (GN) An blank specimen of urine is preferred for urinalysis because the urine is blank, most blank, and filled with more intact blank at that time. Microscopic examination often shows blank casts, as well as blank from other substances. A blank-hour urine collection for total protein assay is obtained. The blank excretion rate for patients with acute GN may be increased from blank mg/24 hr to blank g/24 hr. Serum albumin levels are blank because this protein is lost in the urine and fluid retention causes blank. Serum creatinine and BUN provide information about kidney function and may be blank, indicating impairment of blank. The glomerular filtration rate (GFR), either estimated from a single serum and urine blank value or measured by the blank-hour urine test for blank, may be decreased to blank mL/min.

rapidly progressive, primary, crescentic, weeks, months, excess, htn, oliguria, ESKD

Acute Glomerulonephritis (GN) Blank glomerulonephritis is a blank GN also called blank glomerulonephritis because of the presence of crescent-shaped cells in the Bowman capsule. RPGN develops acutely over several blank or blank. Patients become quite ill quickly and have symptoms of kidney impairment (fluid volume blank, blank, blank, electrolyte imbalances, and uremic symptoms). Regardless of treatment, RPGN often progresses to blank.

erythromycin, azithro, streptococcal, hygiene, immunity, inflammation, corticosteroids, cytotoxic, new infections

Acute Glomerulonephritis (GN) Penicillin, blank, or blankmycin is prescribed for GN caused by blank infection. Check the patient's known allergies before giving any drug. Stress personal blank and basic infection control principles (e.g., handwashing) to prevent spread of the organism. Teach patients the importance of completing the entire course of the prescribed antibiotic. Modifying blank with drugs can also benefit patients with acute glomerulonephritis (GN) that is not due to acute infection but is related to excessive blank. Blank and blank drugs (e.g., cyclosporine, cyclophosphamide) to suppress immunity responses may be used. Patients receiving immunosuppressants need to take precautions to avoid exposure to blank.

kidney, systemic disorder, injure, inflame, filters, protein, blood, BP, progressive, edema, anemia, cholesterol, urinary elimination

Acute Glomerulonephritis (GN) is categorized into conditions that primarily involve the blank (primary glomerular nephritis) and those in which kidney involvement is only part of a blank (secondary GN). It is a group of diseases that blank and blank the glomerulus, the part of the kidney that blank blood. Inflamed glomeruli allow passage of blank and blank in the urine. GN is associated with high blank, blank kidney damage (leading to CKD), and blank. Blank from reduced production of erythropoietin and high blank often co-occur. GN can cause altered blank.

metabolic waste, hours, days, 0.3, 48, 1.5, 7, 0.5, 6, kidney perfusion, liver, stenosis, tissue damage, urine outflow

Acute Kidney Injury (AKI) (before ARF) Rapid dec in kidney function → inc blank in body → FE/AB imbalance. Over few blank/blank. AKI: Inc serum creatinine by blank mg/dL or > within __blank_ hrs. or inc serum creatinine to blank times or > from baseline (presumed to have occurred __blank days________ previously). UO < blank mL/kg/hr. for _blank__ hours. Etiology: Dec blank (BP meds, MI/heart disease, infection, blank failure, NSAIDs, renal artery blank), kidney blank (blood clots, glomerulonephritis, hemolytic uremia, Lupus, scleroderma, thrombotic thrombocytopenic purpura) obstruction to blank (cancer, stones, nerve damage, clots).

protein elimination, 3.5, albumin, 3, lipid, fats, thrombosis

Nephrotic Syndrome The main feature of NS is increased blank with severe proteinuria (with more than blank g of protein in a 24-hour urine sample). Patients also have low serum blank levels of less than blank g/dL (30 g/L), high serum blank levels, blank in the urine, edema, and hypertension. Renal vein blank often occurs at the same time as NS, either as a cause of the problem or as an effect. NS may progress to end-stage kidney disease (ESKD), but treatment can prevent progression.

acute, weeks, oliguria, 100, enlarge, lethargy, K, retention, inc

Blank Rejection Onset: 1 week to any time after sx; occurs over days to blank Blank, anuria. Temp over blank. Inc BP. Blank, tender kidney. Blank. Inc Cr, BUN, blank. Fluid blank. Rx: Blank doses of immunosuppressive drugs.

chronic, years, gradual, fatigue, conservative, dialysis

Blank Rejection: Onset: Occurs gradually during a period of months to blank. Blank inc in BUN and Cr. Fluid retention. Change in serum electrolyte levels. Blank. Rx: Blank management until blank required.

kideny biopsy, immunologic, intrarenal hemorrhage

Blank is performed if the cause of AKI is uncertain and symptoms persist or an blank disease is suspected. Prepare the patient before the test, particularly managing both hypotension and hypertension. Hypertension increases the risk for blank following needle biopsy. Provide follow-up care. Be aware of all test results and understand how they might affect the treatment regimen.

US, size, patency, small, contrast medium, kidney perfusion, MRI

Blank is useful in the diagnosis of kidney and urinary tract obstruction. Dilation of the renal calyces and collecting ducts, as well as stones, can be detected. Ultrasonography can show kidney blank and blank of the ureters. Blank kidney size may indicate an underlying CKD with loss of kidney tissue. CT scans without blank can determine adequacy of blank and identify obstruction or tumors. Contrast medium is usually avoided to prevent further kidney damage. An blank may be used in place of a CT scan.

X-rays, hydronephrosis, US, nuclear, nature, GFR, renal scan, obstructions

Blank of the pelvis or kidneys, ureters, and bladder (KUB) may provide an initial view of kidneys and the urinary tract to determine the cause of AKI. Enlarged kidneys with obstruction may show blank. X-rays can show stones obstructing the renal pelvis, ureters, or bladder. More commonly, blank is used to screen for hydronephrosis. A blank medicine study called MAG3 may be used to determine the blank of the kidney failure and measure blank. A blank can determine whether perfusion of the kidneys is sufficient. Cystoscopy or retrograde pyelography may be needed to identify blank of the lower urinary tract.

Acute tubular necrosis, dialysis, 2-3, dec in UO, ultrasound, emergency sx

Blank: Ischemic damage when transplantation is delayed after kidneys are harvested leads to AKI. Rx: Blank until adequate UO, normal BUN & creatinine. Renal Thrombosis: Occurs during first blank to blank days after transplant. S/S: Sudden blank (impaired perfusion). Diagnosis: Blank (showing dec/ absent blood flow). Rx: Blank to prevent ischemic damage or graft loss.

immunity, inflammation, glomerular filtration, Fabry, liver, lipid

Nephrotic Syndrome The most common cause of glomerular membrane changes is altered blank with blank for nephrotic syndrome. Defects in blank can also occur as a result of genetic defects of the glomerular filtering system, such as blank disease. Altered blank function may occur with NS, resulting in increased blank production.

hypoalbuminemia, hypovolemia, 2-7, idiopathic, permeability, gain, edema, corticosteroids, relapses

Nephrotic syndrome Proteinuria, blank, edema, blank; ages blank to blank; males Blank, glomerular damage, congenital Membrane damage causes blank to protein/albumin Wt blank, fatigue, blank, dec uo Blank 80% favorable, blank

pump, ultrafiltrate tubing, negative pressure, fluid removal, inflow, air embolus, air

CKRT is powered by a blank that drives blood from the patient catheter into the dialyzer (filter). The ultrafiltrate fluid is then collected into a bag for disposal. There may be a second pump that acts on the blank to create blank and increase blank. Replacement fluid is infused via the blank circuit in some systems. The pump increases the risk for an blank, and KRT systems have alarms that detect blank.

unstable, 24, hemofiltration, diffusion, suspension, convective, differential diffusion

CKRTs They are used in hospitalized adults who are too blank to tolerate the changes in blood pressure that occur with intermittent conventional hemodialysis. As with hemodialysis, blood is passed through a filter to remove waste and undesired particles. Although intermittent hemodialysis occurs for 4 hours 3 days a week, CKRTs are typically prescribed for over blank hours. Some CKRT therapies use a different approach to remove particles from the blood. Blank uses ultrafiltration, whereas blank is used in intermittent dialysis to remove toxins and other particles. Ultrafiltration is the separation of particles from a blank by passage through a filter with very fine pores. In ultrafiltration, the separation is performed by blank transport. During intermittent hemodialysis, separation depends on blank. Some approaches to CKRT combine ultrafiltration with diffusion (combined hemofiltration and hemodialysis)

advanced, reasonable, fit, 20, cancer, infection, psychiatric, substance abuse, nonadherence

Candidates for transplantation have blank kidney disease, have a blank life expectancy, and are medically and surgically blank to undergo the procedure. In the United States, patients can be added to the waiting list once the GFR is less than blank mL/min/1.73 m2. Absolute contraindications to transplant include active blank, current blank, active blank illness, active blank, and blank with dialysis or medical regimen.

strep, 20-30, mild, fatigue, occasional, nocturia, dyspnea, slurred speech, ataxia, dry, UO, cognition, small, inc, inc, acidosis, ESKD

Chr. Glomerulonephritis: Cause: Many. -Antigen-antibody complex from recent blank infection Over blank to blank yrs. Cues: blank proteinuria, hematuria, htn, blank, blank edema Voiding pattern (blank = common), systemic fluid overload (blank), uremic s/s (blank, asterixis, blank), skin changes (yellow, blank, bruised, rash), dec blank, blank changes d/t waste product buildup. Abnormally blank kidneys. Lab Cues: UA. 24-hr urine tests. BUN. Serum creatinine. Electrolytes (inc/dec Na, blank K, blank Phos, dec Ca). Metab. blank. Kidney Biopsy. Mngt: Same as for blank

atrophies, nephrons, cell, collagen, fibrosis, immune complexes, sclerosis, proteins, ESKD

Chronic GN Kidney tissue blank, and functional blank are greatly reduced. Biopsy in the late stages of atrophy may show glomerular changes, blank loss, protein and blank deposits, and blank of the kidney tissue. Microscopic examination shows deposits of blank and inflammation. The loss of nephrons reduces glomerular filtration. Hypertension and renal arteriole blank are often present. The glomerular damage allows blank to enter the urine. Chronic GN always leads to blank.

dec, 2, fixed, dilution, low, 6, 30, 100-200, oliguria, 5.4, hyperphosphatemia, Ca

Chronic GN Urine output blank and urinalysis shows protein, usually less than blank g in a 24-hour collection. The specific gravity is blank at a constant level of blank (around 1.010) despite variable fluid intake. Red blood cells and casts may be in the urine. The glomerular filtration rate (GFR) is blank The serum creatinine level is elevated; usually it is greater than blank mg/dL (500 mcmol/L) but may be as high as blank mg/dL (2500 mcmol/L) or more because of poor waste elimination. The BUN is increased, often as high as blank to blank mg/dL (35 to 70 mmol/L). Decreased kidney function disturbs fluid and electrolyte balance. Sodium retention is common, but dilution of the plasma from excess fluid can result in a falsely normal serum sodium level (135 to 145 mEq/L [mmol/L]) or a low sodium level (less than 135 mEq/L [mmol/L]). When blank develops, potassium is not excreted, and hyperkalemia occurs when levels exceed blank mEq/L (mmol/L). Blank develops with serum levels greater than 4.7 mg/dL (1.73 mmol/L). Serum blank levels are usually low normal or are slightly below normal.

immediate, IJ, PTX, SQ emphysema, blood draws, CVP, ICU, intracorporeal

Continuous Renal Replacement Therapy for AKI AKI: Blank vascular access → insert HD catheters into subclavian or blank veins. Informed consent. Time out. Temporary use. Monitor: Blank. Blank post insertion. CXR: Confirm placement. Don't use for: blank (only for dialysis nurse), med. & fluid administration, or blank monitoring. -Uses pump, only in blank (blank circulation)

high, 2000, twice, 3 months, radiologist, HCP, 1, 12, 3, 1, 150, 6

Contrast media can have serious toxic effects on tubular cells. Ensure that kidney function is assessed before an imaging test that includes contrast media. A large volume of contrast, agents with blank osmolarity (>blank mOsm/L [mmol/L]), and frequent administration (given blank in blank or more often) of agents are more likely to cause contrast-induced nephropathy. Ensure that kidney function is assessed before an imaging test and that both the blank and the requesting primary blank are aware of reduced kidney function before contrast medium is given. Communicate with the radiologist so that the lowest dose of the contrast agent is used in high-risk adults. Adequate hydration is essential to prevent contrast-induced nephropathy. The patient may receive IV fluids at a rate of blank mL/kg/hr for blank hours before the imaging test or at blank mL/kg/hr for blank hour just before the procedure to ensure hydration and dilution of the contrast medium and to speed urinary elimination of the agent. A common desired outcome for patients undergoing a procedure with contrast medium is a urine output of blank mL/hr for the first blank hours after administration of the contrast agent.

inc, either, inc, dec, dec, inc, dec, aging, PVD, liver, anemia, ureters, contrast, nuclear, angiogram, retrograde, 1, 12, 3, 150, 6, nsaid, antibiotic

Cues for AKI Serum Creatinine: ___ . Na: ___ , K: ___ , Ca: ___ , Mg: ___ . H/H: ___ . Serum osmolality (g/L): ___ ABGs: (metabolic acidosis) Abdomen/Pelvic X-Ray: Cause of AKI. (blank, sepsis, blank, chronic blank, AIDs, previous kidney sx. Renal Ultrasound: No blank. Size, blank patency. CT Scans: NO blank Blank medicine. Renal blank. Cystoscopy. Blank pyelography. Pre-Imaging: IV fluids at blank mL/kg/hr x blank hrs or blank mL/kg/hr x 1 hr. Eval/outcome: UO blank mL/hr x blank hrs post-imaging. Ask about blank/ blank use.

kidney function, AKI, 500-1000, 1, systolic pressure, pulse pressure, SV, passive leg raise, 45, 30-90, improves, more fluid volume

Diuretics may be used to increase urine output in AKI. Diuretic-induced urine output does not preserve blank or stop blank, but diuretics do rid the body of retained fluid and electrolytes in the patient with AKI that has not progressed to endstage kidney disease (ESKD). Fluid challenges are often used to promote kidney perfusion. In patients without fluid overload, blank to blank mL of normal saline may be infused over blank hour. It is important to assess the patient's response to fluid to prevent fluid overload. Fluid overload in critical illness has been shown to increase mortality. The term fluid responsive is used when identifying patients who have a positive response to fluid. There are many methods to evaluate fluid responsiveness, such as blank variation, blank variation, and blank variation, which are obtained from the arterial or pulse oximetry waveforms. In patients with a method of monitoring stroke volume and cardiac output, a blank can determine if the patient is fluid responsive without the risk of giving fluids. The patient's leg is raised to blank degrees for blank to blank seconds in order to temporarily move fluid by increasing venous return, and if the stroke volume or cardiac output blank, the patient will respond positively to blank.

psych, 65, systemic, htn, infection, graft survival, cardiopulmonary, cool preservation, abdominal aorta, cadaveric, mech vent, perfusion

Living Donors: Related or unrelated to patient. Understand procedure & willing to donate kidney. Blank Evaluation. At least __18__ years & not over _blank_ years (possible comorbidities that may put them at risk). Physical Criteria: ___Absence__ of blank disease (no cancer, blank, kidney disease) & blank. Adequate renal function. Highest rate of blank. Non-Heart-Beating Donors (NHBDs): Declared dead by __blank__ criteria. Preserved by infusing a blank solution into the blank after death declared. Kidneys are harvested immediately after death. Blank Donors: Irreversible brain injury (trauma): on _____blank___________. Must have sufficient ____renal blank____________ - kidneys remain viable.

80-85, a fib, pre-existing

Maintaining a mean arterial pressure (MAP) of blank to blank mm Hg has been shown to lower rates of AKI in patients with pre-existing hypertension. However, there is an increased risk of blank in patients with a mean arterial pressure (MAP) of 80 to 85 mm Hg as opposed to 65 to 70 mm Hg. Accordingly, blood pressure goals are determined based on blank conditions and risk versus benefit to the patient.

concentrate, 1.000, 1.030, myoglobin, nephron

In early AKI, urine tests provide important information. Urine sodium levels may reflect an inability to blank urine. Urine may be dilute with a specific gravity near blank or concentrated with a specific gravity greater than blank. The presence of urine sediment (e.g., RBCs, casts, and tubular cells), blank, or hemoglobin may lead to blank damage.

hemodialysis, BP unstable, critically ill, cont, hemofiltration, rapid shifts, ultrafiltration, very fine

Intermittent KRT (immediate vascular access for AKI) Sometimes called blank. Use dialysis machine. (Need anticoagulation in dialysis circuit- Heparin monitor aPTT). -Over 3-6 hours (possibly longer if blank). 3-4 times/week. May not be tolerated by blank patient. Prefer blank KRT (also called blank). Prevents __blank_ of fluids & electrolytes. Better tolerated than HD. Hemofiltration uses blank: separation of particles from a suspension by passage through a filter with blank pores.

uremia, pericarditis, cognition, K, 6.5, 7.1, fluid overload, toxins

Kidney Replacement Therapy for AKI For patients with loss of kidney function & inadequate waste elimination. Symptomatic blank: Blank, neuropathy, decline in blank. Persistent/rapidly inc high blank+ levels: more than blank mEq/L. Severe metabolic acidosis: pH less than blank. Blank that inhibits tissue perfusion. To remove blank. -Life expectancy 3-5 years. Mortality highest in first several months following dialysis.

sodium, potassium, phosphorus, mixed, fat emulsion, glucose

Most specialty formulas for patients with kidney problems are lower in blank, blank, or blank and higher in calories than are standard feedings. Enteral nutrition, delivered with a nasogastric or nasojejunal tube (these tubes can also be placed orally), can be used for nutrition support. If PN is used, the IV solutions are blank to meet the patient's specific needs. Because kidney function is unstable in AKI, continuously monitor intake and output and serum electrolyte levels to determine how the supplementation affects fluid and electrolyte balance. IV blank (Intralipid) infusions can provide a nonprotein source of calories. In uremic patients, these are used in place of blank to avoid the problems of excessive sugars.

normal, dec, permeability, 3.5, albumin, throat, minimal change, steroids, cholesterol

Nephrotic Syndrome Diet: Protein intake: Blank GFR: Dietary intake needed Blank GFR: Dec protein intake Pathophysiology (immunologic changes): inc glomerular blank → inc loss of protein in urine (> blank g/24 hr.) → edema → dec plasma blank. Recent blank infection? -Cause: blank disease: need electron microscope to see changes Management: Blank. ACE Inhibitors. Diuretics. Blank-lowering drugs.

steroids, cytotoxic, protein loss, blood lipid, heparin, needed, dec, vascular dehydration, worsen, blood flow

Nephrotic Syndrome Excess immunity may improve with suppressive therapy using blank and blank or immunosuppressive agents. Angiotensin-converting enzyme inhibitors (ACEIs) can decrease blank in the urine, and cholesterol-lowering drugs can improve blank levels. Blank may reduce vascular defects and improve kidney function. Diet changes are often prescribed. If the glomerular filtration rate (GFR) is normal, dietary intake of proteins is blank. If the GFR is decreased, protein intake must be blank. Mild diuretics and sodium restriction may be needed to control edema and hypertension. Assess the patient's hydration status because blank is common. If plasma volume is depleted, kidney problems blank. Acute kidney injury (AKI) may be avoided if adequate blank to the kidney is maintained.

proteinuria, hypo, edema, lipid, lipidemia, clotting, bleeding

Nephrotic Syndrome Key features include sudden onset of these symptoms: • Massive blank • Blankalbuminemia • Blank (especially facial and periorbital) • Blankuria • Hyperblank • Delayed blank or increased blank with higher-than-normal values for serum activated partial thromboplastin time (aPTT), coagulation, or international normalized ratio for prothrombin time (INR, PT) • Reduced kidney function with elevated blood urea nitrogen (BUN) and serum creatinine and decreased glomerular filtration rate (GFR)

physical assessment, rejection, infection, urinary catheter, decompression, stretch, ureter attachment

Nursing care includes ongoing blank, especially evaluation of kidney function. The most common complications occurring in patients after kidney transplant are blank and blank. Drug therapy used to prevent tissue rejection reduces immunity, impairs healing, and increases the risk for infection. Urologic management is essential to graft success. A blank is placed for accurate measurements of urine output and Blank of the bladder. Decompression prevents blank on sutures and blank sites on the bladder.

cont bladder irrigation, 3-5, ischemia, AKI, diuretics, osmotic, 2-4

Occasionally, blank is prescribed to decrease blood clot formation, which could increase pressure in the bladder and endanger the graft. Perform routine catheter care, according to agency policy, to reduce catheter-associated urinary tract infection (CAUTI). The catheter is removed as soon as possible to avoid infection, usually blank to blank days after surgery. After surgery, the function of the transplanted kidney (graft) can result in either oliguria or diuresis. Oliguria may occur as a result of blank and blank, rejection, or other complications. To increase urine output, the nephrology health care provider may prescribe blank and blank agents. Closely monitor the patient's fluid status because fluid overload can cause hypertension, heart failure (HF), and pulmonary edema. Evaluate his or her fluid status by weighing daily, measuring blood pressure every blank to blank hours, and measuring intake and output.

emergency transplant nephrectomy, infection, low-grade, mental status, discomfort

Other vascular problems include vascular leakage or thrombosis, both of which require an blank. Transplant recipients may not have the usual symptoms of blank because of the immunosuppressive therapy. Blank fevers, blank changes, and vague reports of blank may be the only symptoms before sepsis. Always consider the possibility of infection with any patient after a kidney transplant.

catabolism, protein, stress, cortisol, glucagon, uremia, azotemia

Patients who have AKI often have a high rate of blank (blank breakdown). Increases in metabolism and protein breakdown may be related to the blank of illness and the increase in blood levels of catecholamines, blank, and blank. The rate of protein breakdown correlates with the severity of blank and blank. Catabolism causes the breakdown of muscle protein and increases azotemia.

10, several months, hydration, NSAID

Post-AKI ~Blank% pf patients who receive KRT for AKI will develop ESKD and require intermittent dialysis or kidney transplantation. Resolution of kidney injury: May occur over blank. Monitor UO, blank, (no blank/nephrotoxic drugs), nephrology consult.

ischemia, osmotic, diuresis, 500-1000, hypotension, impair healing, infection

Post-Operative Care Transplanted kidney function: Oliguria: Due to blank, AKI, rejection. Rx to dec UO: diuretics and blank agents Monitor: pts fluid status: daily wt, BP, I/O. Blank: usually if kidney from living related donor. Monitor: I/O, electrolyte imbalances (dec K, dec Na). REPORT: UO blank to blank mL more than intake over 12-24 hours Blank: Dec blood flow & O2 to new kidney. Immunosuppressive Drug Therapy: Prevents tissue rejection but blank & inc risk for blank.

foley catheterization, 48, rejection, necrosis, obstruction, pink/bloody, acetone, culture, 3-5, HF, pulm edema

Post-Operative Care for Kidney transplant Assess: Kidney function Blank (large bore). Hourly output x blank hrs. Abrupt dec in UO: Blank, acute tubular blank (ATN/ acute kidney failure in past), thrombosis, blank. Urine color: ___blank______ immed. post op x several days to wk. Daily UA: Glucose, blank, specific gravity, blank Routine catheter care: foley catheter is removed blank to blank days post-op. Prevent fluid overload: HTN, blank, blank.

immunologic, tissue, blood, HLA, antigens, 24, before, blood transfusion, before, donor's

Pre-op Care for kidney transplant Blank studies: Blank typing. Blank typing (____same blood type__________). Blank. The more similar the blank of donor to recipient → ____transplant success and no rejection_____ ____. Hemodialysis within blank hours blank surgery. Blank blank sx (usually ___blank______ blood) Increases graft survival of organs from living related donors

GFR, question, dose, combine 2+

Prevention of AKI NURSES: Monitor for AKI (Cr and UO) Early recognition & correction of problems: Labs: Inc Cr over few days/hours. BUN. GFR. Serum K+, Na+, osmolarity, urine specific gravity, albumin-Cr ratio. Electrolytes. Know baseline blank. Nephrotoxic drugs: Blank orders. Pay attention: Blank. Site of drug metabolism. S/E. Never blank nephrotoxic drugs.

dehydration, urinary elimination, sediment, foul, 0.5, 2, 6, 30, 2, dark amber, volume depletion, thirst, inc, oral, inc

Prevention of AKI Prevent blank (dec perfusion causes AKI): Drink 2 - 3 L water daily. NURSES: Monitor for AKI Early recognition & correction of problems: causing dec blank may avoid kidney tissue damage. Fluid status. I/O. Body wt. Urine s/s: new blank, hematuria (smoky or red color), blank odor, etc. UO. REPORT: UO less than blank mL/kg/hr. Persisting more than blank hours. DO NOT wait blank hours of oliguria to meet AKI criteria (too late)! Less than blank mL/hr for blank hours or blank urine. NURSING PRIORITY: Prevent blank. S/S: dec UO, MAP < 65, dec SPB, dec pulse pressure, orthostatic dec BP, blank, blank serum osmolality. Rx: Blank fluids, blank IV fluid rate.

shock, cardiac, mech vent, dm, pvd, liver

Risk factors for AKI include blank, blank surgery, hypotension, prolonged blank, and sepsis. Older adults or adults with blank, hypertension, blank, blank disease, or CKD are at higher risk of AKI if hospitalized.

stenosis, bruit, scan, perfusion, balloon angioplasty, ureteral, contracture, rupture, sx, wound, hematomas, lymphoceles

Renal Artery Blank: Blank over artery anastomosis & dec renal function. HTN. Diagnosis: Renal blank (quantify blank). Rx: Surgery or blank. Determine by amount of healing time after sx. Urinary tract: Blank leakage. Fistula. Obstruction. Stone formation. Bladder neck blank. Graft blank. Infection. Blank interventions. Surgical blank: Blank. Abscesses. Blank (abnormal lymphatic cysts containing lymph fluid). Infection.

time, delays, baseline, GFR, acute, critical, metabolic, diuretics, IV fluids, lack of recovery, longer

The creatinine level is most commonly used in the recognition of AKI. However, this value is not ideal because the creatinine level takes blank to increase, which can create blank in treatment. A blank creatinine value is also necessary to evaluate for AKI, as this provides a means for comparison. Blank is accepted as the best overall indicator of kidney function, but it is not accurate during blank and blank illness. Estimations of GFR from serum creatinine are affected by blank problems and treatments during critical illnesses. Urine output is altered when blank or blank are used. AKI also causes systemic effects and complications. These complications increase discomfort and risk for death. Duration of oliguria or anuria closely correlates with blank of kidney function; the blank the duration of oliguria or anuria, the less likely it is that the patient will return to full or baseline kidney function.

external iliac, internal iliac, external iliac, bladder, mucosa, muscle wall, ureters, stent

The cut end of the donor renal artery is attached to the side of the blank artery. Alternatively the end of renal artery may be attached to end of the cut blank artery. The end of the donor kidney vein is attached to side of the blank vein. Left: Cut end of ureter of donor kidney is attached to patient's blank. An incision is made in muscle wall of bladder to mucosa. Right: Blank is opened & edge of mucosa sutured to end of ureter. Blank is then closed around the ureter Completed transplant. An alternative attachment of the ureter is end to end suture of the donor & recipient blank over a blank.

0.6, 40, 1-1.5, 60-90, 60-70, urine volume, 500, shift

The interprofessional team's registered dietitian nutritionist (RDN) in the ICU setting calculates the patient's protein and caloric needs. A consultation may need to be requested for inpatients outside of the ICU or for those in community settings. Work with the RDN to establish a diet with specified amounts of protein, sodium, and fluids. For the patient who does not require dialysis, blank g/kg of body weight or blank g/day of protein is usually prescribed. For patients who require dialysis, the protein level needed ranges from blank to blank g/kg. The dietary sodium ranges from blank to blank mEq/kg (mmol/kg). If high blood potassium levels are present, dietary potassium is restricted to blank to blank mEq/kg (mmol/kg). The daily amount of fluid permitted is calculated to be equal to the blank plus blank mL. Assess food intake every blank to ensure that caloric intake is adequate.

biomarkers, baseline, 12-24, metalloproteinase, insulin-like, 7

These blank for AKI indicate damage earlier than the creatinine level and do not require a blank value for comparison. These biomarkers specific to kidney injury can be used similarly to biomarkers such as troponin in cardiac injury. These biomarkers can identify patients at high risk for developing AKI during the next blank to blank hours and include tissue injury blank 2 (TIMP-2) and blank growth factor binding protein blank (IGFBP-7)

T-cell, mTOR, infection, high, lower, cardiovascular, cancer

These drugs include corticosteroids, inhibitors of blank proliferation and activity (azathioprine, mycophenolic acid, cyclosporine, and tacrolimus), blank inhibitors (to disrupt stimulatory T-cell signals), and monoclonal antibodies. Patients taking these drugs are at an increased risk for death from blank. Usually, the patient receives a period of blank-dose (induction) therapy followed by blank-dose maintenance immunosuppressive therapy. Kidney transplant recipients are at risk for blank disease (the most common cause of death among kidney transplant recipients), diabetes, blank, and infections.

acute glomerulonephritis, gastroenteritis, allergic reactions, 10, eosinophil, hypotension, cardiac bypass, bowel prep, vasopressors

To identify immunity -mediated AKI (i.e., blank), ask about acute illnesses such as influenza, colds, blank, and sore throats. Blank from a drug or food allergy may result in AKI as late as blank days after exposure. Ask about rashes, hives, or fever and evaluate the white blood cell (WBC) differential for an increased blank count. Anticipate AKI following any episode of blank or shock. Any problem in which the blood volume is depleted can contribute to AKI by reducing perfusion. Such problems include blank surgery, extensive blank, being NPO before surgery, or dehydration from exercise. Recent use of IV blank (e.g., epinephrine or norepinephrine) may contribute to AKI when blood volume is reduced (hypovolemia).

4-5, anterior iliac fossa, ureter, renal, palpation, not removed

Transplantation Surgery Approx. _blank to blank____ hours. Transplanted kidney is placed in the R or L blank. Allows for __easier connection of blank and blank artery & vein. Allows for ____blank_____ of kidney. Recipient's failed kidneys are usually blank. -Unless chronic kidney infection or causes pain.

prerenal, outside, BP, shock, burns, intrarenal, inside, inflammation, allergic, nephrotoxic, postrenal, urine flow, prostate, stones, tumor

Types of Acute Kidney Injury (AKI) 1: Blank AKI. (source blank of kidney causing dec perfusion) Sudden & severe dec in blank (MAP < 65 mmHg) or interruption of blood flow to kidneys: severe injury or illness. Blank dehydration, blank, sepsis. 2: Blank (Intrinsic) AKI. (blank kidney by disorder directly effect renal cortex/medulla) Direct damage to kidneys: blank, toxins, drugs, infection or dec blood supply. Blank reaction, embolism/thrombosis, blank agents. 3: Blank AKI. Sudden obstruction of blank: enlarged blank kidney blank, bladder blank, or injury.

constricting, RAAS, ADH, urine elimination, 400, azotemia, toxins

With prerenal or postrenal pathology, the kidney compensates with the three responses of blank kidney blood vessels, activating the blank pathway, and releasing blank. These responses increase blood volume and improve kidney perfusion. However, these same responses reduce blank, resulting in oliguria (urine output less than blank mL/day) and blank (the retention and buildup of nitrogenous wastes in the blood). Blank can also cause blood vessel constriction in the kidney, leading to reduced kidney blood flow, oliguria, and azotemia