HURST REVIEW: RENAL
Kidney Stones: Signs/Symptoms
Colicky pain - flank/ groin pain that comes and goes Hematuria N/V WBCs in urine
Acute Kidney Injury (AKI) Treatment: Prevent infection by
-using aseptic technique -meticulous skin care -preventing pressure ulcers -mouth care -no catheter, if possible -protect from others who have an infectious disease
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: Dialysate is infused into the peritoneal cavity by
gravity via a Tenckhoff catheter
Peritoneal Dialysis: CAPD (continuous ambulatory peritoneal dialysis) requires a client that
has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions
Glomerulonephritis Signs/Symptoms: Azotemia is
high BUN and creatinine
Nephrotic Syndrome Treatment: Patients on cyclophosphamide are
immunosuppressed
Acute Kidney Injury (AKI) Treatment: During the recovery phase, client's diet is
increased protein and increased calories
Nephrotic Syndrome Treatment: Major complication of nephrotic syndrome and being on cyclophosphamide
infection
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: If the drainage is cloudy, it indicates
infection
Renal Replacement Therapy (RRT) - Hemodialysis: For temporary access, the ___________________ or ___________________ is often used for catheter placement
internal jugular; femoral vein
Nephrolithiasis is
kidney stone disease
Acute Kidney Injury (AKI) Treatment: Fluid and electrolyte replacement is based on
lab results
Acute Kidney Injury (AKI) Signs/Symptoms: Hyperkalemia can cause
lethal arrhythmias
Nephrotic Syndrome: Pathophysiology
Inflammatory process in the glomerulus that results in big holes -> lots of proteinuria -> hypoalbuminemia -> fluid shift into tissue occur -> edema -> decreased fluid in vascular system -> RAAS -> Na+ & water retention -> more edema Anasarca Blood clots Increased cholesterol/ triglycerides
Renal Replacement Therapy (RRT) - Hemodialysis: What anticoagulant is usually given and what must be implemented as a result?
Heparin usually and bleeding precautions should be implemented
AKI treatment
Hourly outputs, check CVP/ fluid status S&S of UTI -> can lead to sepsis Treat HTN quickly - call HCP if BP drops quickly/ significantly Watch for kidney toxic meds
Nephrotic Syndrome Treatment: Nursing care
I&Os, daily weights Measure abdominal girth/ extremity size Good skin care
Continuous Renal Replacement Therapy (CRRT): Where is it done? What are the advantages Who is this for?
ICU setting The client doesn't have drastic fluid shifts that are associated with hemodialysis = less CV stress *For those with fragile cardiovascular status or acute renal failure
Pre-renal AKI priority treatment
IV fluid bolus/ blood & fix problem - if not treated quickly -> risk of intrarenal AKIN and ATN leading to CKD
Acute Kidney Injury (AKI) Treatment: Diet changes
Increase carbohydrates and fats Decrease protein in diet Avoid foods high in phosphorus & potassium
Treatment of kidney stones
Increase fluids May require surgery to remove stone Extracorporeal shock wave lithotripsy (ESWL) Strain urine-> send for analysis
Intra-renal AKI patho
Kidneys have acutely decreased kidney function from direct kidney tissue injury to any part of the nephron due to: Glomerular damage Kidney tubular damage
Intra-renal AKI: causes of glomerular damage
Post-strep. glomerulonephritis/ Nephrotic syndrome -> attacks membrane causing hematuria & proteinuria Malignant hypertension
Diuretic phase of of kidney failure
Sudden onset -> increased urine output Increased UO Client is in fluid volume deficit - Hypokalemia
Renal Replacement Therapy (RRT) - Hemodialysis: The client is given ________________________ during dialysis to prevent ______________________
an anticoagulant; blood clots from forming
Hemodialysis: What is an AVF?
an arteriovenous fistula in forearm with an anastomosis between an artery and a vein
Renal Replacement Therapy (RRT) - Hemodialysis: What is an AVG?
an arteriovenous graft which is a synthetic graft to join the vessels
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: After the fluid has infused into the peritoneal cavity, the bag is ___________________________. This entire process is called ______________________
lowered and the fluid, along with the toxins, etc., are drained; an exchange
Kidney Stones Treatment: What is ondansetron (Zofran) given for?
nausea
Acute Kidney Injury (AKI) Signs/Symptoms: Why would these clients have anemia?
not enough erythropoietin being made by the kidneys
Peritoneal Dialysis: Cold fluid can also cause
pain and cramping
Glomerulonephritis Signs/Symptoms: Periorbital edema will
progress to other areas of the body
Glomerulonephritis: Signs/Symptoms
proteinuria & hematuria increased BUN & creatinine (azotemia) low/ normal specific gravity Decreased urine output increased blood pressure, periorbital/ facial edema Flank pain/ CVA tenderness Sore throat, malaise, headache
Kidney Stones Treatment: What are alpha adrenergic blockers given for?
relax smooth muscles of ureter
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the client have HTN and/or HF?
retaining fluid
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the client experience anorexia, nausea, and vomiting?
retaining toxins
Nephrotic Syndrome Treatment: How does cyclophosphamide decrease the immune response?
shrink holes so protein can't get out
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: What type of client get peritoneal dialysis?
someone who can't tolerate hemodialysis or someone who chooses peritoneal
Urolithiasis is
stone in ureter
Glomerulonephritis: is usually caused by
streptococcus (Group A beta) - can lead to glomerulonephritis - also attacks valves in the heart, leading to S&S of heart failure Also caused by skin infection, hepatitis
Renal Replacement Therapy (RRT): These therapies
take over or replace the kidney function when: - BUN and creatinine can't be decreased - when FVE is compromising heart and lungs - when hyperkalemia & metabolic acidosis can't be treated successfully
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: The prescribed amount of time the fluid remain in the peritoneal cavity is referred to as
the dwell time
Renal Replacement Therapy (RRT) - Hemodialysis: The machine is
the glomerulus (filter)
Nephrotic Syndrome: Why are levels of cholesterol and triglycerides increased with protein loss?
the liver compensates by making more albumin causing an increased release of cholesterol and triglycerides byproducts
Peritoneal Dialysis: What is used as a filter?
the peritoneal membrane
Nephrotic Syndrome: Why would blood clots form as a result of protein loss?
they are losing proteins that normally prevent their blood from clotting
Nephrotic Syndrome: What is anasarca?
total body edema
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: What if all the fluid doesn't come out?
turn client from side-to-side
Acute Kidney Injury (AKI) Signs/Symptoms: Why would these clients have metabolic acidosis?
unable to filter hydrogen or bicarb
Anytime you suspect a kidney stone, get a ________________________ ASAP and have it checked for ___________ - Give ______ immediately
urine specimen; RBCs Pain medication
Renal Replacement Therapy (RRT) - Hemodialysis: The access site takes ___________________ to _____________ and to be ready for ________________________
weeks; mature; repeated venipunctures
Acute Kidney Injury (AKI) Treatment: Diuretic phase begins
when output increases
Acute Kidney Injury (AKI) Treatment: Infection prevention practices
*Infection is the leading cause of death ASEPTIC TECHNIQUE meticulous skin care, prevent ulcers mouth care protect against others with infectious disease RRT may be needed
Glomerulonephritis: patho
- Autoantibodies attach to the glomerular membrane causing an inflammatory process - Glomerular capillaries pathologically vasodilate and leak protein & blood into urine
Renal Replacement Therapy (RRT) - Hemodialysis: What types of vascular access are there?
-AVF (arteriovenous fistula) -AVG (arteriovenous graft)
Peritoneal Dialysis: Signs/Symptoms of peritonitis
-abdominal pain -cloudy effluent
Nephrotic Syndrome: Causes are idiopathic (unknown cause), but have been related to
-bacteria or viral infections -NSAIDs -cancer and genetic predispositions -systemic diseases such as lupus or diabetes
Peritoneal Dialysis: Complications
-exit site infection -peritonitis (#1 complication)
Renal Replacement Therapy (RRT): This includes
-hemodialysis -peritoneal dialysis -continuous renal replacement therapy
Acute Kidney Injury (AKI): Signs/Symptoms
-increased BUN & creatinine -initially increased then becomes low and fixed specific gravity - Anemia (lack of erythropoietin) - HTN, HF -> retaining fluids - anorexia, nausea, vomiting -> retaining toxins - uremic frost Acid base imbalance - Hyper-phosphatemia - hyperkalemia - Hypokalemia - metabolic acidosis
Glomerulonephritis Treatment: How are dietary needs modified?
-increased carbs -decreased sodium (FVE State) -decreased protein (makes BUN go up)
Acute Kidney Injury (AKI) Treatment: Medications
-loop diuretics or osmotic diuretics -IV glucose and insulin (hyperkalemia) -IV calcium gluconate (dysrhythmias) -polystyrene sulfonate (excrete potassium) -phosphate binding drugs (prevent hypocalcemia)
Kidney Stones Treatment: Medications include
-ondansetron (Zofran) -NSAIDs or opioid narcotics -alpha adrenergic blockers
Acute Kidney Injury (AKI) Treatment: Goals
-prevent complications -manage s/s -eliminate the cause of the kidney injury
Nephrotic Syndrome Treatment: How much protein should these clients receive?
1 to 2 grams/kg/day
Glomerulonephritis Client Teaching: Diuresis begins in
1 to 3 weeks after onset
What actions would be appropriate for the nurse to take when performing peritoneal dialysis on a client diagnosed with renal injury? Select All That Apply 1. Dialysate is warmed to body temperature by allowing it to sit out for a short period of time. 2. The dialysate is infused through the catheter into the stomach. 3. Once infused, dialysate remains for prescribed dwell tiime. 4. Withdraws dialysate using a large piston syringe. 5. Assists client to stand if all the drainage is not removed.
1, 3. Correct: These actions are correct. The dialysate should be warmed to body temperature by allowing it to sit out for a short period of time. The dwell time is the length of time that the dialysate stays in the peritoneal cavity. This allows for toxins to be drawn out of the blood and into the peritoneal cavity for removal. 2. Incorrect: The dialysate is infused through the peritoneal catheter into the peritoneal cavity. 4. Incorrect: Allow the dialysate to drain by gravity for 20-30 minutes. 5. Incorrect: The nurse should turn the client from side to side if all the drainage does not come out of the peritoneum. If you missed this question, review pages 132-133* (119-120) *Page numbers will depend on what version of student book applies.
Acute Kidney Injury (AKI) Treatment: 1 kg =
1,000 mL of fluid
Acute Kidney Injury (AKI) Treatment: The oliguric phase ends in
10-14 days
Peritoneal Dialysis: What are the 2 types of peritoneal dialysis?
1. Continuous ambulatory peritoneal dialysis (CAPD) 2. Continuous Cycle Peritoneal Dialysis (CCPD)/ Automated peritoneal dialysis (APD)
Which medication prescription should the nurse question for a client diagnosed with nephrotic syndrome? Choose One 1. Ibuprofen 2. Enalapril 3. Prednisone 4. Cyclophosphamide
1. Correct: The prescription of ibuprofen, a NSAID, would be questioned. Ibuprofen is a nonsteroidal ant-inflammatory medication. NSAIDs can cause acute interstitial nephritis and acute tubular nephritis. The client with nephrotic syndrome currently has damage to the micro blood vessels in the kidneys. 2. Incorrect: Enalapril, an angiotensin converting enzyme inhibitor (ACE), is prescribed for nephrotic syndrome to decrease the intraglomerular pressure. The inhibition of the angiotensin converting enzyme (ACE) results in a reduction of proteinuria. Also an ACE inhibitor blocks aldosterone secretion. This prescription is appropriate. 3. Incorrect: Prednisone's classification is a corticosteroid. Client's with nephrotic syndrome leak protein from the blood into urine. Prednisone action is to reduce the inflammation of the kidneys, and results in decrease proteinuria. The prescription of a corticosteroid is applicable 4. Incorrect: Cyclophosphamide's pharmacology classification is an alkylating agent. This medication is prescribed for the treatment of nephrotic syndrome to suppress the body's immune system. The prescription of cyclophosphamide is appropriate for this client. Review pages 124* (110-111) of your student book if you missed this question. *Page numbers will depend on what version of student book applies.
Acute Kidney Injury (AKI): 4 phases of acute kidney injury
1. initiation phase (injury occurs) 2. oliguric phase (output may be < 100 mL/24 hr) 3. diuretic phase (kidney recovering) 4. recovery phase (3-12 months)
Acute Kidney Injury (AKI): 3 Types
1. Pre-renal 2. Intra-renal 3. Post-renal
What interventions would the nurse implement for a client diagnosed with nephrotic syndrome? Select All That Apply 1. Weigh daily 2. Measure abdominal girth 3. Provide skin care 4. Position in semifowlers 5. Intake and output Submit
1., 2., 3., & 5. Correct: The client with nephrotic syndrome is producing less urine. Due to the decrease in urinary output the client is retaining fluid. The client should be weighed daily, and the girth would be measured to evaluate fluid retention. Edematous skin is prone to skin breakdown, so adequate skin care is necessary. Intake and output is required whenever there is a fluid volume problem. 4. Incorrect: This client with nephrotic syndrome does not require positioning in a semifowlers position. Any position of comfort is acceptable. Review page 124-125* (112) of your student book if you missed this question. *Page numbers will depend on what version of student book applies.
The nurse on a medical unit is reviewing the data on a client admitted to a medical unit. Which data supports the diagnosis of glomerulonephritis? Select All That Apply 1. Malaise 2. Blood pressure - 16O/92 3. 24 hour urinary output - 960 mL 4. Costovertebral angle tenderness 5. Urine specific gravity of 1.0
1., 2., 4., & 5. Correct: A client with glomerulonephritis is retaining toxins. The result is the client has a overall sense of being ill with possible fatigue and decrease interest in activities. A client with glomerulonephritis is producing less and less urine. Due to the retention of fluid, the client's blood pressure is elevated. Costovertebral angle tenderness (CVAT) is elicited by percussing the flank area of the back over both the kidneys. If pain is present, the client would be assessed for a kidney infection. The normal range of urine specific gravity ranges from 1.010 to 1.030. An elevated urine specific gravity of 1.040 is reflective of highly concentrated urine. The client is not diuresing appropriately. The client's specific gravity of 1.040 supports glomerulonephritis. 3. Incorrect: The normal range for a 24 urinary output is 800-2000 mL. The listed 24 hour urinary output of 960 is within the normal range. Urinary output on a client with glomerulonephritis is less than 800 mL per 24 hours. Review page 122* (113) of your student book if you missed this question. *Page numbers will depend on what version of student book applies.
The nurse is planning care for a client admitted with a diagnosis of acute renal injury. What interventions should the nurse include in this plan? Select All That Apply 1. Provide meticulous skin care. 2. Reposition every 2 hours. 3. Maintain a high carbohydrate, high protein diet. 4. Provide foods low in phosphate. 5. Monitor intake and output. 6. Give IV medications in smallest volume allowed.
1., 2., 4., 5., & 6. Correct: The leading cause of death from acute renal injury is infection, so meticulous skin care and aseptic technique are critical. Repositioning every 2 hours will help to prevent pressure ulcers. Clients in acute renal injury have high phosphorus levels and low calcium levels (remember that inverse relationship?). So they need foods low in phosphorus. Monitor intake and output. The client cannot handle excess fluid at this time. This is also why all IV meds should be administered in the smallest possible volume allowed. 3. Incorrect: The client does need to be on a high carbohydrate, high fat diet to prevent protein breakdown. However, a low protein diet is needed because the kidneys cannot excrete BUN and creatinine. If you missed this question review your notes on pages 127-128* (114-115). *Page numbers will depend on what version of student book applies.
A client arrives at the clinic reporting a sharp pain, rated 10/10, radiating from the right flank around to the lower right abdomen. The client also reports nausea and vomiting. Based on this data, what problem does the nurse suspect? 1. Glomerulonephritis 2. Renal lithiasis 3. Nephrotic syndrome 4. Acute kidney injury
2. Correct: These signs and symptoms are classic for renal lithiasis or kidney stones. 1. Incorrect: Glomerulonephritis does present with flank pain but not as severe as a kidney stone and not radiating to the lower abdomen. There is no mention of edema seen with this client. 3. Incorrect: What do you see with neprhotic syndrome? Massive edema or anasarca. 4. Incorrect: Nausea and vomiting can occur with acute kidney injury because of all of the retained toxins. But there is no mention of hypertension, edema, and other s/s of acute kidney injury. If you missed this question, go to page 135* (121) of your student book to review. *Page numbers will depend on what version of student book applies.
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: How much fluid fills the peritoneal cavity?
2000-2500 mLs, which takes about 10 minutes
Glomerulonephritis Treatment: How is fluid replacement calculated?
24 hour fluid loss + 500 mL
Renal Replacement Therapy (RRT) - Hemodialysis: It is done _________________________, so the client has to ____________________________ between treatments
3-4 times per week; watch what they eat and drink
Glomerulonephritis Client Teaching: ____________________ may stay in the urine for _________________
Blood and urine; months
The nurse has initiated discharge instructions for a client diagnosed with glomerulonephritis. What statement by the client would indicate to the nurse that further teaching is needed? Choose One 1. "I will have protein in my urine for several months." 2. "My urinary output will increase in 1 to 3 weeks." 3. "I should keep a record of the headaches I experience over 3 months." 4. "I should notify my primary healthcare provider if my urinary output decreases."
3. Correct: The client should report headaches sooner than 3 months to their primary healthcare provider. The headaches are related to the fluid retention due to the decreased filtration of the glomerulus. The retention of fluid will result in hypertension. This client will require additional discharge instructions. 1. Incorrect: This is a correct statement by the client. Due to the damage to the glomerulus, the kidneys will leak protein. The damage to the kidneys may take several months to heal properly. The kidneys will leak protein for several months. 2. Incorrect: When the glomeruli are restored, the kidneys will begin to diuresis. The diuresis usually starts in 1 to 3 weeks. This is a correct discharge statement by the client. 4. Incorrect: The glomerulus and the surrounding Bowman capsule create a renal corpuscle. The glomerulus filtrates the blood which results in urine formation. Review page 122-123* (110) of your student book if you missed this question.
The nurse is teaching a client who has been prescribed peritoneal dialysis. What statement by the client indicates to the nurse that teaching was successful? Choose One 1. "I need to decrease protein in my diet since my kidneys no longer work." 2. "Heating the dialysate in the microwave for 30 seconds will prevent abdominal cramping." 3. "I will notify my primary healthcare provider if the peritoneal drainage is cloudy." 4. "The automated peritoneal dialysis (APD) cycler is used every few hours during the day."
3. Correct: The number 1 complication of peritoneal dialysis is infection. So, the client does need to monitor the drainage, which should be clear or straw-colored. If it is cloudy, that indicates infection and the primary healthcare provider should be notified. 1. Incorrect: This client needs to increase protein intake because the client is losing protein through the peritoneal membrane with each exchange. 2. Incorect: Do NOT put dialysate in the microwave! We don't want to burn the peritoneum. Take it out of the refrigerator and allow to warm to body temperature. 4. Incorrect: The APD cycler does exchanges automatically throughout the night while the client is sleeping. If you missed this question, review your notes on page 132-133* (120) of your student book. *Page numbers will depend on what version of student book applies.
Peritoneal Dialysis: CAPD (continuous ambulatory peritoneal dialysis) is done how often?
4 times a day, 7 days a week (7a, 12p, 5p, 10p)
A nursing instructor is presenting a discussion on nephrotoxic medications? Which class of medications would the instructor discuss? Choose One 1. Opioids 2. Antidiabetic 3. Corticosteroids 4. Aminoglycoside
4. Correct: Aminoglycoside antibiotics are nephrotoxic. Nephrotoxic medications can cause damage to the kidneys. Examples of aminoglycoside antibiotics are tobramycin, gentamicin, streptomycin, and paromomycin. Clients with kidney damage should not be prescribed aminoglycoside antibiotics. 1. Incorrect: Opioid medications are not classified as nephrotoxic. 2. Incorrect: Antidiabetic medications are not classified as nephrotoxic. 3. Incorrect: Corticosteroid medications are not classified as nephrotoxic. Review page 126* (113) of your student book if you missed this question. *Page numbers will depend on what version of student book applies.
A client, who receives hemodialysis three times a week, has been placed on a fluid restriction of 1000 mL/day. What is the nurse's best action when the client is seen drinking a 12 ounce (360 mL) soft drink? Choose One 1. Take the soft drink away from the client. 2. Document the client is noncompliant. 3. Notify dietary to no longer send beverages with food trays. 4. Reinforce the importance of the fluid restriction with the client.
4. Correct: Educate the client on appropriate choices and lifestyle changes that are necessary to manage the client's condition. 1. Incorrect: It is ultimately the client's choice to drink a soft drink. Education will help the client make an informed decision. 2. Incorrect: The nurse should reinforce the purpose of fluid restriction, not just document noncompliance. Perhaps it is just a matter of lack of knowledge. 3. Incorrect: The client has the right to make choices and the nurse should reinforce teaching. If you missed this question, review your notes on page 126* (116) of your student book. *Page numbers will depend on what version of student book applies.
Post-renal AKI Patho
Acute obstruction b/n kidneys and urethral meatus - Ureteral obstruction (BPH, Prostate cancer, caculi) - Uterine prolapse - Edematous stoma (ileal conduit) Important to tx problem because of the risk for retrograde flow -> hydro-nephrosis & retrograde pressure/ backflow can cause ATN
Post-renal AKI S&S
Acute oliguria & increased serum creatinine S&S of causative problem -> kidney stone, BPH, etc. - Urgency, delay, decreased flow, urine retention
Glomerulonephritis Signs/Symptoms: Uremia
Azotemia & S&S such as... - Fatigue, Anorexia, N & V - Pruritis (itching from deposits of urea) - Uremic encephalopathy (neurological changes à confusion)
Foods high in potassium
Bananas Oranges/ citrus Coffee
Acute Kidney Injury (AKI) Treatment: Nursing Measures
Bedrest (to decrease metabolism & caloric needs) TCDB (turn, cough, deep breathe) Monitor I&Os/ Vital signs Daily weights - 1kg = 1000mL fluid Diuretic therapy IV meds in the smallest volume allowed Prevent infection
Intra-renal AKI S&S
Increased serum creatinine & oliguria Hematuria, proteinuria Urinary cast
Care for the vascular access sued for hemodialysis
DO NOT USE for IV access (drawing blood, administering meds, etc.) -NO BP -NO needle sticks -NO constriction on that arm (no watch, no pulse)
Oliguric phase of kidney failure
Decreased urine output - UO of 100-400mL/hr Client is in fluid volume excess - Hyperkalemia
Pre-renal AKI S&S
Decreased urine output Increased serum creatinine
Intrarenal AKI: causes of tubular damage
Direct damage from toxins - iodine contrast dye - aminoglycosides ("-mycin"), NSAIDs - Diabetes mellitus Tubular ischemia from pre- or post-renal AKI
What individuals are contraindicated for peritoneal dialysis
Disc. disease or arthritis - fluid puts pressure on back One with a colostomy - High risk of infection
Nephrotic Syndrome: Treatment includes
Diuretics -> massive edema ACE inhibitors -> inhibit RAAS system Prednisone -> decrease inflammation, shrink holes Cyclophosphamide -> chemo agent, decreased immune response Diet -> increase protein* Lipid lowering drugs Anticoagulation therapy Dialysis
Before beginning hemodialysis, what must we assess?
Fluid status - Weight, BP, Peripheral edema - Lungs & heart sounds - Temp - Condition of vascular access
Meds to hold be dialysis
Lisinopril Nitroglycerin Water soluble vitamins Ampicillin
Glomerulonephritis Client Teaching: Teach the S&S of renal failure
Malaise, headache, anorexia, N/V, Decreased UO, Increased weight gain
Nephrotic Syndrome: Major S&S
Massive proteinuria/ hypoalbuminemia Anasarca (full body edema) Blood clots (lack of clotting proteins) Hyperlipidemia (by product of liver compensation)
We should limit protein in kidney problems except with...
Nephrotic syndrome
Pre-renal AKI patho
Occurs when arterial blood cannot get to the kidneys, causing ischemia to the tubules -> ATN Due to: - acute Vasoconstriction / trauma to aorta, renal arterial - Hypotension or decreased CO due to hemorrhage, dehydration, HF, sepsis
Hemodialysis: How is the patency of the vascular access assessed?
Palpate for the thrill Auscultate the bruit
What is Continuous cycle peritoneal dialysis/ automated PD
The patient performs peritoneal dialysis at night and the exchange is done at night -> disconnected in the AM - gives the client more freedom
Glomerulonephritis: Treatment
Tx infection with antibiotics I&O, daily weights Monitor BP -> anti-HTN meds for severe HTN Restrict fluids Dietary changes - decrease protein - increase sodium - increase carbs Possible dialysis Teach S&S of renal failure
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the urine specific gravity be fixed?
because they may lose their ability concentrate and dilute urine (nothing to do with hydration)
Glomerulonephritis: Acute injury can lead to
chronic
Peritoneal Dialysis: What should the drainage look like?
clear, straw-colored (should be able to read a newspaper through the drainage/effluent)
Renal Replacement Therapy (RRT) - Peritoneal Dialysis: Why do we warm the fluid?
cold promotes vasoconstriction and will cause blood flow to be limited - Warming fluid promotes vasodilation and more blood flow
Extracorporeal shock wave lithotripsy (ESWL) to
crush stone
Acute Kidney Injury (AKI): Acute tubular necrosis is
damage to the filtering bodies of the kidneys
Acute Kidney Injury (AKI) Signs/Symptoms: Because clients retain phophorous, their serum calcium
decreases (calcium being pulled from bones)
Renal Replacement Therapy (RRT) - Hemodialysis: What are watched constantly during hemodialysis?
electrolytes and BP as some clients cannot tolerate extreme fluid shifts occurring (300-800 mL/min) - those with an unstable CV system
Peritoneal Dialysis: What needs to be increased in the client's diet?
fiber and protein - fiber increases peristalsis, preventing constipation - protein is lost with each exchange
Nephrotic Syndrome: These clients lose a lot more protein than clients with
glomerulonephritis
Acute Kidney Injury (AKI) Signs/Symptoms: Because of uremic frost, clients need
good skin care
