SYSTEM Diagnostics Vocabulary Anatomy & Physiology General Assessment Lab Values

SYSTEM Diagnostics Vocabulary Anatomy & Physiology General Assessment Lab Values

agnostics Radiographic & Others

agnostics Radiographic & Others

SYSTEM Condition ACUTE NEPHROTIC SYNDROME & NEPHROSCLEROSIS PRIMARY GLOMERULAR DISEASE

RENAL CHRONIC GLOMERULONEPHRITIS

After Repeated Bouts of Acute Glomerulonephritis (Nephrotic Syndrome) -- 3rd Leading Cause of EndStage Renal Disease (ESRD) Hardening of Renal Arteries with HTN High Lipids Glomerular Diseases Immune Disorder Abnormal Protein Repeated AGN Bouts Foot Edema -- At Night Yellow-Gray Skin Color May Have No Signs or Symptoms -May Be Detected from Eye Exams Obesity -- Diet HTN Nosebleeds Retinal Bleed Anemia Kidney -- 1/5 Normal Size Fibrosis -- Rough, Irregular Shape

Inflamed Glomerulus Compromises Blood Flow & Filtration Narrowing of Renal Artery Diabetes -- HTN Pathophysiology/ Young Males -- Nephrosclerosis Hardening of Renal Arteries Prognosis 2 Forms -- Malignant & Benign Uremia -- Dialysis & ACE Inhibitors

Acute Glomerulonephritis Follows Group A Beta Hemolytic Strep, Impetigo & Acute Viral Infections of Skin or Throat -- After 21 Days Antigen-Antibody Complexes Deposited in Glomeruli -- Immune System -- From Recent Strep Infection Makes It Hard for Kidneys to Work Inflammation of Glomerular Capillaries Inflammation Headache Edema -- Facial, Periorbital Malaise Fever -- Low Grade Weight Gain Rash Pain -- Abdominal or Flank Proteinuria & Hematuria Dark-Colored Urine Oliguria Chills & Cough HTN Azotemia Nausea & Vomiting Anemia Pruritis CHF Hypervolemia

Signs & Symptoms/ Clinical Manifestations

Proteinuria -- #1 Sign Hypoalbuminemia Hyperlipiduria -- Due to Increased Cholesterol Na+ & Water Retention Edema -- Peripheral Decreased Urine Output Hypervolemia & HTN -- Prolonged Hypercoagulopathy Oliguria Hematuria Azotemia Headache Vision Changes Nausea & Vomiting Seizures Uremia Prolonged Diabetes Mellitus DBP > 130 mmHg Patchy Necrosis -- Fibrosis -Atherosclerosis & HTN Increased Protein > 3.5 g/dL Decreased Albumin Increased BP > 130

Assessment & Diagnostic Findings

Decreased GFR Increased BP -- HTN Increased Phosphorus Increased Sodium Increased BUN Decreased Creatinine Decreased Albumin Urinalysis -- RBCs, WBCs, Protein, Casts Kidney Biopsy -- Needed to Establish Acute Glomerulonephritis (AGN)

Small Kidneys -- 1/5 Normal Size Increased Creatinine Increased Protein Increased BP Fixed Specific Gravity -- 0.0010 Decreased GFR < 50 Increased K+ Increased Phosphorus Increased Sodium Urinary Casts

SYSTEM Condition ACUTE NEPHROTIC SYNDROME & NEPHROSCLEROSIS

Infection -- Glucocorticoid Immunosuppression Scarred Glomeruli -- Can't Repair Decreased Immune Response Renal Vein DVT Pulmonary Edema Hypovolemia Atherosclerosis Prednisone -- Glucocorticoids Needle Biopsy ACE Inhibitors Anti-Lipids Dialysis Anti-HTNs

RENAL PRIMARY GLOMERULAR DISEASE CHRONIC GLOMERULONEPHRITIS

End-Stage Renal Disease -- In Weeks End-Stage Renal Disease (ESRD) If Not Treated

Complications

Medical Management/ Treatment

Antibiotics Urinalysis Corticosteroids Antihypertensives Immunosuppressants Na+ & Water Restriction Bedrest Diet -- High Calorie, Low Protein, Low Phosphorus Urinalysis Kidney Biopsy Plasma Exchange Cancer Drugs

Teach Patient -- Anti-HTNs & ACE Inhibitors

Nursing Management/ Interventions

Patient Privacy I&O Monitoring -- Na+ & Water Restriction Daily Weights -- Monitoring for Fluid Retention Diet Restrictions -- High Calorie, Low Protein, Low Sodium, Low Phosphorus

Patient Privacy

SYSTEM Condition

RENAL ACUTE RENAL FAILURE CHRONIC RENAL FAILURE

End-Stage Renal Disease (ESRD) Decreased GFR > 15 mL/min Diabetes & HTN -- Main Causes Renal Calculi or Obstruction -Vesicoureteric Reflux Hereditary or General Factors -Polycystic Kidney Infection -- Chronic Pyelonephritis, Glomerulonephritis Enviromental Risks -- Heavy Metals Secondary to HTN -- Smoking -- DVTs -- Obesity -- Hypercholesterolemia -- Atherosclerosis Progressive, Irreversible Deterioration

HEMODIALYSIS
Vascular Access -- Subclavian -- Risk for Pneumothorax, Thrombosis, Hematoma, Infection -- Internal Jugular -- IJ -- Femoral Catheter Fistula Arteriovenous Graft -- A-V Graft Chronic or Acute Renal Failure Acute or Chronic Renal Disease

Kidneys Can't Remove Wastes or Perform Regulatory Functions Increased Creatinine > 50% 3 Stages -- Pre-Renal > Decreased Blood Volume > "Pre Kidney Issues" > Decreased BP > Shock > Severe Injury or Illness Pathophysiology/ -- Intra-Renal Prognosis > Ischemic or Nephrotoxic Tubulr Injury > Allergic-Type or NSAID-Type Interstitial Nephritis > Glomerular Disorders > Acute Tubular Necrosis -- Post-Renal > Anatomic or Tubular Obstruction ATN -- Intrinsic ARF 4 Phases -- Initiation -- Oliguria Phase > HTN > Anemia > CHF > PE > SOB > Peripheral Edema > Confusion > MI > Normal-Decreased Urine Output > Oliguria > Proteinuria > Hyperkalemia -- Diuresis Phase > Diuresis > Increased Mental & Physical Ability > Up to 3 Weeks > Hypovolemia -- Recovery Phase > 3-12 Months > Pain > Loss of Kidney Function

Anemia Anorexia & Weight Loss from Uremic Syndrome Fluid Retention Uremia Azotemia Proteinuria HTN Edema Diabetes Mellitus

Signs & Symptoms/ Clinical Manifestations

Hemodialysis Catheter -- Subclavian (Temporary), IJ, Femoral Internal Arteriovenous Fistula -Internal A-V Fistula -- Top -- Preferred -- Mature in 2-3 Months -- Hand Exercises A-V Graft -- Bottom -- Diabetics Pruritis Dialyzer -- Diffusion -- Osmosis -- Ultrafiltration -- Dialysate

SYSTEM Condition

RENAL ACUTE RENAL FAILURE

Oliguric Phase -- Decreased Output < 400 mL/day, < 30 mL/hr -- Increased K+ -- Increased Ca+ -- Increased Na+ -- Increased BUN -- 80-100 -- Increased Creatinine -- Decreased Hct -- Decreased GFR -- hrs-days -- Increased Urea -- Decreased Albumin -- Decreased Specific Gravity -- fixed -- Brown Casts -- Metabolic Acidosis Diuretic Phase -- Output 3-5 L/day -- Increased BUN -- Decreased Na+ -- Decreased K+ Recovery Phase -- Decreased GFR -- 3 Persistent ARF -- Complete Loss of Kidney Function > 4 Weeks Oliguric Phase -- Hyperkalemia -- LifeThreatening -- Increased Respirations, Nausea, Headache, Palpitations, Malaise

CHRONIC RENAL FAILURE

Stage 1 -- Reduced Renal Reserve Stage 2 -- Renal Insufficiency Stage 3 -- End-Stage Renal Disease (ESRD)

HEMODIALYSIS
CAVHF -- Continuous A-V Hemofiltration CAVHD -- Continuous A-V Hemodialysis CVHF -- Continuous V Hemofiltration CVHD -- Continuous V Hemodialysis CVVHD -- Continous V-V Hemofiltration with Dialysis CRRT -- Continuous Renal Replacement Therapy

Assessment & Diagnostic Findings

Diuretics Ineffective Osteodystrophy -- If Too Much Protein & Phosphorus Not Reversible

Complications

Steal Syndome -- Distal Hypoperfusion & Ischemia -- "Steels the Blood" -- 5%10% Hypotension -- Fluid Removal -- Vomiting -- Malnutrition Muscle Cramps -- Late -- Bone Pain & Functions Dysrhythmias -- Fluids & Electrolytes Air Emboli -- Lines Chest Pain Dialysis Disequilibrium -- CSF Shift Hemorrhage Seizures -- If Rapid Fluid Decrease Contraindicated -- If Cannot Receive Anticoagulants Hematoma Pneumothorax Infection Thrombosis of Subclavian Vein Anemia

SYSTEM Condition

RENAL ACUTE RENAL FAILURE

Oliguric Phase -- Safety Precautions -- Limit Fluids -- Administer Kayexalate -- Dialysis -- Diet -- Decrease K+ -- For Blood Flow & BP -- Low Dose Dopamine (Intropin) -- 1-3 mcg/kg Diuretic Phase -- Fluids as Desired -- Increase K+ & Na+ -- Dialysis -- Fluid Boluses -- Dilantin or Composine -- For Nausea & Vomiting -- Tylenol -- Kayexalate -- Lasix, Bumex Recovery Phase -- Increase Calories -- Increase Protein -- D/C ACE Inhibitors Urinalysis Renal Ultrasound IV -- Bicarb -- Give 1st to Protect Kidney

CHRONIC RENAL FAILURE

Dialysis Renal Transplant Diet -- Low Phosphorus, Low Protein IV -- Regular Insulin with D5W -- To Move K+ from ECF to ICF NO METFORMIN Ca+ & Vitamin D Supplements Erythropoietin (E-pogen) -- For Anemia Fluid Restriction Urinalysis Anti-HTNs Reglan Digoxin Na+ Bicarb -- For Metabolic Acidosis

HEMODIALYSIS
Pharmacologic Therapy Nutrition Fluids Mucomyst -- Protects Kidneys Restrict Protein, Fluids, K+, Na+ Vancomycin Benadryl -- Pruritis

Medical Management/ Treatment

SYSTEM Condition

RENAL ACUTE RENAL FAILURE

Reversible -- Renal Function & Nutrition Electrolytes Monitoring IV Fluid Admin I&O Monitoring VS Bladder Scan Daily Weights -- Monitoring Skin Emotional Bedrest Patient Teaching -- Dialysis & Access Care Oliguric Phase -- Safety Precautions -- Fluid Restriction -- Kayexalate Admin -- ADLs -- Diet -- Decrease K+ (Apples) Diuretic Phase -- Give Fluids -- K+ & Na+ Admin -- Monitor Closely -- Check Thrill & Bruit -- Every 8 Hrs Recovery Phase -- Diet -- Increase Protein & Calories

CHRONIC RENAL FAILURE

Patient Privacy Diet -- Low Phosphorus, Low Sodium, Low Portein IV & Fluid Supplement Admin -- Ca+ & Vitamin D Dialysis Interventions Daily Weights -- Monitor -- Gain = Fluid Retention, Loss = Anorexia I&O Monitoring Fluid Restriction -- 500-600 mL/day Prevent Hyperkalemia

HEMODIALYSIS
Access Device Protection -- Failure of Permanent -- Clot Off or Infecton Assess Cardiac & Respiratory Complications -- Hypotension -- Hypertriglyceridemia F & E Balance Infection Prevention Psychological Support Check Thrill & Bruit -- Q8h Comfort -- Phosphorus Deposits in Skin Cause Itching BP & VS Monitoring -- 1st Intervention Hemorrhage Monitoring Patient Teaching -- Protect Access Skin Sterile Technique Check for Steal Syndrome -- 3 P's -- Pain -- Pulselessness -- Pallor Sensation, Temperature, Pulse, Pallor, Capillary Refill, Allen Test, Pain Psychological Support

Nursing Management/ Interventions

SYSTEM Condition KIDNEY TRANSPLANTS

Chronic Renal Failure Renal Trauma -- Abrasions, Lacerations, Crushed -- Kidney Grading System 1-5

RENAL UTIs
Lower Urinary Tract Infections -- LUTI Cystitis Normal -- Bladder Sterile Uropathogenic Bladder Infection Through Ascending Bacteria Commonly from E. Coli Urinary Stasis Tubing on Floor Incontinence Reflux

ACUTE & CHRONIC PYELONEPHRITIS

Bacterial Infection of Renal Pelvis, Tubules & Institial tissue of 1 or Both Kidneys -- E. Coli Mostly Through Ascending Bacteria Through Ureters Enlarged Kidneys with Potential for Scarring Tumor Obstruction Chronic -- Repeat Bouts of Acute Pyelonephritis -- Diabetes Mellitus Flank Pain -- CVA Tenderness Chills Fever Leukocytosis Bacturia Pyuria Interstitial Filtration Chronic -- No Signs or Symptoms Urinalysis -- Protein Casts CT Scan Ultrasound Sepsis Chronic -- Urine Specimen -- Protein Casts -- Creatinine Clearance -- BUN -- Urine Cultures

Pathophysiology/ Prognosis

Hematuria -- Renal Trauma

Signs & Symptoms/ Clinical Manifestations

Urine Samples -- All H&H CT Scan

Urgency Frequency Burning on Urination Pyuria Pain

Assessment & Diagnostic Findings

Increased WBCs Urine C&S -- 1st Intervention Specific Gravity Osmolality Renal Function Tests BUN Creatinine Creatinine Clearance CBC -- RBCs Glucose Protein

SYSTEM Condition KIDNEY TRANSPLANTS

Hemorrhage, Shock, Other CoMorbidities Infection, Hydronephrosis, Pyelonephritis, Obstruction, DVTs, HTN Acute Rejection Signs -- 1 Week to 2 Years -- Oliguria -- Anuria -- Increased Temp > 100 F -- Increased BP -- HTN -- Flank Tenderness -- Lethargy -- Decreased Specific Gravity -- Fluid Retention -- Edema, Weight Gain Chronic Rejection Signs -- Gradual Over Months-Years -- Gradual Increased BUN & Creatinine -- Electrolyte Imbalances -- Fatigue New Kidney Inserted on Opposite Side of Body in Iliac Fossa Immunosuppressants -- Lifelong -Prevents Rejection -- Cyclosporine (Sandimmune) Prednisone -- Short Time Follow-Up -- To 2 Years

RENAL UTIs
Elderly -- Most At Risk -- Decreased Bladder Tone -- Diminished Thirst -- Higher Urosepsis

ACUTE & CHRONIC PYELONEPHRITIS

If Pregnant, Hospitalize Chronic -- Scarring

Complications

Medical Management/ Treatment

Force Fluids -- 3000 mL/day Acidify Urine Antibiotics -- Septra Lithotripsy -- Urolithiasis for Ca+ Renal Calculi Pain Meds -- Renal Calculi Anti-Spasmodics Analgesics -- Pyridium -- Urine Orange Bladder Scan Doppler -- Pulses Meds Avoid Irritants Void Q2-3h Clean Catch Urine Specimen -- For C&S ECG Monitor -- Lithotripsy Patient Privacy Force Fluids -- 3000 mL/day Cranberry Juice -- Acidifies Urine Patient Teaching -- Women Void Before Intercource, Clean After Urination from Front to Back Strain All Urine for Stones

Bedrest Antibiotics -- Doxycycline Chronic -- Dialysis -- Transplant -- Antibiotics -- Long Term -Doxycycline

Nursing Management/ Interventions

I&O Monitoring -- 30 mL/hr minutes after Daily Weights -- Monitoring -- If Weight Gain = Fluid Retention Rejection Signs -- Monitoring -- Daysto-Weeks ALWAYS Use Sterile Technique Limit Exposure to Infection -- LifeThreatening

Watch for Relapse Med Admin Chronic -- Patient Privacy -- Hydrate -- Empty Bladder Regularly -Prevents Infection -- Hygiene -- I&O Monitoring -- Daily Weights

 Limit Exposure to Infection -- LifeThreatening

-- Hygiene -- I&O Monitoring -- Daily Weights

SYSTEM Condition POLYCYSTIC KIDNEY DISEASE

Hereditary -- Autosomal -- 30 Years -Begins In Utero

Pathophysiology/ Prognosis

Back Pain Flank Pain HTN Hematuria Pulmonary Edema Family History Urine -- Foul Odor & Cloudy

Signs & Symptoms/ Clinical Manifestations

H&H IV Urography -- To Confirm Increased BP

Assessment & Diagnostic Findings

SYSTEM Condition POLYCYSTIC KIDNEY DISEASE

Main Cause of Death -- Coronary Vascular Disease End-Stage Renal Disease (ESRD) No Cure

Complications

Medical Management/ Treatment

Thiazides -- Distal Tubules -- Diuretics Blood Transfusions Dialysis or Transplant Kayexalate with Sorbitol Aldactone Lasix Potassium Gluconate Insulin Glucose E-pogen Vitamin D Ca+ & Phosphate Supplements Na+ Bicarbonate, Mg, K+ Antibiotics Cardiac Glycosides Anti-HTNs

Nursing Management/ Interventions

Patient Privacy Teach & Mgmt -- Infection Prevention Avoid Sports, Risky Occupations

SYSTEM Condition

PERITONEAL DIALYSIS
Chronic or Acute Renal Failure For Ambulatory Patients

Pathophysiology/ Prognosis

Signs & Symptoms/ Clinical Manifestations

SYSTEM Condition

PERITONEAL DIALYSIS
CAPD -- Continuous Ambulatory Peritoneal Dialysis -- Patient Self-Dialyzes 24 Hrs x 7 Days -- Dwell 4-8 Hrs APD -- Automated Peritoneal Dialysis -- Warming Chamber -- Dwell/Drain/Volume Set -- 30 Minute Exchange x 8-10 Hrs -Lowest Infusion Rate IPD -- Intermittent Peritoneal Dialysis -- Automated or Manual -- 4 Days/Wk x 10 Hrs/Day CPD -- Continuous Peritoneal Dialysis -- Automated at Night -- Dwell During Day

Assessment & Diagnostic Findings

Complications

Peritonitis -- Life-Threatening -Infection -- If Dialysate Effluent -- Cloudy Seizures -- If Rapid Fluid Decrease Decrease K+ -- Risk for Cardiac Arrhythmias Protein Loss Weight Gain -- 3-5 Lbs/Month Hyperglycemia, Dyslipidemia -- Over Time Hemorrhoids Back Pain CVD -- Highest Risk of Death

SYSTEM Condition

PERITONEAL DIALYSIS
Need Consent Diet -- Low Carb, High Protein, High Fiber No Fluid Restriction Meds in Dialysate -- Insulin, Heparin, KCl, Tylenol

Medical Management/ Treatment

SYSTEM Condition

PERITONEAL DIALYSIS
Warm Solution with Heating Pad Access Device Protection Empty Bowels & Bladder Before Treatment Cardiac & Respiratory Complication Assessment -- Hypotension Fluid & Electrolyte balance Infection Prevention BP & VS Monitorings -- 1st Intervention Sterile Technique Comfort Psychological Support Weigh Patient Before & After Treatment -- Should Weight More Before

Nursing Management/ Interventions

SYSTEM Condition GLOMERULAR FILTRATION RATE

Pathophysiology/ Prognosis

Signs & Symptoms/ Clinical Manifestations

Assessment & Diagnostic Findings

SYSTEM Condition GLOMERULAR FILTRATION RATE

Complications

Medical Management/ Treatment

Nursing Management/ Interventions

SYSTEM Vocabulary Anatomy & Physiology General Assessment Lab Values

Lab Values

Diagnostics Radiographic & Others

SYSTEM Condition

Pathophysiology/ Prognosis

Signs & Symptoms/ Clinical Manifestations

Assessment & Diagnostic Findings

Complications

Medical Management/ Treatment

Nursing Diagnoses