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Galen College of Nursing - Advanced Med Surg - Renal

What will be common with dialysis, especially peritoneal dialysis?

Abdominal pain

If outflow drainage is inadequate with peritoneal dialysis what should the nurse do?

check for kinks, roll or turn patient

Creatinine will do what when renal function is lost?

increase by 50%

What percent of blood flow goes through the kidneys?

20-25%

What does aging do to the kidneys?

shrinks them, creates urgency to void and incontinence, blood flow decreases by 10% per decade

Is BUN increase specific for renal?

No

What other reasons would BUN be elevated?

hypovolemia, starvation, dietary, hydration, nephrotoxic, UTI's

What is the more specific lab test for renal function other than BUN?

Creatinine

What is creatinine not affected by?

dietary intake or hydration

What does the Creatinine Clearance show?

How well the kidneys are functioning, the most accurate renal test

BUN can be decreased by what diet?

high protein or low carb diets

What percent of all kidney tumors are malignant?

85

Is a kidney tumor slow or fast growing?

slow

Risks for kidney cancer?

smoking, HTN, obesity, Exposure to lead (Painters)

What gender does renal cancer affect more?

Males

Clinical manifestations of renal cancer

hematuria, flank pain, palpable abd mass

How many months between onset of hematuria and abd pain for renal cancer?

9 months

How many months between abd pain and diagnosis of renal cancer?

14 months

Renal Carcinoma Stage 1

In capsule, 65% survival rate

Renal Carcinoma Stage 2

In fat, 40% survival rate

Renal Carcinoma Stage 3

In renal vein, rarely have 5 year survival rate

Renal Carcinoma Stage 4

In lung, heart, liver, bone, rarely have 5 year survival rate

Renal traumas are caused by

traffic accidents, stabbing, gun shot wounds

Why are renal traumas uncommon?

the rib cage and surrounding heavy muscles offer protection

A contusion to the kidney can cause

intrarenal bleeding

Minor and Major lacerations can cause

hemorrhage

When will you see Grey Turner's sign?

with renal trauma, especially minor and major lacerations

What is Grey Turner's sign?

bruising around the back and on flank, blood in the tissue

What is the patient susceptible to with lacerations?

sepsis

What is the cardinal sign of renal trauma?

Hematuria, seen in 80% of cases

How are renal injuries usually treated (Except for a clot)?

Conservatively (not rushed to surgery)

What is Acute Renal Failure?

Abrupt loss of kidney function

What do Creatinine and BUN do in ARF?

Increase

What does GFR do in ARF?

Decrease

Normal Urine output?

400/ml/24 hrs or more

Oliguria?

100 - 400ml/24 hrs

Anuria?

less than 100 ml/24 hrs

Causes of ARF?

Prerenal, Intrarenal and Postrenal

Prerenal cause of ARF

hypovolemia, fluid shifts, gram negative sepsis, decreased C.O., Decreased peripheral vascular resistance, vascular obstruction

Anything that stops perfussion or is volume related is what kind of cause of ARF?

prerenal

If fluid is in the tissue rather than in the vascular space and there is decreased peripheral vascular resistance what is needed?

A fluid bolus

What is the most common cause of ARF?

Intrarenal or Acute tubular necrosis

Acute tubular necrosis?

most common cause of intrinsic renal failure. abrupt damage b/c of decrease blood flow associated with shock. characterized by destruction of tubular epithelial cells

Intrarenal cause of ARF

Acute tubular necrosis, damage from nephrotoxins, rhabdomyolysis, surgery, crush injuries, electric shock, use of statin drugs, seen in patients "found down"

Treatment for acute tubular necrosis?

bed rest, correct electrolytes, fluid volume and dialysis

Post renal cause of ARF?

Prostate disease, obstruction (stones), pelvic trauma, surgical accidents, spinal cord injury

Phases of acute renal failure

Onset, Oliguric-anuric, diuretic and recovery

rhabdomyolysis

A condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure

Onset phase of acute renal failure

starts with the precipitating event and continues to the development of renal symptoms (labwork)

Oliguric - Anuric phase of acute renal failure

lasts 1-8 weeks, the longer this phase lasts the poorer the prognosis

Diuretic phase of acute renal failure

starts when BUN and Creat get back to normal

What is most important in the diuretic phase of acute renal failure?

Hydration! Patients can die in the this phase if they aren't hydrated

Recovery phase of acute renal failure

3-12 months long, mild abnormalities, decreased concentration of urine

What is patient at risk of for the rest of their life in the recovery phase of acute renal failure?

Fluid and Electrolyte imbalances

What is a significant cause of death for patients with ARF?

infection

How to prevent infection for pts with ARF?

strict sterile technique, avoidance of indwelling cath's

Medical management of ARF

Prevention, hydration, adequate diuresis, watch labwork, I&O, weights, maintain fluid and electrolyte balance, replace renal function (dialysis), prevent infection

Complications associated with ARF

Pericarditis (fluid backs up), Tachy, fever, friction rub, seizures (due to increased BUN), anemia (due to bleeding from trauma)

Nursing management for ARF

fluid volume deficit or excess, imbalanced nutrition, impaired skin integrity, risk for infection, anxiety

What kind of diet do you want for ARF?

High calorie, low protein

Older clients are at risk for ARF due to decreased what?

cardiac output

Chronic Renal failure

Progressive and irreversible reduction of functional renal tissue

Stage 5 of chronic renal failure is called what?

End stage renal disease

Renal Failure

When kidneys can no longer maintain the body's internal environment

If ARF event happens and a pt does not recover what can happen?

CRF

#1 cause of CRF?

Diabetes (more than 30% of dialysis patients are diabetic

#2 cause of CRF?

HTN

ESRD involves deterioration of _________ with progressive loss of renal function.

nephrons

Clincial manifestations of CRF

Electrolyte imbalance which includes weakness, diarhea, abd cramping, hyperkalemia, hypercalcemia, loss of blood pressure regulation, loss of erythropoietin

Types of dialysis

Peritoneal (continuous and automated), hemodialysis

Peritoneal dialysis

maintain themselves at home, used for clients with severe cardiovascular disease

Hemodialysis

requires AV fistula, dialysis catheter, go to a facility to have done

Most common type of Peritoneal dialysis

tenckhoff

Nursing management before dialysis

complete assessment, v/s, weight, assess the access site (listen for bruit on fistula), review lab results, check meds

What to do with meds for dialysis pt

hold 4 hours before give after

What med is given for BP drops in dialysis?

Dopamine

Nursing Management after dialysis

assessment, v/s, weight, assess access site, monitor for s/s of bleeding or infection, watch for signs of confusion, decreased level of consiousness, sudden severe headache, monitor lab results, administer meds

Why will dialysis get stopped?

Low BP, sudden severe headache, decreased level of consiousness

Renal transplant

surgical implantation of human kidney from a compatible donor

Where is a transplanted kidney placed?

It is attached to the iliac artery

Nursing management for renal transplant?

Monitor for graft rejection, cardiopulmonary complications

S/S of graft rejection

fever, fatigue, tenderness at site, anemia, increased BUN

What is administered for rejection?

steroids

Patient education for renal transplant?

immunosuppressive medications, follow up with MD

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