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Advanced Med Surg - Exam 4 - Renal

Galen College of Nursing - Advanced Med Surg - Renal
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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