NUR 265 EXAM ONE STUDY GUIDE, COMPLETE SOLUTION

NUR 265 EXAM ONE STUDY GUIDE, COMPLETE SOLUTION • Nephrotic Syndrome: o NS is a condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. o Immunological Kidney disorder o This causes massive loss of protein in the urine, edema formation, and decreased plasma albumin levels. ▪ Proteinuria- severe protein loss more than 3.5 g in 24- hour urine sample. o Key features: ▪ Massive proteinuria 3.5g / 24hrs ▪ Hypoalbuminemia 3g/dL ▪ Edema (facial and periorbital) ▪ Lipiduria ▪ Hyperlipidemia ▪ Increased coagulation (renal vein thrombosis) ▪ Reduced kidney function (↑ BUN, ↑ Cr, ↓ GFR) o Treatment- immunosuppressant agents (if immunity based). ▪ ACE inhibitors (to decreased protein loss in urine & ↓BP) ▪ Statins (improve blood lipid levels). ▪ Heparin (↑ coagulation / risk of thrombosis → treat vascular effects and improve kidney function) o Diet: ▪ If GFR is normal- dietary intake of complete proteins is needed ▪ If GFR is decreased- dietary protein is decreased, diuretics and sodium restriction. • Acute Kidney Injury: o AKI is rapid reduction in kidney function resulting in a failure to maintain fluid and electrolyte balance, and acid-base balance. ▪ Can occur over a few hours or days o Severity of AKI is based on serum creatinine increase, and decreased urine output- an increase in specific gravity (meaning urine is more concentrated or the patient is dehydrated). o GFR isn’t used to measure acute injury or illness—only chronic kidney disease. o 3 types of AKI ▪ prerenal - conditions that reduce blood flow / oxygen to the kidney → decreased perfusion to kidneys • azotemia- nitrogenous waste/toxin build up o effects LOC, mood, change in personality o related directly to reduced perfusion to the kidneys • examples of perfusion reduction: o blood/fluid loss- (surgery, sepsis, hypovolemic shock) o blood pressure drugs resulting in hypotension o MI or HF → low ejection fraction → low cardiac output o NSAIDs, ASA o Anaphylaxis o Severe burns o Severe dehydration o Renal artery stenosis o Bleeding or clotting in kidney blood vessels o Atherosclerosis (cholesterol deposits obstructing blood flow to the kidneys) ▪ Intra-renal failure- tissue damage to the actual kidneys • Intra-renal- reflects injury to the glomeruli, nephrons, or tubules • Examples of intra-renal failure: o Bleeding in the kidney o Glomerulonephritis or inflammation of the glomeruli o Pyelonephritis o Thrombi or emboli in the kidney blood vessels o TTP → platelet disorder ↑ clotting o Sepsis or local infection o Lupus o Multiple myeloma o Scleroderma o Chemo/ ABTs / nephrotoxic drugs o Ischemia in kidney failure, including hypoxemia from respiratory and cardiac arrest ▪ Post-renal failure- Urine flow obstruction • Post-renal failure examples: o Bladder cancer o Colon cancer o Prostate cancer o Cervical cancer o Enlarged prostate o Kidney stones o Blood clots in urinary tract o Neurogenic bladder →Nerve damage o Mean atrial pressure is important in determining adequate kidney perfusion!!! ▪ MAP= (systolic+ 2[diastolic])/3 Mean atrial pressure of 65 is needed to perfuse the kidney!! Manifestations (s/s) of AKI o Oliguria o Fluid Volume Overload ▪ Crackles ▪ Edema ▪ Anasarca (generalized edema) ▪ ↓ 02 sats ▪ ↑ RR o LOC changes o Labs (↑BUN, ↑Cr, urine specific gravity 1.030) o Nursing considerations / Interventions for AKI: ▪ Prevention is key! - urge patients to drink 2-3 L of water daily. • Monitor Fluid status (I&O, weight, ↑ hydration, characteristic of urine) • Report Output 0.5mL/kg/hr if persists 2hr 30mL/hr • Monitor for kidney functions o Labs (BUN, Cr, GFR, electrolytes, osmolarity) o I&Os ▪ You want output to be more than input ▪ Sodium, potassium, and specific gravity determine hydration status. o Contrast dyes o MAP 65 mmHg • Diuretic therapy- happens after AKI is starting to be resolved! (Releasing extra fluid through the urine - This is a good sign!!! - Watch for dehydration! - Its normal to have fluids hanging during the diuretic phase! - Titrate fluids!) • Nutrition during AKI: o Low protein ▪ Because protein molecules are huge and put on the strain to process o Low sodium ▪ Since the body has high sodium concentration due to AKI • Fluid restriction o if AKI was due to anything except for perfusion problem • Hemodynamic Monitoring o Temporary Kidney Replacement Therapy ▪ → for Symptomatic Uremia (critical electrolytes, toxicity, metabolic acidosis, fluid overload that inhibits tissue perfusion) ▪ Removes toxins ▪ Requires immediate vascular access • If RRT occurs for 4 weeks or less, then there is no loss of kidney function • If RRT occurs for 3 months or more it is considered kidney failure • Chronic Kidney Disease o CKD- progressive, irreversible disorder and kidney function doesn’t recover. o Focus / Teach on reducing risk factors to slow Progression! o CKD is normally a result of another condition that compromises the kidneys and takes years to progress ▪ Hypertension ▪ Uncontrolled diabetes ▪ Renal stenosis ▪ Infection ▪ Glomerulonephritis ▪ Polycystic kidney disease ▪ African Americans are 4 times more likely to get it o Azotemia- nitrogenous waste build up o Uremia- azotemia with clinical manifestations ▪ Manifestations of uremia • Metallic taste in mouth • Anorexia • Nausea/vomiting • Muscle cramps • Uremic frost on skin • Itching • Fatigue and lethargy • Hiccups • Edema • Dyspnea • Paresthesia o Stages of chronic kidney disease: