Nur 265 Exam One Study Guide, Complete Solution

NUR 265 EXAM ONE STUDY GUIDE, COMPLETE SOLUTION • Nephrotic Syndrome: ◦ NS is a condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. ◦ Immunological Kidney disorder ◦ 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. ◦ 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) ◦ 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) ◦ 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: ◦ 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 ◦ 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). ◦ GFR isn’t used to measure acute injury or illness—only chronic kidney disease. ◦ 3 types of AKI ▪ prerenal - conditions that reduce blood flow / oxygen to the kidney → decreased perfusion to kidneys • azotemia- nitrogenous waste/toxin build up ◦ effects LOC, mood, change in personality ◦ related directly to reduced perfusion to the kidneys • examples of perfusion reduction: ◦ blood/fluid loss- (surgery, sepsis, hypovolemic shock) ◦ blood pressure drugs resulting in hypotension ◦ MI or HF → low ejection fraction → low cardiac output ◦ NSAIDs, ASA ◦ Anaphylaxis ◦ Severe burns ◦ Severe dehydration ◦ Renal artery stenosis ◦ Bleeding or clotting in kidney blood vessels ◦ 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: ◦ Bleeding in the kidney ◦ Glomerulonephritis or inflammation of the glomeruli ◦ Pyelonephritis ◦ Thrombi or emboli in the kidney blood vessels ◦ TTP → platelet disorder ↑ clotting ◦ Sepsis or local infection ◦ Lupus ◦ Multiple myeloma ◦ Scleroderma ◦ Chemo/ ABTs / nephrotoxic drugs ◦ Ischemia in kidney failure, including hypoxemia from respiratory and cardiac arrest ▪ Post-renal failure- Urine flow obstruction • Post-renal failure examples: ◦ Bladder cancer ◦ Colon cancer ◦ Prostate cancer ◦ Cervical cancer ◦ Enlarged prostate ◦ Kidney stones ◦ Blood clots in urinary tract