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 Neurogenic bladder →Nerve damage 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 Oliguria Fluid Volume Overload Crackles Edema Anasarca (generalized edema) ↓ 02 sats ↑ RR LOC changes Labs (↑BUN, ↑Cr, urine specific gravity 1.030) 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 Labs (BUN, Cr, GFR, electrolytes, osmolarity) I&Os You want output to be more than input Sodium, potassium, and specific gravity determine hydration status. Contrast dyes 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: Low protein Because protein molecules are huge and put on the strain to process Low sodium Since the body has high sodium concentration due to AKI Fluid restriction