NUR 265 EXAM ONE STUDY GUIDE.

NUR 265 EXAM ONE STUDY GUIDE

 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