NUR 265 Exam 1

1. What is nephrotic syndrome? - A condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. 2. What are key features of nephrotic syndrome? – -*Massive proteinuria* -*Hypoalbuminemia* -*Edema (facial and periorbital) * -Lipid Uria -Hyperlipidemia -Increased coagulation -Reduced kidney function 3. In nephrotic syndrome, severe protein loss in the urine is greater than what? - 3.5g in 24 hours 4. What is nephrotic syndrome treated with? -immunosuppressant agents (if immunity based). -ACE inhibitors (decreased protein loss in urine) -statins (improve blood lipid levels). -Heparin (used to treat vascular effects and improve kidney function) 5. Describe the "risk" stage for AKI - creatinine x 1.5 of normal, and GFR reduced by 25% 6. Describe the "injury" stage for AKI - creatinine x2 & GFR reduced by 50% 7. Describe the "failure" stage for AKI - creatinine x3 normal, & GFR reduced by 75% (Can’t fix) 8. Describe Prerenal AKI. Give examples. - Decreased perfusion to kidneys. -NSAIDs -Severe dehydration -Renal artery stenosis -MI or HF resulting in low ejection fraction and low cardiac output -Blood/ fluid loss 9. Describe Intrarenal AKI. Give examples. - Tissue damage to the actual kidneys. -Glomerulonephritis or inflammation of the glomeruli -Sepsis -Intrarenal bleeding -Pyelonephritis 10. Describe Postrenal AKI. Give examples. - Obstruction that occurs after the kidney. -Enlarged prostate (BPH) -Bladder Cancer -Kidney stones 11. How do you determine the mean arterial pressure (MAP)? - Systolic + (Diastolic*2) /3 12. What is the MAP needed to perfuse the kidneys? - 65 mmHg 13. What are examples of nephrotoxic drugs? -NSAIDS -Metformin -Diuretics -Antibiotics (especially -mycin) -Contrast dye 14. During the diuretic phase of AKI, what needs to be monitored? - Watch for dehydration and make sure output is greater than input 15. What are the dietary restrictions for an AKI patient? -Low protein -Low sodium -Fluid restriction: mL day (for anything except perfusion problem) 16. What are the 2 most common causes of CKD? -HTN -Uncontrolled diabetes 17. What is azotemia? - Nitrogenous waste build up 18. What are manifestations of uremia? •Metallic taste in mouth •Anorexia •Nausea/vomiting •Muscle cramps •Uremic frost on skin •Itching •Fatigue and lethargy •Hiccups •Edema •Dyspnea •Paresthesia's 19. What effects can CKD have on the cardiac system -HTN -Heart failure (major problem. Call the doctor) -Pericarditis 20. What effects can CKD have on the Integumentary system -Uremic frost 21. What are the dietary restrictions on CKD? -Protein (restrict early in disease process to preserve kidney function) -Potassium -Fluid -Sodium 22. Describe hemodialysis -3x a week- 4-5 hours -At risk for bleeding do to heparin -Extremely fatigued post. -Vitals and weight before and after -Slight fever post is normal. Monitor. 23. Describe peritoneal dialysis -Sterile procedure at home where catheter is placed into the abdomen -Wear a mask -Solution may be warmed using a heating bag or blanket, not microwave! -Make sure patient turns and repositions to mix solution in the cavity 24. Describe nursing care for an AV fistula. – -Palpate and auscultate- bruit and thrill -Distal pulses -ROM- helps form the fistula -Monitor for infection -No heavy lifting or carrying -No pressure -Aneurysm can form at AV fistula site 25. Describe dialysis disequilibrium syndrome – -Life threatening! (occurs if fluid is pulled off too fast) -S/S: restless, headache, decreased LOC, seizures, coma -Call a rapid immediately -Give barbiturates and anticonvulsants 26. What is cirrhosis? - An extensive, irreversible scarring of the liver. 27. What are common causes of cirrhosis? – -ETOH -Viral hepatitis (HEP C) -Autoimmune hepatitis -Drugs and chemicals (aetaminophen or anything else hepatotoxic) 28. What are early S/S of cirrhosis? – -Enlarged liver -Fatigue -Weight loss -Anorexia -N/V -Abdominal pain 29. What are end stage S/S of cirrhosis? – -Ascites -Small liver -clotting disorder (bruising, GI bleed) -Jaundice -Elevated ammonia levels (give Lactulose) -Hepatic encephalopathy -Decreased bile production 30. What are the stages of hepatic encephalopathy? – -Stage 1: personality changes, subtle things that may not be recognized -Stage 2: Continuing mental changes, mental confusion, disorientation to time, place, and person -Stage 3: Marked mental confusion, progressive deterioration -Stage 4: metabolic acidosis, unresponsiveness leading to death in most patients, unarousable 31. What causes hepatic encephalopathy? - The buildup of ammonia in the body 32. Describe the physical assessment of an end stage cirrhosis patient. -Ascites -Jaundice -Coagulation problems -Fatigue -Spider angiomas -Petechiae -Liver flaps (asterixis)