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Nsg 210 Ch. 44

Renal Disorders

500ml of gained wt equals how many pounds? 1 lb or 1kg = 1,000ml 10lb = 5L = 2500ml
s/s of: FVD FVE FVD: wt loss < or equal of 5%, decr skin turgor, dry mucous memb, oliguria/anuria, incr hematocrit, BUN incr out of propor to creatinine FVE: crackles, distended neck vv, wt. gain, edema, decr BUN, hematocrit
s/s of hypo/hypernatremia 135-145 hypona: nausea, malaise, lethargy, HA, abd cramps, apprehension, seizures hyperna: dry sticky mucous mem, thirst, rough dry tongue, fever, restlessness, weakness, disorientation
s/s of hypo/hyperkalemia <3.5 hypo: anorexia, abd distention, paralytic ileus, muscle weak, ECG changes, dysrhythmias >5.0 hyper: diarrhea, colic, N, irritable, muscle weak, ECG change
s/s of hypo/hypercalcemia <8 hypo: abd/muscle cramps, stridor, hyper reflexes, tetany, +Chvostek/Trousseau, tingle finger/mouth >10 hyper: bone/flank pain, muscle weak, depressed reflexes, constipation, N/V, confusion, stones
s/s Mg hypo/hypermagnemesia hypo: like hypocalcemia tx: diet, mg hyper: like hypercalcemia, flushing, resp dep, cardiac arrest tx: Ca gluconate, vent, dialysis
s/s hypo/hyperphosphetemia hypo: like hypercalcemia tx: diet, phosphorus oral hyper: like hypocalcemia tx: diet restrict, phosphate binders(Os-Cal, PhosLo), NS, IV dextrose, insulin
Tx for hypo/hyper fluid volume FVD tx: fluids FVE tx: fluid/Na restrict, diurectics, dialysis
Tx for hypo/hypernatremia hypo tx: diet, NS, hypertonic saline hyper tx: fluids, diurectics, diet restrict
tx for hypo/hyperkalemia hypo tx: diet, PO K, hyper tx: diet restrict, diurectics, IV glucose, insulin and Na bicarb, Ca gluconate, dialysis
tx for hypo/hypercalcemia hypo tx: diet, Ca salt PO hyper tx: fluids, etidronate, pamidronate, mithramycin, calcitonin, glucocorticoids, phosphate salts
mild/mod/severe renal disease mild: GFR 60-90 mod: GFR 30-59 severe: GFR 1-29 ESRD: <15
hardening of the renal aa is termed? nephrosclerosis r/t htn and diabetes and major cause of ESRD and CKD
malignant nephrosclerosis is assoc with? benign? tx: malignant HTN >130 diastole assoc with atherosclerosis/HTN TX: Ace inhibitors & ARBs and treat DM
An inflammation of the glomerular capillaries is termed? cause? tx? nsg mgmt? glomerulonephritis r/t strep or infection. See protein/blood in urine tx: plasmophoresis, antibiotics, antiHTN, corticosteroids Nsg: carb diet to clear proteins, I/O
what is azotemia? abnormal concentration of nitrogenous waste in blood
These s/s are seen in renal failure or chronic glomerulonephritis hyperkalemia- not pass K metabolic acidosis: not pass acid and not regenerate bicarb anemia- decr erythropoiesis hypoalbuminemia- protein loss incr phosphate - not lose phosphate decr Ca- Ca binds phosphate mental changes impaired nerve cond - urem
Other s/s or renal failure enlarged heart, pulmonary edema, L vent hypertrophy, tented T waves from hyperK, shrinking kidney cortex
What happens with Goodpasture syndrome? tx? antibodies attack lung and renal tiss tx: immunosuppression wtih Cytoxin and steroids, plasmaphoresis/dialysis
One type of renal failure from incr glomerular permeability with massive proteinuria, edema, high cholesterol tx? nephrotic syndrome tx: protein diet(meat), diruetics, ACE inhibitors to reduce proteinuria, chol. meds
what is preferred tx for renal Ca? radical nephrectomy- remove kidney, adrenal gland, fat & lymph nodes Torisel is IV infusion to tx adv renal cell carcinoma
50% incr in creatinine above baseline indicates? ARF- acute renal failure
The three categories of ARF are prerenal: happens b4 reaches kidney(hypofusion) intrarenal: damage to glomeruli/tubules from inf, toxins, tumors, incr K/ph postrenal: after kidney(obstruction in tract: stones, prostate
What are the 4 phases of ARF intiation: initial insult, ends when oliguria starts oliguria: incr BUN, creatinine, K, Na diuresis: incr output recovery: takes 3-12mos
What is one of the earliest signs of tubular damage in the kidney? low sp. gravity, inability to concentrate urine
Decr GFR, oliguria, anuria make pt high risk for? tx? hyperkalemia Kayexalate, low dose dopamine, IV glucose & insulin or Ca Gluconate(drives K back into cell TEMPORARILY until removed dialysis Na Bicarb diet restrictions
Complications of ESRD and tx hyperkalemia pericarditis r/t uremic waste htn r/t na & h2o retention anemia bone disease r/t retention of phosphorus and low Ca and decr of Vit D
Med mgmt of ESRD antacids, antihtn(lisinopril), antiseizure(dilantin, Valium), EPO, restrict fluid, dialysis, transplant
Wastes and fluid are removed in dialysis by diffusion:high concentrationin blood to lower in dialysate osmosis:from low concentration(blood) to high concentration(dialysate bath)
what is preferred method of permanent access? arteriovenous fistula(AVF) by joining art to vein. Needs 2-3mos to mature b4 use
what is common complication of dialysis? diet? hypotension(N/V, diaphoresis, tachycardia, dizzy) SOB, muscle cramps, dysrhythmias diet: low protein, high calorie
What is main adv in peritoneal dialysis vs hemodialysis? PD for those who can't do hemo, more gradual, those susceptible to rapid fluid/electrolye/metabolic changes like diabetes, cardio pts and htn,HF, pul edema. PD takes 36-48h and hemo 6-8h
With dialysis, how should nurse adm htn meds? htn is common and htn meds must be withheld to avoid hypotension
what is main complication of kidney surgery? hemorrhage and shock
An important nsg fx for kidney transplant pts is assess psychological stress and coping
Created by: palmerag