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68wm6 p2 Dis of Kid

Disorders of the Kidneys

What do changes in the glomeruli interfere with in the PT with nephrotic syndrome? Changes in the glomeruli interfere with permeability, allowing protein loss through the kidney
What incites Nephrotic Syndrome? upper respiratory infection or allergic reaction.
What maintains serum osmotic pressure? Protein (More specifically Albumin)
What does a loss of serum protein result in? decreased serum osmotic pressure, allowing fluid to seep into interstitial spaces resulting in edema and decreased intravascular volume
What is a major cause of morbidity and mortality in PTs with Nephrotic Syndrome? Infection
Why is infection an increased threat in a PT with nephrotic syndrome? Immune responses are decreased in nephrotic syndrome
What characterizes nephrotic syndrome? *Marked proteinuria *Hypoalbuminemia *Edema
How does the urine appear in a PT with nephrotic syndrome (nephrosis)? Foamy from the presence of protein
What diet will a PT with nephrotic syndrome (nephrosis) be pplaced on? Low-sodium, High-protein (meat, fish, poultry, cheese, eggs)
What is Acute Glomerulonephritis? An inflammatory process of the kidneys usually preceded by an infection or other pre-existing disease (i.e., systemic lupus erythematosus)
Who does Acute Glomerulonephritis occur most in? Children and young adults
List 3 clinical manifestations of Acute Glomerulonephritis. *Periorbital edema and visual disturbances *Generalized edema, exertional dyspnea *Hematuria or other urinary disfunction *pain/tenderness in flanks *Cerebral involvement and altered mental status *HTN, CHF, distended neck veins
What is the diet for a PT with Acute Glomerulonephritis? Low protein, low sodium
What drug types are given for Acute Glomerulonephritis? Diuretics, Anti-HTN, Corticosteroids, Immunosuppressants, Iron and vitamins
Why is the PT with Acute Glomerulonephritis given a low sodium/low protein diet? to decrease blood urea levels.
What becomes the main energy source for a Acute Glomerulonephritis PT on a low sodium/low protein diet? Carbohydrates
What are signs and symptoms of worsening glomerulonephritis that need to be evaluated by a physician? *Hematuria *Headache *Edema *Hypertension
What is Chronic Glomerulonephritis associated with? with clients with multiple episodes of acute glomerulonephritis and autoimmune connective tissue disorders
When do the symptoms of Chronic Glomerulonephritis become apparent? When kidney damage is severe
What systemic issues can Chronic Glomerulonephritis lead to? *Hyperkalemia *Anemia *Hypoalbuminemia. *Metabolic acidosis *Hypomagnesemia
What may be done to determine the severity of renal involvement in the PT with glomerulonephrosis? Kidney biopsy
If the PT with Acute/Chronic Glomerulonephritis suffers from edema or HTN, what must they be placed on? Bedrest until edema/HTN is controlled
True or False: Acute renal failure is reversable with early intervention True. Often reversible in a majority of clients with early intervention.
List 4 causes of acute renal failure *Thrombosis of the renal arteries *Severe, prolonged hypotensive episodes *Loss of intravascular volume *Blood transfusion reactions *MI/CHF *Nephrotoxins *Crushing injuries
List 4 nephrotoxic drugs *Cephalosporins *Aminoglycoside *Amphotericin B *Lithium *Cimetidine *Ibuprofen *Chemo-therapy
Diabetes Mellitus contributes to what percentage of cases of acute renal failure? 40% of cases
What are the three phases of acute renal failure? *Oliguric *Diuretic *Recovery
What percentage of cases of acute renal failure occure in the pre-renal area? 40-70%
What percentage of cases of acute renal failure occure in the renal area? 20-50%
What percentage of cases of acute renal failure occure in the post renal area? 10-20%
How long can the oliguric phase of acute renal failure last? 4-6 weeks
What characterizes the oliguric phase of acute renal failure? Increased BUN and serum creatinine, decreased urine output, Metabolic acidosis, and Hyperkalemia.
What can the hyperkalemia from acute renal failure cause? life-threatening dysrhythmias
If acute renal failure is caused by hemorrhage, will it lead to a fluid volume deficit or overload? Volume deficit
If acute renal failure is caused by heart failure, will it lead to a fluid volume deficit or overload? Volume overload
True or False: Oliguria is always a defining factor in acute renal failure False. Nonoliguric renal failure also exists with urine output exceeding 2 liters/day
What characterizes the diuretic phase of acute renal failure? *Polyuria (May exceed 2L/day) *Hypokalemia *Hypocalcemia *Hyperphosphatemia
What characterizes the recovery phase of acute renal failure? Kidneys return to normal or near normal function.
How long can the recovery phase of acute renal failure take? May take up to one year
List 4 clinical manifestations of acute renal failure *Anorexia *N/V/D *Oliguria *Hematuria *Proteinuria *Lethargy *Muscle twitching and convulsion *Anasarca, edema
What activates the renin-angiotensin-aldosterone system (retaining Na+ and h2o leading to increased vascular resistance)? Decreased renal blood flow
What test results will confirm a Dx of acute renal failure? Elevated serum BUN and creatinine (azotemia) will confirm a diagnosis
Acute renal failure can cause decreased erythropoietin, which can lead to what? Decreased hemoglobin and hematocrit
What kind of diet should a PT with acute renal failure be put on? Low protein/potassium/sodium, high carbohydrate diet
What is used to manage fluid overload and treat electrolyte imbalances when drug therapy is unsuccessful? Renal dialysis
What are signs of worsening acute renal failure? *Decreased alertness *Confusion *Headache
Up to what percentage of renal function may be lost in a PT with chronic renal failure before symptoms are noticed? up to 80%
What is the terminal stage of chronic renal failure called? Uremia
Define uremia: a toxic state characterized by a marked accumulation of urea and other nitrogenous waste products in the blood
What is Uremic halitosis? Urine smelling breath
What is Uremic frost? Urine smelling skin
What causes uremic halitosis/frost Bodies inability to clear waste products from the kidneys, so they are excreted through the skin and lungs
What are notable clinical manifestations of end stage renal failure? *Anuria *Pulmonary edema, pneumonia, apnea or Cheyne-Stokes respirations *Uremic pericardial effusion - fluid surrounding the heart *Dusty yellow-tan or gray skin *Uremic halitosis, uremic frost *May progress to seizures and coma
What procedures are done to determine the level of function and degree of damage in renal failure? *Intravenous pyelogram (IVP) *Intravenous urography (IVU) *Renal biopsy
Patients with iron-deficiency anemia must be treated with what before receiving Epogen (synthetic erythropoieten)? Ferrous Sulfate (Iron)
List four medications that patients with chronic renal failure are prescribed: *Electrolyte replacements (Mg, Ca) *Diuretics (Lasix) *Antihypertensive agents *Anticonvulsants
Define hemodialysis: process by which blood is circulated with dialysate through a semi-permeable membrane to remove nitrogenous waste products, control fluid and electrolyte balance and maintain acid-base balance
Does hemodialysis work by diffusion or osmosis? Trick question. Works by diffusion (movement of electrolytes) and osmosis (movement of water) from an area of higher to lower concentration
Created by: Shanejqb