chronic

acute glomerulonephritis can lead to

glomerulonephritis

inflammatory reaction in the glomerulus

antibodies, filtering

with glomerulonephritis, ______ lodge in the glomerulus causing scarring and decreased ______

strep group A

the main cause of glomerulonephritis is ________ because it attacks the valves in the heart

flank, malaise

with glomerulonephritis, there will be _____ pain, _____ and headaches

decreases, increases, increases, excess

with glomerulonephritis, urinary output ______, BP ________, urine specific gravity _________, and they will be in a fluid volume ______

hematuria, proteinuria, edema, azotemia

with glomerulonephritis, there will be _______ and _________, periorbital _______, and _______

azotemia

abnormally high BUN and creatinine

cause, diuretics, fluids

treatment for glomerulonephritis is to get rid of the _____, I&O and daily weights, ______, monitor BP, restrict ______

activity, dialysis, dietary

treatment for glomerulonephritis is to balance ______ with rest, ______, and modify ______ needs

24 hour fluid loss + 500 mL

fluid replacement formula

carbs, sodium, protein

with glomerulonephritis, they need to increase ______, decrease ______ and ________

protein

makes BUN go up

1-3, blood, protein

with glomerulonephritis, diuresis begins in _______ weeks after onset, and _____ and ______ may stay in the urine for months

renal failure

the S&S of _____ include malaise, headache, anorexia, N&V, decreased output, and weight gain

nephrotic syndrome

loosing MASSIVE amounts of protein and EXTREME total body edema

nephrotic syndrome

an inflammatory response in the glomerulus where big holes form so protein starts leaking out in the urine (proteinuria)

hypoalbuminemic

when proteinuria happens, this causes the client to become ______

tissues

when a client is hypoalbuminemic, this causes the fluid to go into the ______ (edema) because without albumin you cannot hold onto fluid in the vascular space

decreases, aldosterone, tissues

with edema, the circulating blood volume ______ and the renin-angiotensin system kicks in and produces _______ which retains sodium and water but there is no protein to hold onto so it goes into the _____

anasarca

total body edema

blood clots, cholesterol, triglycerides

problems associated with protein loss, include __________, increased ________ and ________

proteins

blood clots form because they are losing _______ that normally prevent their blood from clotting

albumin

high cholesterol and triglycerides with nephrotic syndrome because with increased protein loss, the liver compensates by making more ______ causing an increased release of cholesterol and triglycerides

idiopathic, infections, NSAIDS

nephrotic syndrome is _______ but has said to be related to bacterial or viral ______, ______, cancer and genetic predispositions, lupus, diabetes

nephrotic syndrome

S&S of _______ include MASSIVE proteinuria, hypoalbuminemia, anasarca, hyperlipidemia

diuretics, ace inhibitors, prednisone, cyclophosphamide

treatment for nephrotic syndrome includes ______, _______ to block aldosterone secretion, _______ to decrease inflammation, and _______ to decrease the body's immune response

shrinking

cyclophosphamide decreases the body's immune response by shrinking holes so ______ can't get out

immunosuppressed, infection

patients on cyclophosphamide are ______ so this is why ______ is a major complication of nephrotic syndrome

protein, sodium, lipid lowering drugs

with nephrotic syndrome, they need to increase _______ and decrease ________, ________ for hyperlipidemia, anticoagulation therapy, dialysis

1-2, malnourished

with nephrotic syndrome, they should receive _______ grams/kg of protein per day because the client can become ______ fast

nephrotic syndrome

limit protein with kidney problems EXCEPT with

weights, I&Os, girth, skin

with nephrotic syndrome, we need to take daily ______ and ________, measure abdominal _____ or extremity size, and perform good ____ care

acute kidney injury

a sudden episode of renal damage and the goal is to reverse it to prevent chronic renal failure

pre-renal, intra-renal, post-renal

types of acute kidney injury are (3)

pre-renal

which of the 3 types occur 60-70% of the time?

pre-renal failure

blood can't get to the kidneys

hypotension, decreased, hypovolemia

causes of pre-renal failure include ________, _______ heart rate, _______, or any type of shock

intra-renal failure

damage has occurred within the kidney

glomerulonephritis, nephrotic syndrome, aminoglycoside, NSAID

intra-renal failure can be caused by ______ or ________, malignant hypertension, diabetes mellitus, acute tubular necrosis, dyes, ______ or _______ medications

acute tubular necrosis

damage to the filtering bodies of the kidneys caused by hypotension, sepsis, drugs

post-renal failure

urine can't get out of the kidneys

prostate, obstruction, stoma

post renal failure is caused by an enlarged _______, kidney stones, tumors, ureteral ________, edematous _______

ileal conduit

edematous stoma is an

initiation, oliguric, diuresis, recovery

phases of acute kidney injury are (4)

injury, <100, kidney, 3-12

in the initiation phase _____ occurs, in the oliguric phase output may be ______ in 24 hour, in the diuretic phase the _____ is recovering, and in the recovery phase it could last _____ months

increased

with AKI, the creatinine, BUN, and specific gravity will all be

hypertension, heart failure, anorexia

S&S of acute kidney injury could be ____ or _____ because they are retaining fluid or _____, N&V because they are retaining toxins

skin care

because of uremic frost, clients need good _____

phosphorus, decreases

with acute kidney injury, they retain _______ so the serum calcium _______ because it is being pulled from the bones

anemia, hyperkalemia

______ can occur with kidney injury because not enough erythropoietin and _______ could cause lethal arrhythmias

metabolic acidosis

with acute kidney injury, they may have ________ because they are unable to filter or retain hydrogen or bicarb

complications, cause

treatment of AKI include preventing ______, managing S&S, eliminate the _____ of kidney injury

decrease, I&O, daily weights, VS

with acute kidney injury, they will need bedrest to _____ metabolism and caloric needs, turn cough and deep breath, monitor ______, ________, ______ closely

1,000

1 kg = ______ mL of fluid

diuretics, insulin, calcium gluconate

medications for AKI include ______, treat hyperkalemia with IV ______, IV ______ for dysrhythmias

potassium, hypocalcemia

medications for AKI include polstyrene sulfonate to decrease _______ and phosphate binding drugs to prevent _______

carbs, fat, protein, phosphate, potassium

with AKI, increase _____ and ______, low ______ diet, and avoid foods high in _____ and ______

smallest amount

give any IV medications in the ______ allowed to avoid overloading the client

bananas, citrus, coffee

foods high in potassium (3)

aseptic, skin, pressure ulcers, catheters

to prevent infection in AKI, use _______ technique, meticulous ____ care, prevent _______, mouth care, no _____ if possible, protect from others who have an infectious disease

infection

with AKI, the leading cause of death is

renal replacement therapy

with AKI, _____ may be needed

10-14, increases

the oliguric phase ends in ______ days, and the diuretic phase begins when output __________

increased

during the recovery phase, client is placed on _________ protein and calories, resume activity as tolerated

renal replacement therapy

these therapies take over or replace the kidney function

BUN, creatinine, FVE, hyperkalemia, metabolic acidosis

RRT is started when when ______ and ______ levels can't be decreased, when _______ is compromising the heart and lungs, and when _____ and ______ can't be treated successfully

hemodialysis, continuous renal replacement therapy, peritoneal dialysis

RRT includes (3)

hemodialysis

the machine is the glomerulus (filter)

3-4

hemodialysis is done ______ times per week so the client has to watch what they eat and drink between treatments

anticoagulant, bleeding precautions

during hemodialysis, the client is given an _____________ to prevent blood clots from forming, so need to implement ______

fluid status

before beginning hemodialysis, assess their

electrolytes, BP

what are watched constantly during hemodialysis?

unstable cardiovascular system

not all clients can tolerate hemodialysis, these are usually clients with an ________

vascular access, 300-800

hemodialysis requires ______ and the blood is being removed, cleansed, and then returned at a rate of ______ mL/min

vascular access

a site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis

arteriovenous fistula, arteriovenous graft

types of vascular accesses (2)

arteriovenous fistula

in forearm with an anastomosis between an artery and a vein

arteriovenous graft

synthetic graft to join the vessels

surgery

both types of vascular access require _____ and take weeks to mature and be ready for repeated venipunctures

blood, return

during dialysis, two needles are inserted into the. vascular access, one needle will allow _____ to be pulled from the circulation and sent to the hemodialysis machine and the other needle will _______ the filtered blood to the client's circulation

arterial, venus

the _______ end of the access will remove the blood and return it through the low pressure _______ end

internal jugular, femoral vein

for temporary access with dialysis, the ___________________ or ___________________ is often used for catheter placement and surgery is not required

IV

Do NOT use ______ access (drawing blood, administering meds, etc.) through the vascular access (fistula)

NO bp, needle sticks, constriction

when a client has an alternate vascular access, what is the associated nursing care for that extremity?

patency, thrill, bruit

the vascular access need to assessed frequently to ensure _______ and is done by feel the ______ and hear the ______

ICU

continuous RRT is typically done in an _________ setting and is continuous so the client doesn't have drastic fluid shifts

80 mL

with continuous renal replacement therapy there should never more than ___________________ of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much

cardiovascular, acute kidney injury

continuous RRT is performed on those with a fragile _________ status and _______

peritoneal membrane

with peritoneal dialysis the ________ is used as a filter

Tenckhoff

dialysate is infused into the peritoneal cavity by gravity via a ______ catheter

2000-2500, 10

_______ mLs of fluid fill the peritoneal cavity in about _____ minutes

dwell time

prescribed amount of time the fluid remain in the peritoneal cavity is referred to as

exchange

after the fluid has infused into the peritoneal cavity, the bag is lowered and the fluid, toxins, etc are drained

warm

we ______ the fluid with peritoneal dialysis because cold promotes vasoconstriction and will cause blood flow to be limited

clear, straw-colored

with peritoneal dialysis, the drainage should be _______, _______ (should be able to read a newspaper through the drainage/effluent)

infection

with peritoneal dialysis, if the drainage is cloudy, it indicates _____

side-to-side

with peritoneal dialysis, if all the fluid doesn't come out turn the client from

hemodialysis, chooses

peritoneal dialysis is either for someone who can't tolerate ______ or someone who _______ peritoneal

continuous ambulatory peritoneal dialysis, automated peritoneal dialysis

types of peritoneal dialysis (2)

continuous ambulatory peritoneal dialysis

requires a client that has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions

4, 7

CAPD is done _____ times a day, ______ days a week

fluid causes pressure on the back

why can't a client with disc disease or arthritis do CAPD?

high risk for infection

why can't a client with a colostomy do CAPD?

automated peritoneal dialysis

connect their peritoneal dialysis catheter to a cycler at night and their exchange is done automatically while they sleep, needs to be disconnected in the AM

APD

_____ allows the client to have more freedom

exit site infection, peritonitis

complications of peritoneal dialysis (2)

peritonitis

with peritoneal dialysis _______ is the #1 complication

abdominal pain, cloudy effluent

S&S of complications with peritoneal dialysis (2)

fiber, protein

_____ and _____ need to be increased in the client's diet with peritoneal dialysis

fiber

increase ______ because they have decreased peristalsis due to abdominal fluid

protein

increase _______ because they have big holes in peritoneum and lose protein with each exchange

nephrolithiasis

kidney stone disease

urolithiasis

stone in ureter

kidney stones

S&S of ____ are sharp pain, N/V, WBCs in urine, hematuria

urine specimen, RBCs, pain medication

anytime you suspect a kidney stone, get a ______ASAP and have it checked for ____, and give ____ immediately

ondansetron, NSAIDS, alpha adrenergic blockers

medications for kidney stones include ______, _____ or opioid narcotics, or ________ to relax smooth muscles of ureter

fluids, lithotripsy

with kidney stones, make sure to increase _______, they may need surgery to remove stone, or _____ to crush stone, and strain urine to send stone for analysis