Renal Study Guide Exam 1

Renal Study Guide Exam 1

• Acute Kidney Injury (AKI):
  • Caused by nephrotoxic drugs, occurring in hours or days.
  • Three phases: prerenal, intrarenal, and postrenal.
  • Prerenal: Caused by decreased blood volume/pressure (e.g., heart failure, renal artery stenosis).
  • Intrarenal: Problems inside the kidney (e.g., glomerulonephritis, lupus nephritis, NSAIDs, contrast dyes).
  • Postrenal: Obstructions after the kidney (e.g., kidney stones, BPH).

Expected Clinical Manifestations

• Oliguria: Urine output less than 0.5 mL/kg/hr.
• Increased creatinine and BUN: Elevated levels indicate kidney dysfunction.
• Fluid volume overload: Anasarca (generalized edema).
• Other complications: Seizures, asterixis (hand tremor), hyperkalemia, metabolic acidosis, bounding pulse, JVD, tachycardia, and changes in lung sounds.

Nursing Actions

• Priority: Prevent AKI
• Recognition: Identify early signs.
• Fluid status: Assess daily hydration and weight.
• Urine characteristics: Monitor for color, concentration, and other characteristics.

Risk Factors

• Nephrotoxic agents.
• Contrast media.
• Advanced age.

Interventions

• Maintain mean arterial pressure (MAP) >65 mm Hg.
• Diuretics therapy
• Fluid challenge
• Hemodynamic monitoring
• Nutrition (Protein, sodium, potassium restrictions)

Specific Labs and Diagnostics

• Arterial blood gases (ABGs)
• Ultrasound of kidneys
• CT of abdomen/pelvis
• KUB
• Cystoscopy
• Kidney biopsy

Chronic Kidney Disease (ESRD)

• Progressive and irreversible kidney dysfunction.
• End-stage occurs when kidney function cannot sustain life.
• Expected lab values: Increased BUN, creatinine (Uremia), metallic taste, anorexia, N/V, muscle cramps, pruritus, edema, dyspnea, paresthesia.

Complications of AKI and ESRD

• Various complications can arise including but not limited to cardiovascular issues, fluid imbalances and electrolyte abnormalities, neurological complications.

Complications of Hemodialysis

• Complications include hypotension, headache, nausea, dizziness, muscle cramps, disequilibrium syndrome, restless, headache.
• Nursing care of AV fistula/graft; aseptic technique, BP monitoring, no sticks, evaluate for infections and swelling, and monitor distal pulses.
• Concerns: PVCs occurrence (Hyperkalemia)

Peritoneal Dialysis

• Repeated cycles of fluid instillation into the peritoneal cavity.
• Complications: Peritonitis, exit-site/tunnel infections, pain, bleeding at site, poor flow, dialysate leakage, bowel perforation.

Acute Pancreatitis

• Intense, continuous pain, frequently in the upper abdomen.
• Associated with symptoms of nausea and vomiting.
• Can present with complications such as cardio-renal syndrome, shock, pneumonia, pleural effusions, and atelectasis, and neurological complications such as ataxia, peripheral neuropathy, tremors, seizures and coma.

Cardiovascular Study Guide

• Causes of Angina (Chest Pain): Ischemic heart disease.
  • Stable angina: Occurs with exertion and is relieved by rest or nitroglycerin.
  • Unstable angina: Chest pain or discomfort not relieved by rest or nitroglycerin.
• Diagnoses: EKG, stress test, CT/MRI, echocardiogram, coronary angiography, cardiac catheterization, chest x-ray.
• Medications: Nitroglycerin, hypertensives, beta-blockers, calcium channel blockers, statins, anticoagulants.

Myocardial Infarction (MI)

• Presentation: Severe chest pain lasting longer than 30 minutes, not relieved by nitroglycerin. Shortness of breath, nausea, vomiting (N/V), diaphoresis.
• Diagnostics: EKG, cardiac enzymes (Troponin).

Cardiovascular Complications (e.g., heart failure, cardiac tamponade)

• Heart failure: Left-sided=pulmonary congestion, right-sided=systemic congestion.
• Cardiac tamponade: Compression of the heart due to the accumulation of fluid in the pericardial sac.

Endocarditis

• Infection of the inner lining of the heart.
• Treatments with antibiotics (Antimicrobials, IV).
• Monitoring: education on good oral hygiene
• Ongoing monitoring and reporting of recurring symptoms.

Dilated Cardiomyopathy

• Cardiomyopathy characterized by the enlargement of the heart muscle.
• Interventions to lower blood pressure, and symptoms management.

Abdominal Aortic Aneurysm (AAA)

• A bulge or weakening in the wall of the aorta.
• Signs and symptoms: Abdominal pain, pulsatile mass, and possible rupture (hypovolemic shock).
• Diagnostics: CT, ultrasound.
• Treatment: Surgery or medical management

Surgical Management of AAA and Aortic Dissection

• Surgical repairs and interventions for AAAs and aortic dissection.
• Risk factors for complications: complications of the procedure, and bleeding.
• Post-operative monitoring and care.