NUR 265 EXAM 1 STUDY GUIDE

NUR 265 EXAM 1 STUDY GUIDE

NUR 265 EXAM ONE STUDY GUIDE

• Nephrotic Syndrome:

• NS is a condition of increased glomerular permeability that

allows larger molecules to pass through the membrane into the urine and then be excreted.

• Immunological Kidney disorder
• This causes massive loss of protein in the urine, edema

formation, and decreased plasma albumin levels.▪ Proteinuria- severe protein loss more than 3.5 g in 24- hour urine sample.

o Key features:

▪ Massive proteinuria >3.5g / 24hrs ▪ Hypoalbuminemia <3g/dL ▪ Edema (facial and periorbital) ▪ Lipiduria ▪ Hyperlipidemia ▪ Increased coagulation (renal vein thrombosis) ▪ Reduced kidney function (↑ BUN, ↑ Cr, ↓ GFR)

• Treatment- immunosuppressant agents (if immunity based).

▪ ACE inhibitors (to decreased protein loss in urine & ↓BP) ▪ Statins (improve blood lipid levels).▪ Heparin (↑ coagulation / risk of thrombosis → treat vascular effects and improve kidney function)

o Diet:

▪ If GFR is normal- dietary intake of complete proteins is needed ▪ If GFR is decreased- dietary protein is decreased, diuretics and sodium restriction.

• Acute Kidney Injury:

• AKI is rapid reduction in kidney function resulting in a failure to

maintain _uid and electrolyte balance, and acid-base balance.▪ Can occur over a few hours or days

• Severity of AKI is based on serum creatinine increase, and

decreased urine output- an increase in speci`c gravity (meaning urine is more concentrated or the patient is dehydrated).

• GFR isn’t used to measure acute injury or illness—only chronic

kidney disease.

• 3 types of AKI

▪ prerenal - conditions that reduce blood _ow / oxygen to the kidney → decreased perfusion to kidneys • azotemia- nitrogenous waste/toxin build up

• effects LOC, mood, change in personality 1 / 3

• related directly to reduced perfusion to the

kidneys

• examples of perfusion reduction:

• blood/_uid loss- (surgery, sepsis, hypovolemic

shock)

• blood pressure drugs resulting in hypotension
• MI or HF → low ejection fraction → low cardiac

output

• NSAIDs, ASA
• Anaphylaxis
• Severe burns
• Severe dehydration
• Renal artery stenosis
• Bleeding or clotting in kidney blood vessels
• Atherosclerosis (cholesterol deposits

obstructing blood _ow to the kidneys) ▪ Intra-renal failure- tissue damage to the actual kidneys • Intra-renal- re_ects injury to the glomeruli, nephrons, or tubules

• Examples of intra-renal failure:

• Bleeding in the kidney
• Glomerulonephritis or in_ammation of the

glomeruli

• Pyelonephritis
• Thrombi or emboli in the kidney blood vessels
• TTP → platelet disorder ↑ clotting
• Sepsis or local infection
• Lupus
• Multiple myeloma
• Scleroderma
• Chemo/ ABTs / nephrotoxic drugs
• Ischemia in kidney failure, including hypoxemia

from respiratory and cardiac arrest ▪ Post-renal failure- Urine =ow obstruction

• Post-renal failure examples:

• Bladder cancer
• Colon cancer
• Prostate cancer
• Cervical cancer
• Enlarged prostate
• Kidney stones
• Blood clots in urinary tract 2 / 3

• Neurogenic bladder →Nerve damage
• Mean atrial pressure is important in determining adequate kidney

perfusion!!!▪ MAP= (systolic+ 2[diastolic])/3 Mean atrial pressure of 65 is needed to perfuse the kidney!!➢ Manifestations (s/s) of AKI

• Oliguria
• Fluid Volume Overload

▪ Crackles ▪ Edema ▪ Anasarca (generalized edema) ▪ ↓ 02 sats

▪ ↑ RR

• LOC changes
• Labs (↑BUN, ↑Cr, urine speci`c gravity >1.030)

o Nursing considerations / Interventions for AKI:

▪ Prevention is key! - urge patients to drink 2-3 L of water daily.• Monitor Fluid status (I&O, weight, ↑ hydration, characteristic of urine) • Report Output <0.5mL/kg/hr if persists >2hr <30mL/hr • Monitor for kidney functions

• Labs (BUN, Cr, GFR, electrolytes, osmolarity)
• I&Os

▪ You want output to be more than input ▪ Sodium, potassium, and speci`c gravity determine hydration status.

• Contrast dyes
• MAP > 65 mmHg

• Diuretic therapy- happens after AKI is starting to be resolved! (Releasing extra _uid through the urine - This is a good sign!!! - Watch for dehydration! - Its normal to have _uids hanging during the diuretic phase! - Titrate _uids!)

• Nutrition during AKI:

• Low protein

▪ Because protein molecules are huge and put on the strain to process

• Low sodium

▪ Since the body has high sodium concentration due to AKI • Fluid restriction

• / 3