NUR 265 EXAM ONE STUDY GUIDE

NUR 265 EXAM ONE STUDY GUIDE

Nephrotic Syndrome:

oNS is a condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted.oThis causes massive loss of protein in the urine, edema formation, and decreased plasma albumin levels.Most common cause is an immune or inflammatory response.Genetic defects- Fabry disease.Altered liver production occurs with NS which results in increased lipid production, and hyperlipidemia.Proteinuria- severe protein loss more than 3.5 g in 24- hour urine sample.

oKey features:

Massive proteinuria Hypoalbuminemia Edema (facial and periorbital) Lipiduria Hyperlipidemia Increased coagulation Reduced kidney function oTreatment- immunosuppressant agents (if immunity based). ACE inhibitors (decreased protein loss in urine), statins (improve blood lipid levels).Heparin- used to treat vascular effects and improve kidney function

oDiet:

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:

oAKI is rapid reduction in kidney function resulting in a failure to maintain fluid and electrolyte balance, and acid-base balance.Can occur over a few hours or days oSeverity of AKI is based on serum creatinine increase, and decreased urine output- an increase in specific gravity (meaning urine is more concentrated or the patient is dehydrated).oGFR isn’t used to measure acute injury or illness—only chronic kidney disease.Risk stage creatinine x 1.5 of normal, and GFR reduced by 25% NUR 265 Exam 1 Study Guide 1 / 4

Injury stage creatinine x2 & GFR reduced by 50% Failure stage creatinine x3 normal, & GFR reduced by 75% Can’t fix failure Loss persistent injury requiring RRT for 4+ weeks End stage KD  requiring RRT 3+ months o3 types of AKI prerenal azotemia- decreased perfusion to kidneys prerenal- occurs before blood gets to the kidney- or a lack of blood to the kidneys azotemia- nitrogenous waste build up oeffects LOC, mood, change in personality orelated directly to reduced perfusion to the kidneys

examples of perfusion reduction:

oblood/fluid loss- hypovolemic shock oblood pressure drugs resulting in hypotension oMI or HF resulting in low ejection fraction and low cardiac output oInfection oLiver failure oNSAIDs oAnaphylaxis oSevere burns oSevere dehydration oRenal artery stenosis oBleeding or clotting in kidney blood vessels oAtherosclerosis or obstruction that blocks blood flow to the kidneys Intra-renal failure- tissue damage to the actual kidneys Intra-renal- reflects injury to the glomeruli, nephrons, or tubules

Examples of intra-renal failure:

oBleeding in the kidney oGlomerulonephritis or inflammation of the glomeruli oThrombi or emboli in the kidney blood vessels oSepsis oLocal infection oLupus oMultiple myeloma oScleroderma oIngesting toxins- alcohol 2 / 4

oIschemia in kidney failure, including hypoxemia from respiratory and cardiac arrest Post-renal failure- obstruction that occurs after the kidney

Post-renal failure examples:

oBladder cancer oColon cancer oProstate cancer oCervical cancer oEnlarged prostate oKidney stones oBlood clots in urinary tract oNerve damage in bladder control oMean 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!!!

oNursing considerations for AKI:

Prevention is key! - urge patients to drink 2-3 L of water daily.Always be on the lookout for signs of impending kidney dysfunction oCreatinine elevation quickly!oPreventing volume depletion and providing intervention early when volume depletion occurs is important!Reduced perfusion from volume depletion is most common cause for AKI

Signs of volume depletion:

Low urine output Decreased systolic blood pressure Decreased pulse pressure Orthostatic hypotension Thirst Rising blood osmolity Replace with oral fluids or IV fluids.Monitor nephrotoxic substances oQuestion any order of two or more nephrotoxic drugs taken at one time.If they must receive these drugs, carefully monitor lab values

oExamples of nephrotoxic substances:

NSAIDS 3 / 4

Antibiotics Especially your –mycins Diuretics Contrast dye Metformin Monitor for kidney functions oLabs oI&Os You want output to be more than input Sodium, potassium, and specific gravity determine hydration status.oContrast dyes oMAP > 65 mmHg oDiuretic phase- happens after AKI is starting to be resolved!Releasing extra fluid through the urine This is a good sign!!!Watch for dehydration!Its normal to have fluids hanging during the diuretic phase!Titrate fluids!

oNutrition 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 if AKI was due to anything except for perfusion problem 1000-1500 mL/day oTemporary RRT- dialysis to get the fluid off, and give the kidneys a break.If RRT occurs for 4 weeks or less, then there is no loss of kidney function If RRT occurs for 3 months or more it is considered kidney failure Chronic Kidney Disease oCKD- progressive, irreversible disorder and kidney function doesn’t recover.oCKD is normally a result of another condition that compromises the kidneys and takes years to progress Hypertension Uncontrolled diabetes

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