System and Condition Charts -- Renal

8/2/2019 System and Condition Charts -- Renal

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SYSTEM

Lab ValuesVocabulary Anatomy & Physiology General AssessmentDiagn


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SYSTEM

Lab ValuesVocabulary Anatomy & Physiology General AssessmentDiagn


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Radiographic & Othersstics


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Radiographic & Othersstics


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SYSTEM

Condition

& NEPHROSCLEROSIS

DISEASE

GLOMERULONEPHRITIS

Assessment &Diagnostic

Findings

Increased Protein > 3.5 g/dL Decreased Albumin Increased BP > 130

Decreased GFR Increased BP -- HTN Increased Phosphorus Increased Sodium Increased BUN Decreased Creatinine

Decreased Albumin Urinalysis -- RBCs, WBCs, Protein,Casts Kidney Biopsy -- Needed to EstablishAcute Glomerulonephritis (AGN)

Small Kidneys -- 1/5 Normal Size Increased Creatinine Increased Protein Increased BP Fixed Specific Gravity -- 0.0010 Decreased GFR < 50

Increased K+ Increased Phosphorus Increased Sodium Urinary Casts

Signs &Symptoms/

ClinicalManifestations

Proteinuria -- #1 Sign Hypoalbuminemia Hyperlipiduria -- Due to IncreasedCholesterol Na+ & Water Retention Edema -- Peripheral

Decreased Urine Output Hypervolemia & HTN -- Prolonged Hypercoagulopathy Oliguria Hematuria Azotemia Headache Vision Changes Nausea & Vomiting Seizures Uremia

Prolonged Diabetes Mellitus DBP > 130 mmHg Patchy Necrosis -- Fibrosis --Atherosclerosis & HTN

Inflammation Headache Edema -- Facial, Periorbital Malaise Fever -- Low Grade Weight Gain

Rash Pain -- Abdominal or Flank Proteinuria & Hematuria Dark-Colored Urine Oliguria Chills & Cough HTN Azotemia Nausea & Vomiting Anemia Pruritis

CHF Hypervolemia

After Repeated Bouts of AcuteGlomerulonephritis (NephroticSyndrome) -- 3rd Leading Cause of End-Stage Renal Disease (ESRD) Hardening of Renal Arteries with HTN High Lipids Glomerular Diseases Immune Disorder Abnormal Protein

Repeated AGN Bouts Foot Edema -- At Night Yellow-Gray Skin Color May Have No Signs or Symptoms --May Be Detected from Eye Exams Obesity -- Diet

HTN Nosebleeds Retinal Bleed Anemia Kidney -- 1/5 Normal Size Fibrosis -- Rough, Irregular Shape

RENAL

Pathophysiology/Prognosis

Inflamed Glomerulus CompromisesBlood Flow & Filtration Narrowing of Renal Artery Diabetes -- HTN Young Males -- Nephrosclerosis Hardening of Renal Arteries 2 Forms -- Malignant & Benign Uremia -- Dialysis & ACE Inhibitors

Acute Glomerulonephritis Follows Group A Beta HemolyticStrep, Impetigo & Acute Viral Infectionsof Skin or Throat -- After 21 Days Antigen-Antibody ComplexesDeposited in Glomeruli -- ImmuneSystem -- From Recent Strep Infection Makes It Hard for Kidneys to Work Inflammation of Glomerular Capillaries


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SYSTEM

ConditionACUTE NEPHROTIC SYNDROME

& NEPHROSCLEROSIS

PRIMARY GLOMERULAR

DISEASE

CHRONIC

GLOMERULONEPHRITIS

NursingManagement/Interventions

Teach Patient -- Anti-HTNs & ACEInhibitors

Patient Privacy I&O Monitoring -- Na+ & Water

Restriction Daily Weights -- Monitoring for FluidRetention Diet Restrictions -- High Calorie, LowProtein, Low Sodium, Low Phosphorus

Patient Privacy

RENAL

Medical

Management/Treatment

Prednisone -- Glucocorticoids Needle Biopsy ACE Inhibitors Anti-Lipids Dialysis Anti-HTNs

Antibiotics Corticosteroids Antihypertensives Immunosuppressants Na+ & Water Restriction Bedrest Diet -- High Calorie, Low Protein, LowPhosphorus

Urinalysis Kidney Biopsy Plasma Exchange Cancer Drugs

Urinalysis

Complications

Infection -- GlucocorticoidImmunosuppression Scarred Glomeruli -- Can't Repair Decreased Immune Response Renal Vein DVT Pulmonary Edema Hypovolemia Atherosclerosis

End-Stage Renal Disease -- In WeeksIf Not Treated

End-Stage Renal Disease (ESRD)


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SYSTEMCondition ACUTE RENAL FAILURE CHRONIC RENAL FAILURE HEMODIALYSIS

Signs &Symptoms/


4 Phases-- Initiation-- Oliguria Phase

> HTN> Anemia> CHF> PE> SOB> Peripheral Edema> Confusion> MI> Normal-Decreased Urine Output> Oliguria> Proteinuria> Hyperkalemia

-- Diuresis Phase> Diuresis> Increased Mental & Physical

Ability> Up to 3 Weeks> Hypovolemia

-- Recovery Phase> 3-12 Months

Anemia Anorexia & Weight Loss from UremicSyndrome Fluid Retention Uremia Azotemia Proteinuria HTN Edema Diabetes Mellitus

RENAL


Kidneys Can't Remove Wastes or Perform Regulatory Functions Increased Creatinine > 50% 3 Stages

-- Pre-Renal> Decreased Blood Volume> "Pre Kidney Issues"> Decreased BP> Shock> Severe Injury or Illness

-- Intra-Renal> Ischemic or Nephrotoxic Tubulr

Injury> Allergic-Type or NSAID-Type

Interstitial Nephritis> Glomerular Disorders> Acute Tubular Necrosis

-- Post-Renal> Anatomic or Tubular Obstruction ATN -- Intrinsic ARF

End-Stage Renal Disease (ESRD) Decreased GFR > 15 mL/min Diabetes & HTN -- Main Causes Renal Calculi or Obstruction --Vesicoureteric Reflux Hereditary or General Factors --Polycystic Kidney Infection -- Chronic Pyelonephritis,Glomerulonephritis Enviromental Risks -- Heavy Metals Secondary to HTN

-- Smoking-- DVTs-- Obesity-- Hypercholesterolemia-- Atherosclerosis

Progressive, Irreversible Deterioration

Vascular Access-- Subclavian -- Risk for

Pneumothorax, Thrombosis, Hematoma,Infection

-- Internal Jugular -- IJ-- Femoral Catheter

Fistula Arteriovenous Graft -- A-V Graft Chronic or Acute Renal Failure Acute or Chronic Renal Disease

Hemodialysis Catheter -- Subclavian(Temporary), IJ, Femoral Internal Arteriovenous Fistula --Internal A-V Fistula -- Top -- Preferred

-- Mature in 2-3 Months-- Hand Exercises

A-V Graft -- Bottom -- Diabetics Pruritis Dialyzer

-- Diffusion-- Osmosis-- Ultrafiltration-- Dialysate


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Assessment &DiagnosticFindings

Oliguric Phase-- Decreased Output < 400 mL/day, 4 Weeks Oliguric Phase -- Hyperkalemia -- Life-Threatening -- Increased Respirations,Nausea, Headache, Palpitations,Malaise

Diuretics Ineffective Osteodystrophy -- If Too Much Protein& Phosphorus Not Reversible

Steal Syndome -- Distal Hypoperfusion& Ischemia -- "Steels the Blood" -- 5%-10% Hypotension -- Fluid Removal

-- Vomiting-- Malnutrition

Muscle Cramps -- Late-- Bone Pain & Functions

Dysrhythmias -- Fluids & Electrolytes Air Emboli -- Lines Chest Pain Dialysis Disequilibrium -- CSF Shift Hemorrhage Seizures -- If Rapid Fluid Decrease Contraindicated -- If Cannot ReceiveAnticoagulants Hematoma Pneumothorax Infection Thrombosis of Subclavian Vein Anemia

RENAL


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MedicalManagement/

Treatment

Oliguric Phase-- Safety Precautions-- Limit Fluids-- Administer Kayexalate-- Dialysis-- Diet-- Decrease K+-- For Blood Flow & BP -- Low Dose

Dopamine (Intropin) -- 1-3 mcg/kg Diuretic Phase

-- Fluids as Desired-- Increase K+ & Na+-- Dialysis-- Fluid Boluses-- Dilantin or Composine -- For

Nausea & Vomiting-- Tylenol-- Kayexalate-- Lasix, Bumex

Recovery Phase-- Increase Calories-- Increase Protein-- D/C ACE Inhibitors

Urinalysis Renal Ultrasound IV -- Bicarb -- Give 1st to ProtectKidney

Dialysis Renal Transplant Diet -- Low Phosphorus, Low Protein IV -- Regular Insulin with D5W -- ToMove K+ from ECF to ICF NO METFORMIN Ca+ & Vitamin D Supplements Erythropoietin (E-pogen) -- For Anemia Fluid Restriction Urinalysis Anti-HTNs Reglan Digoxin Na+ Bicarb -- For Metabolic Acidosis

Pharmacologic Therapy Nutrition Fluids Mucomyst -- Protects Kidneys Restrict Protein, Fluids, K+, Na+ Vancomycin Benadryl -- Pruritis

RENAL


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Reversible -- Renal Function &Nutrition Electrolytes Monitoring IV Fluid Admin I&O Monitoring VS Bladder Scan Daily Weights -- Monitoring Skin Emotional Bedrest Patient Teaching -- Dialysis & AccessCare Oliguric Phase

-- Safety Precautions-- Fluid Restriction-- Kayexalate Admin-- ADLs-- Diet -- Decrease K+ (Apples)

Diuretic Phase-- Give Fluids-- K+ & Na+ Admin -- Monitor Closely-- Check Thrill & Bruit -- Every 8 Hrs

Recovery Phase-- Diet -- Increase Protein & Calories

Patient Privacy Diet -- Low Phosphorus, Low Sodium,Low Portein IV & Fluid Supplement Admin -- Ca+ &Vitamin D Dialysis Interventions Daily Weights -- Monitor -- Gain =Fluid Retention, Loss = Anorexia I&O Monitoring Fluid Restriction -- 500-600 mL/day Prevent Hyperkalemia

Access Device Protection-- Failure of Permanent -- Clot Off or

Infecton Assess Cardiac & RespiratoryComplications

-- Hypotension-- Hypertriglyceridemia

F & E Balance Infection Prevention Psychological Support Check Thrill & Bruit -- Q8h Comfort

-- Phosphorus Deposits in SkinCause Itching BP & VS Monitoring -- 1st Intervention Hemorrhage Monitoring Patient Teaching -- Protect Access Skin Sterile Technique Check for Steal Syndrome -- 3 P's

-- Pain-- Pulselessness-- Pallor

Sensation, Temperature, Pulse, Pallor,Capillary Refill, Allen Test, Pain Psychological Support

RENAL


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SYSTEM

Condition KIDNEY TRANSPLANTS UTIs

PYELONEPHRITIS

Signs &Symptoms/


Hematuria -- Renal Trauma Urgency Frequency Burning on Urination

Pyuria Pain

RENAL


Chronic Renal Failure Renal Trauma -- Abrasions,Lacerations, Crushed -- Kidney GradingSystem 1-5

Lower Urinary Tract Infections -- LUTI Cystitis Normal -- Bladder Sterile Uropathogenic Bladder Infection Through Ascending Bacteria Commonly from E. Coli Urinary Stasis Tubing on Floor Incontinence Reflux

Bacterial Infection of Renal Pelvis,Tubules & Institial tissue of 1 or BothKidneys -- E. Coli Mostly Through Ascending BacteriaThrough Ureters Enlarged Kidneys with Potential for Scarring Tumor Obstruction Chronic

-- Repeat Bouts of AcutePyelonephritis

-- Diabetes Mellitus


Urine Samples -- All H & H CT Scan

Increased WBCs Urine C&S -- 1st Intervention Specific Gravity Osmolality Renal Function Tests

BUN Creatinine Creatinine Clearance CBC -- RBCs Glucose Protein

Urinalysis -- Protein Casts CT Scan Ultrasound Sepsis Chronic

-- Urine Specimen -- Protein Casts-- Creatinine Clearance-- BUN-- Urine Cultures

Flank Pain -- CVA Tenderness Chills Fever

Leukocytosis Bacturia Pyuria Interstitial Filtration Chronic -- No Signs or Symptoms


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SYSTEM

Condition KIDNEY TRANSPLANTS UTIs

PYELONEPHRITIS

Complications

Hemorrhage, Shock, Other Co-Morbidities Infection, Hydronephrosis,Pyelonephritis, Obstruction, DVTs, HTN Acute Rejection Signs

-- 1 Week to 2 Years-- Oliguria-- Anuria-- Increased Temp > 100 F-- Increased BP -- HTN-- Flank Tenderness-- Lethargy-- Decreased Specific Gravity-- Fluid Retention -- Edema, Weight

Gain Chronic Rejection Signs

-- Gradual Over Months-Years-- Gradual Increased BUN &

Creatinine-- Electrolyte Imbalances-- Fatigue

Elderly-- Most At Risk-- Decreased Bladder Tone-- Diminished Thirst-- Higher Urosepsis

If Pregnant, Hospitalize Chronic -- Scarring

MedicalManagement/

Treatment

New Kidney Inserted on Opposite Sideof Body in Iliac Fossa Immunosuppressants -- Lifelong --Prevents Rejection -- Cyclosporine(Sandimmune) Prednisone -- Short Time

Follow-Up -- To 2 Years

Force Fluids -- 3000 mL/day Acidify Urine Antibiotics -- Septra Lithotripsy -- Urolithiasis for Ca+ RenalCalculi Pain Meds -- Renal Calculi

Anti-Spasmodics Analgesics -- Pyridium -- Urine Orange Bladder Scan Doppler -- Pulses Meds Avoid Irritants Void Q2-3h Clean Catch Urine Specimen -- For C&S ECG Monitor -- Lithotripsy

Bedrest Antibiotics -- Doxycycline Chronic

-- Dialysis-- Transplant-- Antibiotics -- Long Term --

Doxycycline

NursingM t/

I&O Monitoring -- 30 mL/hr minutesafter Daily Weights -- Monitoring -- If WeightGain = Fluid Retention Rejection Signs -- Monitoring -- Days-

Patient Privacy Force Fluids -- 3000 mL/day Cranberry Juice -- Acidifies Urine Patient Teaching -- Women VoidBefore Intercource, Clean After Urination

Watch for Relapse Med Admin Chronic

-- Patient Privacy-- Hydrate

RENAL


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-- Daily Weights


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SYSTEM

Condition


Signs &Symptoms/



POLYCYSTIC KIDNEY DISEASE

H & H IV Urography -- To Confirm Increased BP

Back Pain Flank Pain HTN Hematuria Pulmonary Edema Family History Urine -- Foul Odor & Cloudy

Hereditary -- Autosomal -- 30 Years --Begins In Utero


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SYSTEM

Condition


Medical

Management/Treatment

Complications

POLYCYSTIC KIDNEY DISEASE

Patient Privacy Teach & Mgmt -- Infection Prevention

Avoid Sports, Risky Occupations

Thiazides -- Distal Tubules -- Diuretics Blood Transfusions Dialysis or Transplant Kayexalate with Sorbitol Aldactone Lasix Potassium Gluconate Insulin

Glucose E-pogen Vitamin D Ca+ & Phosphate Supplements Na+ Bicarbonate, Mg, K+ Antibiotics Cardiac Glycosides Anti-HTNs

Main Cause of Death -- CoronaryVascular Disease End-Stage Renal Disease (ESRD) No Cure


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SYSTEMCondition

Signs &Symptoms/



PERITONEAL DIALYSIS

Chronic or Acute Renal Failure For Ambulatory Patients


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SYSTEMCondition


Complications

PERITONEAL DIALYSIS

CAPD -- Continuous AmbulatoryPeritoneal Dialysis

-- Patient Self-Dialyzes 24 Hrs x 7Days

-- Dwell 4-8 Hrs APD -- Automated Peritoneal Dialysis

-- Warming Chamber-- Dwell/Drain/Volume Set-- 30 Minute Exchange x 8-10 Hrs --

Lowest Infusion Rate IPD -- Intermittent Peritoneal Dialysis

-- Automated or Manual-- 4 Days/Wk x 10 Hrs/Day

CPD -- Continuous Peritoneal Dialysis-- Automated at Night-- Dwell During Day

Peritonitis -- Life-Threatening --Infection -- If Dialysate Effluent -- Cloudy Seizures -- If Rapid Fluid Decrease Decrease K+ -- Risk for CardiacArrhythmias Protein Loss

Weight Gain -- 3-5 Lbs/Month Hyperglycemia, Dyslipidemia -- Over Time Hemorrhoids Back Pain CVD -- Highest Risk of Death


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SYSTEMCondition

MedicalManagement/

Treatment

PERITONEAL DIALYSIS

Need Consent Diet -- Low Carb, High Protein, HighFiber No Fluid Restriction Meds in Dialysate -- Insulin, Heparin,KCl, Tylenol


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SYSTEMCondition


PERITONEAL DIALYSIS

Warm Solution with Heating Pad Access Device Protection Empty Bowels & Bladder BeforeTreatment Cardiac & Respiratory ComplicationAssessment -- Hypotension Fluid & Electrolyte balance

Infection Prevention BP & VS Monitorings -- 1stIntervention Sterile Technique Comfort Psychological Support Weigh Patient Before & After Treatment -- Should Weight More Before


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SYSTEM

Condition

Signs &Symptoms/


Pathophysiology/

Prognosis


GLOMERULAR FILTRATION

RATE


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SYSTEM

Condition

Complications

MedicalManagement/

Treatment

Nursing

Management/Interventions

GLOMERULAR FILTRATION

RATE


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SYSTEM

Vocabulary Anatomy & Physiology General Assessment


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ab Values Radiographic & OthersDiagnostics


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SYSTEM


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SYSTEMCondition


Signs & Symptoms/Clinical

Manifestations

Assessment &Diagnostic Findings

Complications


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Nursing Diagnoses

MedicalManagement/

Treatment


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System and Condition Charts -- Renal

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