Glomerulonephritis: Acute can lead to
chronic
Glomerulonephritis: It is an
inflammatory reaction in the glomerulus
Glomerulonephritis:
... [Show More] Antibodies lodge in the ________________, causing _____________________________________
glomerulus; scarring and decreased filtering
Glomerulonephritis: Main cause
streptococcus (Group A beta) (attacks the valves in the heart)
Glomerulonephritis: Signs/Symptoms
-flank pain
-oliguria
-hematuria
-proteinuria
-periorbital edema
-increased BP
-FVE
-increased urine specific gravity
-azotemia
-malaise and H/A
Glomerulonephritis Signs/Symptoms: Flank pain is
costovertebral angle tenderness (CVA tenderness)
-tap on back to see how high the infection is in the kidney
Glomerulonephritis Signs/Symptoms: Periorbital edema will
progress to other areas of the body
Glomerulonephritis Signs/Symptoms: Azotemia is
abnormally high BUN and creatinine
Glomerulonephritis Signs/Symptoms: Why does the client experience malaise and H/A?
toxins
Glomerulonephritis: Treatment
-get rid of the strep or cause
-I & O and daily weights
-diuretics
-monitor BP
-restrict fluids
-balance activity with rest
-dialysis
-modify dietary needs
Glomerulonephritis Treatment: How is fluid replacement determined?
24 hour fluid loss + 500 mL
Glomerulonephritis Treatment: How are dietary needs modified?
-increased carbs
-decreased sodium
-decreased protein (makes BUN go up)
Glomerulonephritis Client Teaching: Diuresis begins in
1 to 3 weeks after onset
Glomerulonephritis Client Teaching: ____________________ may stay in the urine for _________________
Blood and urine; months
Glomerulonephritis Client Teaching: Teach the signs/symptoms of
renal failure
Glomerulonephritis Client Teaching: Signs/Symptoms of renal failure
-malaise
-H/A
-anorexia
-nausea
-vomiting
-decreased output
-weight gain
Glomerulonephritis Client Teaching: If you notice s/s of renal failure present....
call the provider
Nephrotic Syndrome: These clients lose a lot more protein than clients with
glomerulonephritis
Nephrotic Syndrome: Pathophysiology
-it is an inflammatory response in the glomerulus
-big holes form so protein starts leaking out in the urine (proteinuria)
-NOW the client is hypoalbuminemic
-without albumin you can't hold onto fluid in the vascular space
-so the fluid goes out into the tissues
-NOW the client has edema
-the circulating blood volume is decreased as a result
-the kidneys sense this decrease & the want to replace it
-the RAS system kicks in
-aldosterone is produced and retains sodium and water
-but there is no protein (albumin) in the vascular space to hold it
-so this fluid goes into the tissues (MORE edema)
-this results in ANASARCA
Nephrotic Syndrome: What is anasarca?
total body edema
Nephrotic Syndrome: Problems associated with protein loss
-blood clots (thrombosis)
-increased cholesterol
-increased triglycerides
Nephrotic Syndrome: Why would blood clots form as a result of protein loss?
they are losing proteins that normally prevent their blood from clotting
Nephrotic Syndrome: Why are levels of cholesterol and triglycerides increased with protein loss?
the liver compensates by making more albumin causing an increased release of cholesterol and triglycerides
Nephrotic Syndrome: Causes are idiopathic (unknown cause), but have been related to
-bacteria or viral infections
-NSAIDs
-cancer and genetic predispositions
-systemic diseases such as lupus or diabetes
Nephrotic Syndrome: Signs/Symptoms
-massive proteinuria
-hypoalbuminemia
-edema (anasarca)
-hyperlipidemia
Nephrotic Syndrome: Treatment includes
-diuretics
-ACE inhibitors
-prednisone
-cyclophosphamide
-diet
-lipid lowering drugs
-anticoagulation therapy
-dialysis
Nephrotic Syndrome Treatment: We give ACE inhibitors to block
aldosterone secretion
Nephrotic Syndrome Treatment: We give prednisone for
inflammation
Nephrotic Syndrome Treatment: We give cyclophosphamide to
decrease the body's immune response
Nephrotic Syndrome Treatment: How does cyclophosphamide decrease the immune response?
shrink holes so protein can't get out
Nephrotic Syndrome Treatment: Patients on cyclophosphamide are
immunosuppressed
Nephrotic Syndrome Treatment: Major complication of nephrotic syndrome and being on cyclophosphamide
infection
Nephrotic Syndrome Treatment: How much protein should these clients receive?
1 to 2 grams/kg/day
Nephrotic Syndrome Treatment: The client can become _______________________ fast
malnourished
Nephrotic Syndrome Treatment: We should decrease their ________________ intake
sodium
Nephrotic Syndrome Treatment: RULE
limit protein with kidney problems EXCEPT with nephrotic syndrome
Nephrotic Syndrome Treatment: We need to take daily
weights and I & Os
Nephrotic Syndrome Treatment: Measure
abdominal girth or extremity size
Nephrotic Syndrome Treatment: They need good
skin care
Acute Kidney Injury (AKI): This is
a sudden episode of renal damage
Acute Kidney Injury (AKI): Goal
reverse it to prevent chronic renal failure
Acute Kidney Injury (AKI): 3 Types
1. Pre-renal
2. Intra-renal
3. Post-renal
Acute Kidney Injury (AKI): Which of the 3 types occur 60-70% of the time?
pre-renal
Acute Kidney Injury (AKI): Pre-renal failure is when
blood can't get to the kidneys
Acute Kidney Injury (AKI): Causes of pre-renal failure
-hypotension
-decreased HR (arrhythmia)
-hypovolemia
-any type of shock
Acute Kidney Injury (AKI): Intra-renal failure is when
damage has occurred within the kidney
Acute Kidney Injury (AKI): Causes of intra-renal failure
-glomerulonephritis or nephrotic syndrome
-malignant hypertension (uncontrolled HTN)
-diabetes mellitus
-acute tubular necrosis
-dyes used in test such as heart cath & CT scan
-drugs (aminoglycosides - "-miacins")
-NSAIDS
Acute Kidney Injury (AKI): Acute tubular necrosis is
damage to the filtering bodies of the kidneys
Acute Kidney Injury (AKI): What causes acute tubular necrosis?
-hypotension
-sepsis
-drugs that damage kidneys (dyes)
Acute Kidney Injury (AKI): Post-renal failure is when
urine can't get out of the kidneys
Acute Kidney Injury (AKI): Causes of post-renal failure
-enlarged prostate
-kidney stone
-tumors
-ureteral obstruction
-edematous stoma (ileal conduit)
Acute Kidney Injury (AKI): 4 phases of acute kidney injury
1. initiation phase (injury occurs)
2. oliguric phase (output may be < or equal to 100
mL/24 hr)
3. diuretic phase (kidney recovering)
4. recovery phase (3-12 months)
Acute Kidney Injury (AKI): Signs/Symptoms
-increased BUN & creatinine
-increased or fixed specific gravity
-HTN
-HF
-anorexia, nausea, vomiting
-uremic frost
-retain phophorus
-anemia
-hyperkalemia
-metabolic acidosis
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the urine specific gravity be fixed?
because they may lose their ability concentrate and dilute urine (nothing to do with hydration)
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the client have HTN and/or HF?
retaining fluid
Acute Kidney Injury (AKI) Signs/Symptoms: Why would the client experience anorexia, nausea, and vomiting?
retaining toxins
Acute Kidney Injury (AKI) Signs/Symptoms: Because of uremic frost, clients need
good skin care
Acute Kidney Injury (AKI) Signs/Symptoms: Because clients retain phophorous, their serum calcium
decreases (calcium being pulled from bones)
Acute Kidney Injury (AKI) Signs/Symptoms: Why would these clients have anemia?
not enough erythropoietin being made by the kidneys
Acute Kidney Injury (AKI) Signs/Symptoms: Hyperkalemia can cause
lethal arrhythmias
Acute Kidney Injury (AKI) Signs/Symptoms: Why would these clients have metabolic acidosis?
unable to filter hydrogen or bicarb
Acute Kidney Injury (AKI) Treatment: Goals
-prevent complications
-manage s/s
-eliminate the cause of the kidney injury
Acute Kidney Injury (AKI) Treatment: Nursing Measures
-bedrest (to decrease metabolism & caloric needs)
-TCDB (turn, cough, deep breathe)
-monitor I & Os
-daily weights
-monitor VS closely
Acute Kidney Injury (AKI) Treatment: 1 kg =
1,000 mL of fluid
Acute Kidney Injury (AKI) Treatment: Medications
-loop diuretics or osmotic diuretics
-IV glucose and insulin (hyperkalemia)
-IV calcium gluconate (dysrhythmias)
-polystyrene sulfonate (excrete potassium)
-phosphate binding drugs (prevent hypocalcemia)
Acute Kidney Injury (AKI) Treatment: Give any IV medications in the
smallest volume allowed to avoid overloading the client
Acute Kidney Injury (AKI) Treatment: Regarding nutrition, we need to increase
carbohydrates and fats
Acute Kidney Injury (AKI) Treatment: Regarding nutrition, clients need a low
protein diet
Acute Kidney Injury (AKI) Treatment: Regarding nutrition, clients need to avoid
foods/fluids high in phosphate
Acute Kidney Injury (AKI) Treatment: Regarding nutrition, clients need to avoid foods
high in potassium like bananas, citrus, and coffee
Acute Kidney Injury (AKI) Treatment: Prevent infection by
-using aseptic technique
-meticulous skin care
-preventing pressure ulcers
-mouth care
-no catheter, if possible
-protect from others who have an infectious
disease
Acute Kidney Injury (AKI) Treatment: What is the leading cause of death?
infection
Acute Kidney Injury (AKI) Treatment: What may be needed?
Renal replacement therapy (RRT)
Acute Kidney Injury (AKI) Treatment: The nurse needs to support
the client and family
Acute Kidney Injury (AKI) Treatment: The oliguric phase ends in
10-14 days
Acute Kidney Injury (AKI) Treatment: Diuretic phase begins
when output increases
Acute Kidney Injury (AKI) Treatment: Fluid and electrolyte replacement is based on
lab results
Acute Kidney Injury (AKI) Treatment: During the recovery phase, client is placed on
increased protein and increased calories
Acute Kidney Injury (AKI) Treatment: During the recovery phase, the client is to resume
activity as tolerated
Renal Replacement Therapy (RRT): These therapies
take over or replace the kidney function
Renal Replacement Therapy (RRT): When is it started?
-when BUN and creatinine levels can't be
decreased
-when FVE is compromising the heart and lungs
-when hypercalcemia and metabolic acidosis can't
be treated successfully
Renal Replacement Therapy (RRT): This includes
-hemodialysis
-continuous renal replacement therapy
-peritoneal dialysis
Renal Replacement Therapy (RRT) - Hemodialysis: The machine is
the glomerulus (filter)
Renal Replacement Therapy (RRT) - Hemodialysis: It is done _________________________, so the client has to ____________________________ between treatments
3-4 times per week; watch what they eat and drink
Renal Replacement Therapy (RRT) - Hemodialysis: The client is given ________________________ during dialysis to prevent ______________________
an anticoagulant; blood clots from forming
Renal Replacement Therapy (RRT) - Hemodialysis: What anticoagulant is usually given and what must be implemented as a result?
Heparin usually and bleeding precautions should be implemented
Renal Replacement Therapy (RRT) - Hemodialysis: These clients can be ______________________ and can lead to ____________________
depressed; suicide (eating something they shouldn't)
Renal Replacement Therapy (RRT) - Hemodialysis: Before beginning, assess
fluid status
Renal Replacement Therapy (RRT) - Hemodialysis: What are watched constantly during hemodialysis?
electrolytes and BP
Renal Replacement Therapy (RRT) - Hemodialysis: Not all clients can tolerate this. These are usually clients with
an unstable cardiovascular system
Renal Replacement Therapy (RRT) - Hemodialysis: This requires
vascular access
Renal Replacement Therapy (RRT) - Hemodialysis: Blood is being removed, cleansed, and then returned at a rate of
300 to 800 mL/min
Renal Replacement Therapy (RRT) - Hemodialysis: What is a vascular access?
a site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis
Renal Replacement Therapy (RRT) - Hemodialysis: What types of vascular access are there?
-AVF (arteriovenous fistula)
-AVG (arteriovenous graft) [Show Less]