• What is nephrotic syndrome?: A condition of increased
glomerular permeabil- ity that allows larger molecules to pass
through the membrane into the urine andthen be excreted.
• What are key features of nephrotic syndrome?: -
*Massive proteinuria*
-*Hypoalbuminemia*
-*Edema (facial and periorbital)*
-Lipiduria
-Hyperlipidemia
-Increased coagulation
-Reduced kidney function
• In nephrotic syndrome, severe protein loss in the
urine is greater thanwhat?: 3.5g in 24 hours
• What is nephrotic syndrome treated with?: -
immunosuppressant agents (ifimmunity based).
-ACE inhibitors (decreased protein loss in urine)
-statins (improve blood lipid levels).
-Heparin (used to treat vascular effects and improve kidney function)
• Describe Prerenal AKI. Give examples.: Decreased
perfusion to kidneys.
-NSAIDs
-Severe dehydration
-Renal artery stenosis
-MI or HF resulting in low ejection fraction and low cardiac output
-Blood/ fluid loss
,• Describe Intrarenal AKI. Give examples.: Tissue damage
to the actual kid-neys.
-Glomerulonephritis or inflammation of the glomeruli
-Sepsis
-Intrarenal bleeding
-Pyelonephritis
• Describe Postrenal AKI. Give examples.: Obstruction
that occurs after thekidney.
-Enlarged prostate (BPH)
-Bladder Cancer
-Kidney stones
• How do you determine the mean arterial pressure
(MAP)?: Systolic + (Dias-tolic*2) /3
• What is the MAP needed to perfuse the kidneys?: 65
mmHg
• What are examples of nephrotoxic drugs?: -NSAIDS
-Metformin
-Diuretics
-Antibiotics (especially -mycin)
-Contrast dye
• During the diuretic phase of AKI, what needs to be
monitored?: Watch fordehydration and make sure output is
greater than input
• What are the dietary restrictions for an AKI patient?: -
Low protein
-Low sodium
,-Fluid restriction: 1000-1500mL day (for anything except perfusion
problem)
• What are the 2 most common causes of CKD?: -HTN
-Uncontrolled diabetes
• What is azotemia?: Nitrogenous waste build up
• What are manifestations of uremia?: •Metallic taste in
mouth
•Anorexia
•Nausea/vomiting
•Muscle cramps
•Uremic frost on skin
•Itching
•Fatigue and lethargy
•Hiccups
•Edema
•Dyspnea
•Paresthesia's
• What effects can CKD have on the cardiac system: -
HTN
-Heart failure (major problem. Call the doctor)
-Pericarditis
• What effects can CKD have on the Integumentary
system: -Uremic frost
• What are the dietary restrictions on CKD?: -Protein
(restrict early in diseaseprocess to preserve kidney function)
-Potassium
, -Fluid
-Sodium
• Describe hemodialysis: -3x a week- 4-5 hours
-At risk for bleeding do to heparin
-Extremely fatigued post.
-Vitals and weight before and after
-Slight fever post is normal. Monitor.
• Describe peritoneal dialysis: -Sterile procedure at home
where catheter isplaced into the abdomen
-Wear a mask
-Solution may be warmed using a heating bag or blanket, not
microwave!
-Make sure patient turns and repositions to mix solution in the cavity
• Describe nursing care for an AV fistula.: -Palpate and
auscultate- bruit andthrill
-Distal pulses
-ROM- helps form the fistula
-Monitor for infection
-No heavy lifting or carrying
-No pressure
-Aneurysm can form at AV fistula site
• Describe dialysis disequilibrium syndrome: -Life
threatening! (occurs if fluidis pulled off too fast)
-S/S: restless, headache, decreased LOC, seizures, coma
-Call a rapid immediately
-Give barbiturates and anticonvulsants
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