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Help

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Submitted By rsjohnson
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VIII. RENAL
A. Glomerulonephritis:
Acute can lead to chronic.

1. Pathophysiology:
a. Inflammatory reaction in the _______________________.
b. Antibodies lodge in the glomerulus; get scarring & _____________ filtering.
c. Main cause: _______________________
2. S/S:
a. Sore throat
b. Malaise and headache
c. BUN & Creatinine _______
d. Sediment/protein/blood in urine
e. Flank pain (costovertebral angle tenderness)
f. BP_________
g. Facial ________
h. UO ________
i. Urine specific gravity ______
Client going into fluid volume ______________.

3. Tx:
a. Get rid of the strep.
Renal

b. Balance activity with rest.
c. I & O and daily weights
d. Monitor blood pressure.
e. How is fluid replacement determined?


Fluid replacement = 24 hour fluid loss + __________.

f. Dietary needs:

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Protein? ______ Na? __________ Carbs? _______

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g. Dialysis
h. Diuresis begins in ___ to ___ weeks after onset.
i. ___________ and protein may stay in the urine for months.
j. Teach S/S of_________________________.


Malaise, headache, anorexia, nausea, vomiting, decreased output, weight gain. B. Nephrotic Syndrome:
1. Pathophysiology:
It’s an inflammatory response in the ________________→ big holes form so protein starts leaking out in the urine (what do we call this? ______________)→ Now the client is hypoalbuminemic (low albumin in the blood)→ without albumin you can’t hold on to fluid in the vascular space→ so where does all the fluid in the vascular space go?
___________________→ Now the client is edematous→ since all the fluid is going out into the tissue what has happened to the circulating blood volume?________→
The kidneys sense this decreased volume and they want to help replace it→ The renin-angiotensin system kicks in→ aldosterone is produced→ and causes the retention of ___________ and __________________→ but is there any protein
(albumin) in the vascular space to hold it?__________→ So where does this fluid go?____________ Total Body Edema = ____________________________________
Renal

Problems associated with protein loss:


Blood ________(thrombosis)
They are losing protein that normally prevents their blood from clotting without these proteins, the blood can clot and put them at risk for thrombosis.



Cholesterol and triglycerides will be ______
The liver compensates by making more albumin causing an increased release of cholesterol and triglycerides.

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2. Causes; Idiopathic, but has been related too:
a. Bacteria or viral ___________
b. NSAIDs
c. Cancer and ___________ predisposition.
d. Systemic disease like lupus or diabetes.
e. Strep
3. S/S:
a. Proteinuria
b. Hypoalbuminemia
c. Edema (anasarca)
d. Hyperlipidemia
4. Tx:
a. Diuretics
b. ___________________ to block aldosterone secretion.
c. Prednisone to _____________ inflammation.


Shrink holes so ____________ can’t get out.



Immunosuppressed.

d. Lipid lowering drugs for hyperlipidemia.
Renal

e. Na? __________
f. Protein? _______
g. Anticoagulation therapy for up to 6 months.
h. Dialysis
Rule: Limit protein with kidney problems except with Nephrotic Syndrome.

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C. Renal Failure:


Requires bilateral failure.

1. Causes:
a. Pre-Renal Failure: _________ can’t get to the kidneys.


Hypotension



_________ heart rate. (arrhythmia)



Hypovolemic



Any form of __________

b. Intra-Renal Failure: damage has occurred ____________ the kidney.


Glomerulonephritis



Nephrotic syndrome



________ used in test such as heart cath and CT scan



Drugs (Aminoglycosides, Mycins)



Malignant ____________________ (uncontrolled HTN)



And DM causes severe ________________ damage.

c. Post-Renal Failure: _________ can’t get out of the kidneys.
Enlarged ______________



Kidney stone



Tumors



Ureteral obstruction



Edematous __________ (Ileal conduit)

Renal



NCLEX® Critical Thinking Exercise:
18- month old went to surgery for bilateral ureteral stents. After surgery you notice the UO has dropped. 1. Call primary healthcare provider
2. Turn from side to side.
3. Irrigate
4. Reassess in 15 minutes
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1. S/S:
a. Creatinine and BUN ___________
b. Specific gravity


Initially _______



Fixed specific gravity:


May lose ability to concentrate and dilute urine.



Fluid challenge- bolus with 250 mLs or greater of normal saline

c. Anemia


Not enough erythropoietin.

d. HTN
Retaining __________

e. HF
f. Anorexia, nausea, vomiting→ retaining ____________.
g. Itching frost (Uremic frost)


Good skin care

h. Acid- base/fluid and electrolyte imbalances


____________________ could cause lethal arrhythmias.



Metabolic acidosis.



Retain phosphorous→ serum calcium _____→ calcium pulled from _____

2. Two phases of Acute Renal Failure:
Renal



Kidneys have been damaged by one of the causes, this damage leads to the oliguric phase.

a. Oliguric phase:



UO of _______ to _______ mL/ 24 hours.



This client is in a fluid volume ____________


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What has happened to UO? ________________

What do you think will happen to the K+? ______________

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b. Diuretic phase:


____________ onset



What is happening to the UO? _____________



This client is in a fluid volume ______________. (Shock)



What do you think will happen to the K+? _________

D. Dialysis:
1. Hemodialysis:
a. General Information:


The machine is the glomerulus. (filter)



Is done 3-4 times per week; so the client has to watch what they _______ and
_________ between treatments.



To prevent blood ____________ from forming the client is given an anticoagulant during dialysis.
Usually Heparin- implement what? _________________________



Depression → Suicide



Electrolytes and ___________ are watched constantly.



Can all clients tolerate hemodialysis? ________
Unstable cardiovascular system can’t tolerate hemodialysis.
NCLEX ® Critical Thinking Exercise
Renal

What medications should you hold for a client going to dialysis?
Select all that apply.

1.
2.
3.
4.
5.

Lisinopril (Zestril®)
Nitroglycerin (Nitro-Bid®)
Water soluble vitamin
Ampicillin (Polycillin®)
Famotidine (Pepcid®)

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b. Vascular Access:


Must have a vascular access:

1) Types of Access:


With hemodialysis, blood is being removed, cleansed, and then returned at a rate of _________ mL/min.



What is vascular access?
A site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis.
AVF (arteriovenous fistula) in forearm with an anastomosis between an artery and a vein.



AVG (arteriovenous graft) a synthetic graft to join the vessels.



Both require surgery, takes weeks to mature and to be ready for repeated venipunctures.

Renal



116

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During dialysis two needles are inserted into the vascular access.
One needle will allow blood to be pulled from the circulation and sent to the hemodialysis machine.
The other is used to return the filtered blood to the client’s circulation. •

The _________ end of the access will remove the blood and the return is through the low pressure _________ end.



For temporary access, the internal jugular or femoral vein is often used for catheter placement. Surgery is not required for temporary placement. 2) Care of Access:


Do not use any of the above for IV access (drawing blood, administering meds, etc.)



When a client has an alternate vascular access what is the associated nursing care for that extremity?
No __________________________
No ________________ sticks
No ____________________________

3) Assessment of Access:


Why? ______________________



How?
Thrill-cat purring sensation (palpate)
Bruit-turbulent blood flow (auscultate)
Feel a_________…Hear the _________.
Renal

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117

2. Peritoneal Dialysis:


Use peritoneal membrane as a _____________.



Dialysate is warmed and infused into the peritoneal cavity by gravity via a
Tenckhoff catheter.



The fluid (2000-2500 mL) fills the peritoneal cavity (takes about 10 min) remains in peritoneal cavity for a prescribed amount of time. This is called the dwell time.



Then the bag is lowered and the fluid along with the ________, etc., are drained.
And that is called the exchange.



Why do we warm the fluid? Cold promotes vasoconstriction→ limits blood flow
We want it warm, this promotes _______________, and more blood flow.



What should the drainage look like?
__________, straw-colored cloudy = _______________
Should be able to read a newspaper through the drainage/effluent.



What type of client gets peritoneal dialysis? Someone who can’t tolerate
___________ or someone who chooses peritoneal.



What if all the fluid doesn’t come out? __________________________________

a. Two Types of Peritoneal Dialysis:
1) CAPD (Continuous Ambulatory Peritoneal Dialysis):
Must have a client that has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions. •

Done ______ times a day, 7 days a week.



Renal



Could a client with disc disease or arthritis do this? ________
Fluid causes pressure on back.



Could a client with a colostomy do this? _______
High risk for ________________________

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2) CCPD (Continuous Cycle Peritoneal Dialysis):


Connect their peritoneal dialysis catheter to a cycler at _______ and their exchange is done automatically while they sleep. Disconnected in the AM; has more freedom.

b. Complications of Peritoneal Dialysis:


Major complication is ___________________ (Cloudy effluent 1st sign)



Constant sweet taste



May get a _____________.



Altered body image/sexuality



Anorexia



Low back pain

c. Dietary Needs of the Peritoneal Client:


Increase what in the diet?
Fiber→ Have decreased peristalsis due to abdominal fluid.
Protein→ Big holes in peritoneum and lose protein with each exchange. 3. Continuous Renal Replacement Therapy (CRRT):
Typically done in an _______ setting and is continuous so that the client doesn’t have drastic fluid shifts.



Never more than 80 mL of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much.



CRRT is performed on a client with:

Renal



A fragile cardiovascular status and acute ____________ failure.

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119

E. Kidney Stones (urolithiasis, renal calculi):
1. S/S:


Pain (nausea/vomiting)



WBCs in ________________.



Hematuria



Anytime you suspect a kidney stone get a ________ specimen ASAP and have it checked for ________.



If a kidney stone is present the client will get pain medication immediately.

2. Tx:
Ketorolac (Toradol®), Ondansetron (Zofran®), Hydromorphone (Dilaudid®)



____________ fluids.



Maybe surgery



Strain urine



Extracorporeal shock wave lithotripsy (ESWL)

Renal



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NCLEX® Critical Thinking Exercise:
The nurse is assessing a client diagnosed with kidney stones who just returned from extracorporeal shock wave therapy (lithotripsy).
The client is supine in bed with a Foley catheter in place. Which finding would be the best indicator that the treatment has been effective?

1. Total absence of pain.
2. The Foley catheter is draining freely.
3. Rebound tenderness is absent during abdominal assessment.
4. Sand-like sediment has settled in the bottom of the Foley catheter bag.

NCLEX® Critical Thinking Exercise:
A nurse is working in the ED and assigned to care for the clients in examination rooms 1, 2, and 3. The nurse received the following report from the off going nurse: 1. The client in Room 1 is an elderly person who has fallen and is currently in CT to rule out a subdural hematoma.
2. Client in room 2 is diagnosed with kidney stones, positive for hematuria and has 8/10 pain.
3. The client in room 3 has a blood pressure of 90/40.
Renal

Let me ask you a question: which client would you go see first?

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Help Desk System

...Functional Requirements: 1. Incident Identification and Incident Logging Incidents can be any failure or interruption to an IT service. A service call can be created from - Web Interface - User Phone Call - Email Technician Staff 2. Incident Categorization Incidents can be organized with three levels of categorization - Category, Subcategory and Item. The incidents can be assigned to these categories depending upon the failure that is reported and can be automatically routed to the appropriate support engineer. 3. Automatic Dispatch of Incidents. Business rule criteria can be created based on the pattern of failure. The incidents will be automatically assigned to technicians, categories and levels. 4. Incident Prioritization - Predefined Prioritization Define the priority based on the impact and urgency of the incident. System can then automatically assign the priorities based on Predefined prioritization. - Dynamic Prioritization Allow technician to assign the priority manually or to override the values set by the priority matrix. 5. Incident Diagnosis Searching the existing workarounds or solution from the KnowledgeBase and getting back to the users immediately with the resolution. 6. Incident Escalations When the first-level support is unable to resolve the incident, the incident can be assigned to the second-level support. The incident will be escalated to the third-level support when the second-level support is not able to resolve it within the...

Words: 435 - Pages: 2