NUR 265 - EXAM ONE STUDY GUIDE (100% correct)..

NUR 265 - EXAM
ONE STUDY
GUIDE (100%
correct).

,NUR 265 EXAM ONE STUDY GUIDE

 Nephrotic Syndrome:
o NS is a condition of increased glomerular permeability that
allows larger molecules to pass through the membrane into the
urine and then be excreted.
o This 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.
o Key features:
 Massive proteinuria
 Hypoalbuminemia
 Edema (facial and periorbital)
 Lipiduria
 Hyperlipidemia
 Increased coagulation
 Reduced kidney function
o Treatment- 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
o Diet:
 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:
o AKI 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
o Severity 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).
o GFR 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%

,  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
o 3 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
o effects LOC, mood, change in personality
o related directly to reduced perfusion to the
kidneys
 examples of perfusion reduction:
o blood/fluid loss- hypovolemic shock
o blood pressure drugs resulting in hypotension
o MI or HF resulting in low ejection fraction and
low cardiac output
o Infection
o Liver failure
o NSAIDs
o Anaphylaxis
o Severe burns
o Severe dehydration
o Renal artery stenosis
o Bleeding or clotting in kidney blood vessels
o Atherosclerosis 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:
o Bleeding in the kidney
o Glomerulonephritis or inflammation of the
glomeruli
o Thrombi or emboli in the kidney blood vessels
o Sepsis
o Local infection
o Lupus
o Multiple myeloma
o Scleroderma
o Ingesting toxins- alcohol

, o Ischemia in kidney failure, including hypoxemia
from respiratory and cardiac arrest
 Post-renal failure- obstruction that occurs after the
kidney
 Post-renal failure examples:
o Bladder cancer
o Colon cancer
o Prostate cancer
o Cervical cancer
o Enlarged prostate
o Kidney stones
o Blood clots in urinary tract
o Nerve damage in bladder control
o Mean 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!!!
o Nursing 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
o Creatinine elevation quickly!
o Preventing 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
o Question any order of two or more nephrotoxic
drugs taken at one time.
 If they must receive these drugs,
carefully monitor lab values
o Examples of nephrotoxic substances:
 NSAIDS