-MANIFESTATIONS INCLUE:

Study guide for exam 2 NUR 212 (Professor Goldharts review) CKD- What labs are we looking at with this disease? Calcium and potassium *We want to watch the calcium and potassium in the late stages of CKD* Know the assessment findings of CKD and what are the clinical Manifestations of this disease?Prevention/detection of CKD: Monitor BP to detect elevations so that treatment can be started early.The manifestations result from retained urea, creatinine, phenols, hormones, electrolytes, and water. Uremia is a syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems (Fig. 46.2). It often occurs when the GFR is 15mL/min or less -what’s their skin going to look like?

-MANIFESTATIONS INCLUE:

-watch for metabolic acidosis (KUSSMAL’S RESPIRATIONS) -HTN-(Monitor BP) -Uremic Fetor=foul breath odor smells like pee Peritoneal dialysis- that is where they run a catheter into the perineum and run Dialysate through the catheter into the perineum and let it sit. Then it acts as the kidney and the dialysate sits there for a prescribed amount of time and then they drain it. Observe the fluid after draining to see the characteristics of it, is it clear, is it cloudy, are there streaks in it or sediment.

Pt comes into the ER by driving themselves there and they do peritoneum dialysis at home and they come in c/o abdominal cramping, diarrhea, and fever we suspect peritonitis so we would…..Obtain peritoneal fluid and send it off to a culture and sensitivity.Know all your complications of the peritoneal dialysis The most common complication with peritoneal dialysis is PERITONITIS!*Obtain fluid from peritoneum and obtain a culture and sensitivity* -Abdominal pain is the most common symptom of peritonitis Blood pressure is priority to monitor with any type of dialysis d/t hypotension If the nurse gets busy and the dwell time is not adhered to then what kind of complications are going to be anticipated?Hyperglycemia Know s/s of acute glomerulonephritis -With these 3 diagnosis they all have edema and anasarca. We have to be able to know how to manage edema. What all would we do to control it?-A renal biopsy may be done to confirm the disease.-symptoms come on suddenly and may be temporary or reversible.How to manage edema-daily weights, diuretics, monitor intake and output, measure abdominal girth, monitor those and trend them so we can keep track of the edema and see if its getting better or worse, elevate extremities, compression socks, limit sodium/salt intake, limit fluid intake, HTN, monitor bp and give anti-hypertensives, fatigue is a common symptom so provide rest periods for pts

Manifestations include: generalized body edema, hypertension,

oliguria, hematuria, and varying degrees of proteinuria. Fluid retention occurs because of decreased glomerular filtration. At first, edema appears in low-pressure tissues, such as those around the eyes (periorbital edema). Later it progresses to involve the total body, with ascites or peripheral edema in the legs.One of the most important ways to prevent APSGN is to encourage early diagnosis and treatment of sore throats and skin lesions.*** During assessment ask your pt if they have a hx of sore throat or strep throat*** Know s/s of nephrotic syndrome/ clinical manifestations / know what is important to teach pt’s with nephrotic syndrome/ know what is important to report to the HCP on nephrotic syndrome- One of the complications with nephrotic syndrome is hypercoagulability so they are at risk for developing a renal artery thrombus which can lead to the lungs causing a PE. Monitor for this

Know s/s of chronic glomerulonephritis -Chronic glomerulonephritis is often discovered coincidentally with the finding of an abnormality on a urinalysis, high BP, or increased serum creatinine.

S/S include: proteinuria, hematuria, and the slow development of uremia

Need to know pt education for B-interferon injection and pt teaching Acute kidney injury- know the type and causes pre-renal, intra-renal, and post-renal, and know what causes each prerenal, intra renal and post renal, know phases: Oliguric phase, diuretic phase, and recovery phase. Know what you need to watch for in each phase  Pre-Renal-Consider prerenal causes when there is a history of dehydration, hypotension, or blood loss

Intrarenal causes: The damage from intrarenal causes usually results from prolonged ischemia, nephrotoxins (e.g., aminoglycoside antibiotics, contrast media), hemoglobin released from hemolyzed red blood cells(RBCs), or myoglobin released from necrotic muscle cells.

• Suspect intrarenal causes if the patient has been exposed to potentially nephrotoxic drugs or contrast

media usedin a radiologic study.Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI in hospitalized patients Post renal: Postrenal causes of AKI involve mechanical obstruction in the outflow of urine Post-renal causes: The most common postrenal causes are benign prostatic hyperplasia (BPH), prostate cancer, stones, trauma, and extrarenal tumors.A pt receiving IV Contrast, what would cause you to want to call the doctor and stop the nephrotoxic drug? Serum Creatine, know the levels for this LAB VALUES to know: BUN 10-20 GFR 90-120, Mag 1.5-2.5, Calc 8.5-10, Electrolytes, Serum creatinine 0.6-1.2, creatinine clearance 1.001-1.035 Pt that has AKI and Hyperkalemia, how would we move the potassium back into the cell: -Regular insulin IV -Sodium Bicarbonate IV -Calcium Gluconate IV- protects the heart from dysrhythmias Know with AKI and CKD what happens with the different systems: CNS, Metabolically, Respiratory system, Electrolytes CKD, know all manifestations and be able to recognize them by s/s, abg results, lab value, etc

Manifestations include: varying degrees of hematuria (ranging from microscopic to gross), proteinuria, and urinary excretion of various formed elements, including red blood cells (RBCs), WBCs, and casts.Increased BUN and serum creatinine levels are common. Ultrasound and CT scan are the preferred diagnostic measures. However, a renal biopsy may be done to determine the exact cause of theglomerulonephritis. Hemodialysis can be used temp with a pt with AKI if their GFR is lower than a 15 CKD can have peritoneal or hemodialysis

Know medication: Levodopa

-know side effects, and what pt teaching you would do with this medication Know Carbidopa/levodopa side effects Parkinson’s- know your clinical manifestations and what you teach these pts, espically little things like when they freeze up when they walk, eat foods that are soft and easy to swallow Possibly be familiar with Lewy body Know s/s of MS and clinical manifestations Know how to manage exacerbations of MS and what medications we would give to assist with these, the classifications Know what we need to teach pts with MS to prevent exacerbations MS starts out with slow progression, may start with red, green color distortion Loss of sphincter control as the disease progresses so they may need to learn how to self-catheterize Know your lermets sign Know manifestations for myasthenia crisis and what precipitates this Know what precipatates cholinergic crisis and the symptoms of it Gullian barre know the ax finding and clinical manifestations Symptoms start at the feet and they start to ascend, they will eventually end up paralyzing pt. know the most critical point for that pt and what to do about it Important to educate pts that take antibiotics to stay on them the entire prescribed time and to always finish them even if they start to feel better. Educate on the things that can happen if they stop taking too early.-Encourage the patient to take the full course of antibiotics to ensure that the bacteria have been eradicated.Chronic glomerulonephritis- hard to dx, fatigue, abnormal bp and urinalysis often caught in the doctor’s office. Know how you would diagnose chronic glomerulonephritis. They don’t always know the cause of this and the only way to find out is with a renal biopsy