Renal Fabs - Antidote:

- Calcium gluconate: Antagonist

Sodium: - Calcium decreases your magnesium
- Purpose: Most important electrolyte of the brain. levels
- Stimulant of the brain
- Hangovers are most likely related to hyponatremia.
- Related to water balance because sodium attracts your
Hypomagnesemia Hypermagnesemia
water.
Potassium Konti depressant (Up Marami depressant (Down
- Most important electrolyte of the heart Symptoms) symptoms)
- Promotes your neuromuscular contractility
I
- Hyperkalemia: Overworking of the heart
Altered LOC (Confusion, Altered LOC (Stupor,
Irritability) Obtunded, Lethargy, Coma)
- It could lead to the possibility of cardiac arrest
Chloride Deep tendon reflexes: Deep tendon reflexes:
- Has the same function as sodium Increased, hyperreflexia Decreased, hyporeflexia
- Not really a priority.
Seizures, Muscles cramps, Muscle weakness
Calcium
Tremors
- For the bones and teeth
- Significantly for the: neuromuscular contractility Insomnia, Increased RR HR Drowsiness, Decreased HR
- Muscles are related to the calcium RR BP
- Hypocalcemia: muscles will not contract
Cause: Alcoholism, Cause: Magnesium sulfate
- Indirectly related to phosphate
decreased intake in the diet toxicity, renal failure (down
Magnesium glomerular filtration rate):
- Depressant Magnesium in diet: Fiber, increased waste and fluids
- OD: Pre-eclampsia grains, legumes, spinach,
- Preeclampsia has a risk for seizures so we can use nuts.
magnesium to prevent it.
MGT: Least to most invasive MGT: Magnesium is
- Magnesium sulfate toxicity must be monitored.
- Oral magnesium rich eliminated via saline diuresis
- Symptoms: foods (urination), we can give
- Decreased tendon reflexes - Oral magnesium diuretics and replace lost
- Heart rate RRBP: Decreased supplements fluid via IV fluid
- Urine output: Decreased

If magnesium is critically low: Renal failure: decreased
Intravenous functional nephrons:
diuretics are no longer
Observe magnesium sulfate effective (Dialysis)
toxicity
Antidote to
hypermagnesemia: Calcium
gluconate, will be given via
IV
Hyperkalemia:
- Most important electrolyte in the heart.
- Cause metabolic acidosis
- “The body CARED too much about K+”
- Cellular movement of K+ from intracellular to
extracellular (burns, tissue damage, etc)
- The potassium goes out of the cell to the
blood. The sodium goes in to the cells
- Burns: HYPERkalemia
- Sodium: HYPOnatremia
- Adrenal insufficiency with Addison’s disease
- Addison’s disease: Decreased
aldosterone levels (Aldosterone:
promotes water and sodium retention)
- Decreased aldosterone: decreased
sodium leading to HYPOnatremia,
leading to HYPERkalemia
- Renal failure: Decreased filtration rate
- Increased electrolytes because blood
cannot be filtered
- Hyperkalemia, Hypernatremia,
Hypocalcemia, Hyperphosphatemia,
Hypermagnesemia
- Excessive potassium intake
- Increased fluid or supplement
- Drugs:
- Potassium sparing drugs
- Spironolactone
- ACE inhibitors
- Lisinopril
- Captopril
- NSAIDs
- Take with food because
they are gastric irritants
- Signs and symptoms of Hyperkalemia “MURDER”
- Muscle weakness
- Too much contraction weakens the
muscle.
- Urine output little or none (renal failure)
- Respiratory failure (due to muscle weakness)
- Strongest respiratory muscle:
Diaphragm
- It may cause cardiac arrest
- Decreased cardiac contractility
- Weak pulse or Low HR
- Early: muscle twitches and cramps
- Early signs and symptoms causes
cramps but if late, it gets tired and leads
to muscle weakness
- Rhythm changes
- Tall peaked T waves, prolonged PR
interval
- Management of critical hyperkalemia - Low potassium in the diet
- Initial management: - Potassium wasting diuretics
- 10% Calcium gluconate: protects - Loop diuretics
myocardium - Thiazide diuretics (Microcide)
- Not related to potassium
- Fastest way to decrease your potassium HYPOKALEMIA
- Glucose insulin: stimulate uptake of - Causes
glucose with potassium “Your body is trying to DITCH K+”
- Insulin (Through IV) - Drugs:
- Given for the - Loop diuretics : Wasting
hyperkalemia - Furosemide
- Side effect of insulin: - Laxatives: Wasting
HYPOGLYCEMIA - Inadequate consumption of K+
- Therefore giving glucose to the - Too much water intake
patient to counteract the side - Cushing’s syndrome
effect of the insulin - Endocrine problem
- For DM Type I: Insulin with - Increased aldosterone
Potassium because side effect of - Increased sodium
insulin in patients with DM is - HYPERnatremia causing
hypokalemia. HYPOkalemia
- Sodium bicarbonate (Alkaline in nature) - Heavy fluid loss
- Correct metabolic acidosis to lower - Nasogastric tube suction
plasma K+ - Vomiting
- Metabolic acidosis: Increased - Diarrhea
potassium - Wound drainage
- Renal failure: Metabolic acidosis - Signs and symptoms
- Usually VIA IV drips - Asymptomatic: Late nadedetect
- Kayexelate - 7Ls (7 Lows)
- Via Enema or oral - Lethargic
- Sodium rich - Low shallow respirations…failure
- Sodium potassium exchange - Failure in muscle
- Potassium restriction - Lethal Cardiac dysrhythmias
 - ST depression - Has a stimulant effect
- Shallow T wave - Signs and Symptoms of Hypernatremia
- Projecting U wave - Usually caused by dehydration
- Earliest symptom of - FRIED SALT
Hypokalemia - Flushed skin and fever (low grade)
- But cannot be seen by - Restless, irritable, anxious and confused
the naked eye (Up symptoms)
- Needs ECG - Increased blood pressure and fluid
- Lots of urine (Frequent and large retention
amount) - Edema, peripheral and pitting
- Problems with fluid loss - Third spacing (Fluid entered
- Leg cramps interstitial space)
- Limp muscles - Decreased urine output
- Low blood pressure (Severe) - Can be related to dehydration,
- Decreased contractility of heart decreased urine output because
- Management it is conserving fluid
- IV potassium replacement concentration in the blood
- Not more than 10-20 mEq/hr - Skin flushed
- Critically low - Agitation
- Incorporated: mix with IV fluid - Low grade fever
- But if doctor’s order is more than 20, it is - Thirst
required to have Cardiac monitor and - Management:
infusion pump - I/O : Watch out for fluid volume deficit
- High potassium diet - Urine specific gravity:
- Oral potassium replacement concentration of the urine (NV:
- For stable patients 1.010-1.030)
- It should be given with juice to increase - Dehydrated: Concentrated:
palatability Higher SG (>1.025) “Mabigat”
- Monitor cardiac rhythm - Neck veins: Flat
- Weak and thready pulses
SODIUM - Increased HR and RR
- Sodium is the most important electrolyte of the brain - Altered LOC (Up symptoms)
 - Anxious - Seizures/Headache
- Weight - Related to severe sodium losses
- Most sensitive indicator of fluid - Stomach cramping
volume - Abdominal discomfort related to nausea
- In case of hypernatremia, there and vomiting
will be weight loss - Management of Hyponatremia
- Dry Mouth/Mucosa - Related to overhydration
- Poor skin turgor - Diluted sodium
- How do we remove sodium? - I/O: Monitor for overhydration
- Via diuresis with replacement of fluid - Specific gravity: <1.010 urine is diluted
- Low sodium diet “Magaan”
- Canned food - Bounding pulses
- Condiments - Distended neck veins
- Instant foods, processed food - BP: Increased BP, HRRR: Increased
- HYPONATREMIA (Vascular resistance)
- Down symptoms - Altered LOC: Down symptoms
- “SALTLOSS” - Weight gain because of
- Stupor overhydrated status
- Anorexia - Sodium tablet
- Nausea and vomiting - 0.9 NaCl PNSS
- Decreased stimulant - Electrolyte drinks
- Lethargy
- Tendon Reflexes CALCIUM
- Limp Muscles HYPERCALCEMIA
- Orthostatic Hypotension “BACKME”
- Drop in DP - Bone pain
- With respect with rapid change in - Arrhythmias
position - Cardiac arrest
- There will be dizziness and risk for falls - Kidney stones
- Management: - Muscle weakness
- Change position slowly, sit at the - Late symptom of late hypercalcemia
bed side because of the increased contractility
 - Excessive urination
- Osmotic diuresis
- With the effort to remove the calcium
- Parathormone (Katabi ng thyroid)
- Promote calcium balance
- Promotes bone decalcification or bone
resorption (Sisirain ang buto para lumabas ang
calcium from the bone to the blood)
- Calcitonin: from thyroid
- Promotes calcium uptake of the bone
(Pinapapasok si calcium sa boto)
- Calcitonin and Parathormone has opposite
effect
- Hyperparathryoidism (Tumor)
- Increased parathormone
- Increased bone decalcification
- Increased calcium in the blood
- Hypercalcemia
- That may lead to kidney stones
- Increased contractility of the
heart, causing overworking of the
heart that will cause
ARRHYTHMIAS that would lead
to Cardiac Heart
- Weak brittle bones
- Prone to pathologic fracture
- Nursing Management for Hypercalcemia
- Promote calcium excretion via the urine
- Loop diuretic
- Furosemide
- Ethacrynic acid
- Hydration to 3000 to 4000 mL to
flush calcium and to decreased
renal calculi formation
- Synthetic calcitonin can be given to
lower calcium levels
- Monitor I and O, vital signs,
muscle weakness and heart rate
and rhythm
- Calcitonin:
- To promote calcium from the
blood to the bone
HYPOCALCEMIA
- Signs and symptoms: “CATS”
- Convulsions
- Can lead to cerebral edema
- Decreased contractility
- Increased ICP
- Arrhythmias
- Decreased calcium leads to decreased
contractility of the heart
- Tetany
- Numbness and stiffness of the muscles
due to loss of ability to contract
- Stridor and Spams
- Weakness of diaphragm
- Hypoparathyroidism
- Related to accidental removal of parathyroid
(Post thyroidectomy)
- Unexpected
- Hypocalcemia is lifetime
- Malpractice of the doctor
- Calcium is for contractility
- Trousseau’s sign : Severe - Possible mapagod si
- Induction of carpopedal spasms by inflation of a heart if dumami si
sphygmomanometer above SBP for 3 minutes calcium bigla
- Response: - Other Management
- Carpopedal spasms characterized by - IV: Main
- Adduction of thumb - High calcium diet of the
- Flexion of metacarpophalangeal filipinos (Sardines)
joints - High calcium diet of the
- Extension of interphalangeal world (Anchovies)
joints - Vitamin D Supplements
- Flexion of the wrist - Promotes calcium
- Chvotek’s sign absorption
- Contraction of the ipsilateral facial muscle
elicited by tapping the facial nerve just anterior KIDNEYS
to the ear Mnemonic for functions “WET BREAD”
- Response:
- Twitching of the lip to spasm of all facial
Function of the Renal Failure Management
muscles kidney
- Nursing management for Hypocalcemia
- IV: Calcium gluconate Water Balance Hypervolemia : it Fluid restriction (1
- Vesicant solution can cause to 1.5 L/day)
- Irritating to the vein causing cerebral edema,
congestive heart Diet: Low sodium
extravasation (Nasunog ang
failure, portal diet
ugat) hypertension,
- Can lead to Phlebitis pulmonary Diuretics : for
- Management: Use bigger veins hypertension acute renal
- More blood, better failure, reversible,
dilution high percentage of
functioning
- Bleeding gums and mucosa
nephrons
- Calcium is related to your Chronic renal
clotting factors failure:
- Watch out for: Cardiac Monitor
 Irreversible, Altered LOC: Renal
decreased Different focusing, Encephalopathy:
functioning of seizures, coma Safety is priority
nephrons,
diuretics are no Uremic Frosts Calamine lotions,
long effective (Acid): Itchy skin antihistamines,
oatmeal bath,
cocoa butter
Electrolyte Hypernatremia Restrict Na in the lotions, cut
balance diet fingernails short,
sodium
Hyperkalemia Insulin with bicarbonate
glucose
Sodium Dialysis
bicarbonate can
be given Blood pressure Hypertension Calcium channel
control because of fluid blockers
Hypocalcemia, Phosphate volume excess Betablockers
Hyperphosphatem binders to
ia decrease
phosphate (Ex. RAAS system: Increased ACE inhibitors-
Alum hydroxide, Renin and aldosterone: causes
Antacids) angiotensin hypernatremia hyperkalemia
aldosterone and hypervolemia ARBS:
Hypermagnesemi Calcium system Angiotensin
a gluconate: Severe receptor blockers
cases Aldosterone: (Sartans):
sodium and water Prevents
Toxin Removal Urea build up Low protein retention aldosterone
Urea (Ntirogen - (Uremia) source from high formation:
byproduct of Nitrogen build up biologic source : Decreased
protein) (Azotemia) Low nitrogen Sodium and water
byproduct, white retention
Urea build up: can meat, Poultry,
cause renal Dairy, Tofu
encephalopathy: Erythropoietin : Decreased Synthetic
 Stimulates RBC erythropoietin: erythropoietin :
production Decreased RBC stimulates RBC Hypertension
production production
(Decrease DM: decreased blood flow
oxygenation, easy because viscous
fatigability, activity
intolerance) Intrarenal failure: Inside the Glomerulonephritis,
kidneys nephrotoxic drugs,
Acid balance Hyperkalemia Sodium Nephron, glomerular, tubular dye/contrast medium:
causes metabolic bicarbonate drip damage : Decreased Tubular necrosis (Tissue
acidosis : Cardiac filtration rate, decreased death)
arrest urine production Tubular sclerosis (Tissue
scarring)
D- Vitamin D : Hypocalcemia : Vitamin D
promotes Hyperphosphatem supplements Post renal failure (After the > Renal calculi
absorption of ia kidneys), with urine > Benign prostatic
calcium production but hyperplasia
OBSTRUCTED > Bladder cancer > Bladder
failure
Causes:
- Acute renal failure
- High reversible in nature
Stages of Chronic Kidney Disease
- Goal: to preserve kidney functioning
- Stage 1: Kidney damage with normal or increased
- Acute renal failure would cause chronic renal failure
EGFR
- Chronic renal failure: Irreversible
- Normal EGFR: 90 to 125mL/min
- Stage 2: Mild
- Weakness
Causes of Renal Failure Examples - Nausea and vomitin
- Stage 3: Moderate
Prerenal failure (before the Decreased cardiac output or
kidneys), decreased related to heart future - Stage 4: Severe
perfusion status - decreased - Stage 5: Kidney failure
filtration status - little to none Hemorrhage
urine production Renal transplant: High risk for rejection
Sepsis - By the immune system
 - Management: immunosuppressants
Uses dialyzer to filter blood
- Ex. Azathioprine, steroids, cyclosporine and remove waste (More
- High risk for infection efficient)
- Symptom of kidney rejection
- Oliguria
- Flank pain Access points: AV fistula
(takes 3 months to be
- Renal encephalopathy
prepared), if not yet
available, intrajugular
DIALYSIS catheter
- Hemodialysis
- Dialyzer serves as the kidney For severe cases with
- Peritoneal decreased renal functioning
- Dialysate : high in glucose
- Osmosis: from lower to higher concentration AV fistula care: Keep it clean
and dry, avoid BP taking,
phlebotomy, at the affected
site
Check patency: Present bruit
> (Aucultate: Whooshing
sound) and thrill (palpate :
machine like vibrations)
Prio complication:
- Disequilibrium syndrome
WHAT: It offers you cerebral
Hemodialysis Vs. Peritoneal dialysis edema - increased ICP -
Altered LOC, BP decreased,
HRRR increased, possible
for coma and seizures
Hemodialysis Peritoneal dialysis WHY:Rapid removal of
nitrogen waste related to
Dialysate: high in glucose
that would cause
hyperglycemic,
hyperosmolar ultrafiltration
Access point: Peritoneum
(Between umbilicus and
suprapubic area)
(More accessible)
For young, milder cases,
ambulatory with high renal
functioning
Dialysate: rich in glucose,
watch out for hyperglycemia
Prio complication: Peritonitis
Clinical symptoms: Rigid
boardlike abdomen, fever,
increased HR RR
Why? Dialysate -Rich in
glucose - attracts infection
Management: Report,
medical emergency, it may
 - Decreased albumin, down oncotic pressure,
rapid rate of HD lead to septic shock
third spacing (Edema, Ascites, Anasarca)
Management: Stop, report Patient home based - Cause:
- Infections
Teach sterile technique - Post GABS (Group A Beta
hemolytic Strep) : history of strep
AV Fistula: Large blood Peritoneum: risk of bowel
throat infection or rarely impetigo
vessels, high chance of perforation
bleeding - Bacterial endocarditis
- Viral:HIV hepa B, Hepa C
WOF: Muscle cramps. That - Autoimmune disorders
is caused by rapid removal - SLE: Systemic lupus
of fluid and sodium erythematosus
- Systemic inflammation
Management: administer
fluid and sodium (PNSS) - Good pasture’s syndrome
- Mimics pneumonia,
causes bleeding in the
lungs or glomerulus
GLOMERULONEPHRITIS
- With secretions
- Inflammation of glomerulus inside the nephron
- IgA nephropathy
- Usually caused by Staphylococcus spp.
- D/T recurrent episodes of
- Decreased EGFR: will cause increased fluid and waste
blood in the urine, can be
- Acute renal failure (Irreversible)
asymptomatic for years
- Long term, it will lead to chronic renal failure
- Beurger’s disease:
- Headache and lethargy: renal encephalopathy
cola-colored urine :
(increased urea)
hematuria
- Urea: highly toxic to your brain
- Other conditions
- Hypertension and Edema
- High BP
- Related to fluid retention
- Diabetic nephropathy
- Fever
- Focal segmental
- Related to inflammatory responses
glomerulosclerosis: scattered
- Proteinuria
scarring of glomeruli either
pathologic or idiopathic
 - Intraproblem
- Diagnostics:
- Urine: presence of RBCs, red cell casts,
WBCs, elevated creatinine and urea
- Blood tests: Elevated BUN and
Creatinine
- Kidney UTz, Xray, CT scan
- Kidney biopsy
- Treatment
- General goal is to treat underlying cause
and preserve kidney function
- To prevent the progression to chronic
renal failure
- For GABS - Collection of symptoms
- Might improve without treatment, - Nephritic syndrome:
antibiotics can also be used - Inflammation of the glomerulus
- For autoimmune DO - HIHO
- Corticosteroid or - HTN
immunosuppressants - Inflammation of glomerulus
- For DM - Hematuria
- Blood sugar control via insulin or - Oliguria
OHA - Nephrotic syndrome
- For hypertension - Hypoalbuminemia: oncotic pressure problem >
- Sodium restriction and loop Third spacing,
diuretics - Ascites
- Dietary protein and potassium restriction - Hyperlipidemia
for BUN elevation, carbohydrates given - Cholesterol
liberally - Oh my god! Ang taas ng cholesterol!
- Fluid balance is utmost priority - Oil or Olesterol
- Proteinuria
NEPHROTIC VS NEPHRITIC SYNDROME - Foamy urine
- OEdema
 - Weight gain - Blood tests for albumin, cholesterol and
- Periorbital trigly
- Causes of nephrotic syndrome - Kidney biopsy
- DM - Management
- Chronic GN - Objective is to preserve renal function
- SLE and prevent complications
- Multiple myeloma - Diuretics , ACE inhibitors, ARBS : To
- Cancer of the plasma decrease BP
- Causes an abnormal globulins - Antineoplastics : Multiple myeloma
- Amyloidosis of the kidneys - Immunosuppressants : Autoimmune
- Accumulation of amyloid proteins disorders
in the kidney - Corticosteroid: Autoimmune disorders
- Renal vein thrombosis - Blood thinners: Prevents risk of clots
- Emboli formation - Low sodium diet
- Infections (HIV, Hepa B and C, Malaria) - Dietary restrictions of protein and
- Complications cholesterol
- Blood clots: due to poor filtration that
leads to loss of protein needed to Nephritic Syndrome
prevent clotting - Inflammation of glomerulus
- Aspirin or anticoagulants - Down GFR
- High BP and triglycerides: loss of - Acute
albumin stimulates liver to produce - Major cause of Beurger’s disease
albumin and produce cholesterol and - Diagnostics
trigly consequently - Urine tests for hematuria, dark colored urine
- Poor nutrition - Blood tests for uremia or azotemia
- Acute kidney injury - Uremia: increased urea in the blood
- Chronic kidney disease - Azotemia: increased nitrogen in the
- Higher risk of infection blood
- Diagnostics - Kidney biopsy
- Urine test for albumin levels: Low, - Treatment
hypoalbuminemia - Bed rest
 - A diet that is restricted in salt, potassium and - Manageable
fluid - Management
- Medication to control BP - Alpha blockers: relax bladder neck
- Medication to reduce inflammation muscles and muscle fibers of prostate,
- Medication to remove fluids from the body making urination easier
- Dialysis to replace kidney function in severe - Examples: alfuzosin, doxazosin,
cases tamsulosin, and silodosin
- Side effects: dizziness and
Benign Prostatic Hyperplasia harmless condition in which
- FUN-WISE semen goes back into the
- Irritative symptoms bladder instead out of the tip of
- Frequency the penis (Retrograde
- Urgency ejaculation)
- Nocturia - Priority is safety
- Obstructive symptoms - 5-alpha reductase inhibitors
- Weak stream - Shrink your prostate by
- Intermittency preventing hormonal changes
- Straining that cause prostate growth
- Emptying incomplete - Examples: Finasteride and
- Prostate gland: produces glucose and fluid for the dutasteride
sperm to survive - Side effect: Retrograde
- Aging men: decreased sexual practice ejaculation
- BPH: causes obstruction of urine - Tadalafil
- Postrenal failure - Studies suggest this medication
- Increased frequency and urgency to void - Often used to treat erectile
- Diagnostics dysfunction
- Digital Rectal Exam - Can also treat prostate
- 1 finger, gloved with lubricant enlargement
- Poc: left side lying, with knees - Sildenafil: Purpose: Vasodilator
flexed/Sim lateral position, straighten the - To decrease BP
colon - SE: Penis erection
- PSA - WOF: Hypotension
 - Surgical procedures: Prostatectomy - Flush out clots and electrolytes
- TURP: Transurethral resection of - Normal within 24 hours
prostate gland (No incision) - Pinkish red because there is still
- Faster recovery bleeding (Increased flow rate)
- Risk for bladder clots and - Normal after 24 to 48 hrs
bleeding - Clear na dapat (Decreased flow rate)
- Perform cystoclysis/
continuous bladder
irrigation
- Radical prostatectomy
- With incision
- Via the rectum
- Slower recovery

Cystoclysis
- Three way foley catheter
- Inflow port
- Outflow port
- Anchor
- Urobag:
- Below the bladder because it works via gravity
- Solution
- Ideally PNSS (with sodium)
- Equal concentration with bladder as
bladder has sodium
- Prevents water toxicity
- No osmosis (no movement of water)
- If distilled water, without sodium (Lower conc)
- There will be osmosis
- Promotes water toxicity
- Priority
- Patent system