Common Renal Terms & Diagnosis Explained

Common Renal Terms Explained

COMMON RENAL TERMS AND DIAGNOSES EXPLAINED BELOW:

-Acute Renal Failure: Generally reversible. Can often be treated with IV fluids. Dehydration, kidney stones or other blockages, sepsis, decreased blood flow to the kidneys, blood loss, and some cause of ARF.

-Anuric: Urine output <100 cc a day. Often seen in chronic kidney disease patients on diaylsis

-Chronic kidney disease: There are 5 stages. The 5th Stage being End Stage and usually necessitating dialsysis in order for the body to filter extra fluid & toxins. The kidneys are no longer able to do this on their own. The GFR is <15 at this stage. Daily weights, fluids restrictions, strict diet restrictions, medication and scheduled dialysis compliance is extremely important at the 5th stage.

-Glomerulonephritis: Inflammation of the filters of the kidneys which can seriously damage the kidneys. Some potential causes are: strep throat, lupus.

-Hydronephrosis: kidney swelling due to blockage of ureters causing a back-flow of urine into the kidneys

-Nephrotic syndrome: Also known as leaky kidneys. With nephrotic syndrome, the filters of the kidneys (the glomeruli) are damaged. Because of this damage, protein begins to leak into the urine. Protein is not normally supposed to leak out in the urine. Protein retention is important because it keep fluids where they are supposed to be in the body- your bloodstream. So when it leaks, you have less in system and therefore the fluids start to leak into the tissues and thus causing swelling of tissues. Fluid retention develop and swelling of body is often seen (eyes, feet, hands, legs).

-Nephrolithiasis: Renal stone in the actual kidney

-Oliguric: Urine output <500 cc urine a day

-Pyelonephritis: Infection of the kidneys

-Ureterolithiasis: Kidney stone in ureters. The passage way that connects your kidneys to the bladder. Each kidney has one

REFERENCES:

https://medlineplus.gov/ency/article/000490.htm

https://www.kidney.org/atoz/content/nephrotic

http://www.healthline.com/health/glomerulonephritis#Overview

Image from Pixabay-Royalty free pictures

 

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COPD Snapshot

DEFINE: A lung disease that is a combination of chronic bronchitis and emphysema. This disease limits airflow due to inflammation and C02 retention. These individuals often have a chronic cough, wheezing, shortness of air, and increased mucus production. The also generally have destruction of inter-alveolar septa destruction. Alveoli sacs are where 02 and C02 exchange happens.

RISK FACTORS:
1. Smoker
2. Alpha 1 antitrypsin deficiency
3. Chemical irritant exposure

SUBJECTIVE:
1. Shortness of air
2. Wheezing
3. Tight chest
4. Increased mucus production

PHYSICAL EXAM: (HALLMARK SIGNS=**)
1. Barrel chest
2. Clubbing fingernails
3. Wheezes**
4. Rhonchi
5. Decreased lung sounds
6. Thick sputum**
7. Percussion: hyper-resonance
8. Cyanosis

LABS:
1. Spirometry; FEV1/FVC ratio <70%
2. CBC- may see elevated hit
3. Pulse oximetry: Varies from patient to patient but often seen 88-92%
4. ABG: C02 is often elevated
5. D-dimer
6. Continuous pulse oximetry
7. A1-antitrypsin screen (specifically in those <45 yrs old)
8. CXR: Hyperinflation
9. PFT
10. Sleep studies
11. Sputum culture

STAGES: (FEV1=Amount of air that can be forcefully expelled in 1 second)
1. Stage 1- Mild FEV1 80% greater than or equal to this. May have some mild shortness of air and increase mucus. Also an ongoing chronic cough
2. Stage 2- Moderate FEV1 between 50-79%
3. Stage 3-Severe FEV! Between 30-49%
4. Stage 4- END STAGE Very severe. FEV1 <30%
5. Lung transplant. 02 around the clock

MEDICATIONS COMMONLY USED:
1. Short acting B-agonist: Example: Albuterol scheduled and PRN
2. Anticholinergic-example: Ipratropium, Tiotropium. These meds ease the airways
3. Long Acting B-agonist: Salmeterol, Formoterol
4. Expectorants
5. Oxygen (typical 2-3 L in pm)

ACUTE CARE:
1. IV steroids
2. Empiric antibiotic
3. 02 nasal cannula

RISK FOR ACUTE FLARES:
1. Recent URI
2. Influenza
3. Allergies
4. Environmental irritants
5. Weather changes

TEACHING
1. Vaccination- pneumovax & influenza recommended
2. Smoking cessation
3. Your airflow (in & out) is limited due to obstruction, thus you may have ongoing mild shortness of air. If you shortness of air suddenly increases you should be seen ASAP by a medical healthcare
provider (Emergency Room)
4. Pursed lip breathing
5. Avoid triggers: cold air, infections, air pollutants, cigarette smoke
6. Eat smaller more frequent meals

REFERRALS
1. Pulmonologist

COMPLICATIONS:
1. Chronic anemia
2. Respiratory failure
3. Right ventricular hypertrophy
4. Recurrent lung infections
5. Cor pulmonale: right sided heart failure secondary to COPD

DIFFERENTIAL DIAGNOSIS (Dx that can appear similar)
1. Congestive heart failure
2. Bronchitis
3. Pneumonia: Fever, more acute
4. Asthma: may be younger.
5. Lung cancer
6. Chronic pulmonary embolism
7. Bronchiectasis
8. Reactive airway
9. Bronchospasms

WORDS LINKED-ASSOCIATED
1. Emphysema
2. Blue Bloater
3. Pink Puffer
4. Hypoxic drive theory
5. Hypoxia
6. Hypercapnia
7. Spiromerty
8. FEV1

ONLINE RESOURCES:
1. American Lung Association http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/
2. National Heart, Lung, And Blood Institute http://www.nhlbi.nih.gov/health/health-topics/topics/copd
3. Medscape http://emedicine.medscape.com/article/297664-overview
4. COPD Foundation http://journal.copdfoundation.org
REFERENCES:
1. The 5-minute Clinical consult 2015 43rd Edition page 240. Alan J Crop MD, Bryon Veynovich. Editor in Chief Frank J Domino
2. Epocrates COPD May 2016
3. COPD Foundation http://www.copdfoundation.org/What-is-COPD/COPD-Facts/Glossary.aspx
4. Healthline, End-Stage COPD, Written by Rachel Nall, RN, BSN, CCRN Medically Reviewed by Mark R Laflamme, MD on November 19, 2015 http://www.healthline.com/health/copd/end-stage-copd#Overview1
5. UPMC Life Change Medicine http://www.upmc.com/patients-visitors/education/breathing/pages/chronic-obstructive-pulmonary.aspx

Update on May 2nd,2016

Pulmonary Embolism Snapshot

AKA: Lung clot, PE

SYMPTOMS: Shortness of air, dyspnea, chest pain, potential leg pain (if DVT first), chest tightness, anxiety, coughing (sometime with blood), diaphoretic

PHYSICAL EXAM: Tachypnea, tachycardia, hypotension, cyanosis, low 02 saturation

RISK FACTORS: Current DVT, PE or DVT history, Long period best rest, Recent long travel (road trip, plane), family history, clotting disorder (Factor V Leiden), malignancy, birth control, estrogen, smoking, recent surgery, implantable devices, obesity

LABS & TESTS: May consider EKG, Cardiac enzymes, CXR, BNP, ABGs, etc., first depending upon the situation, in order to r/o other causes. More specific tests, if PE specifically suspected, are: D-dimer, CT of chest with contrast (important with contrast), VQ scan if can’t do CT due to renal function (contrast). Will also want to get PT/INR monitoring especially if placed on heparin drip (protocol) and or warfarin.

MEDICATIONS EMERGENT: Lovenox therapeutic dose or the drip below

DRIPS: Heparin (Heparin drip vs SQ Lovenox- usually one or the other)

PROCEEDURES: Inferior vena cava filter (aka: Green filter) (if recurrent and or anticoagulants are contraindicated)

CHRONIC MEDICATIONS: Anticoagulants (Ex: Warfarin)

CONSULTANTS: Pulmonology

TOOLS: Wells Score tool (Score >6 high probability)

WAYS TO PREVENT: Lovenox prophylaxis dose (in hospital, ongoing bed rest, risk to develop), compression stockings, regular physical activity

Note: This is not an all-inclusive list. This is a generalized overview list

Delirium Tremens Snapshot

AKA: DTs, Alcohol withdrawal

WHAT IS IT: Withdrawal symptoms that generally start a couple of days after an alcoholics last drink

SYMPTOMS: Auditory & visual hallucinations, nausea/vomiting, diarrhea, pins & needles, agitation, shaking, confusion, anxiety, palpitations, chest pains (MedlinePlus)

PHYSICAL ASSESSMENT: Fever, tachycardia, high blood pressure, pale skin color, diaphoretic, tremors, tachypnea

RISK FACTORS: Stopping chronic alcohol use abruptly

EMERGENT MEDICATIONS USED FOR TX: Lorazepam, Valium (benzodiazepines help prevent seizures)

OTHER MEDS THAT MAY BE USED: Folic acid, magnesium, multivitamin, thiamine injection, Famotidine (alcoholic gastritis), Zofran

POTENTIAL DRIPS/FLUIDS: Banana bag, IV fluids

ABNORMAL LABS COMMONLY SEEN: Click here to see the post listing commonly seen labs

TESTS: EKG, ETOH level, Mag, phosphorus, CBC, CMP, GABA, Urine drug screen, ABG’s

COMPLICATIONS: Seizures, myocardial infarction, liver complications, gastritis, Wernicke encephalopathy, Wernicke Korsakoff Syndrome, severe electrolyte disturbances, injury from seizures

TREATMENT GOAL: Prevent seizures, control agitation, control nausea & vomiting, and other uncomfortable symptoms, prevent injury

NURSING ORDERS/PROCEDURES: Seizure, fall, elopement precautions. Psyche consult as indicated for depression/SI/HI, CIWA (3)

AFTER CARE: AA meetings, Counseling,

DIFFERENTIAL DX: Opioid overdose, illicit drug use overdose, encephalopathy, stroke, amphetamine toxicity Click here for a more comprehensive list on emedicine.medscape.com)

REFERENCES:

MedlinePlus medical Encyclopedia
Emedicine.medscape.com
AAFP.org