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renal failure
From the powerpoint posted on D2L
| Term | Definition |
|---|---|
| Normal GFR | 125mL/min |
| Secretion | Movement of substances from capillaries to tubules |
| Where does reabsorption of water take place? | Loop of Henle |
| Where does reabsorption of electrolytes take place? | Proximal tubules |
| Where does secretion of substances into tubules take place | Distal tubules |
| Which gland secretes ADH? | Posterior pituitary |
| What is ADH, and what does it do? | Antidiuretic Hormone; stimulates reabsorption of water by the kidneys |
| Where is aldosterone formed? | In the adrenal cortex |
| What does aldosterone do? | Stimulates the reabsorption of sodium and the excretion of potassium |
| When is renin secreted by the kidneys? | When there is poor renal perfusion |
| What does renin do? | Causes vasoconstriction which increases blood pressure in an attempt to increase renal perfusion. |
| What is PTH and what does it do? | Parathyroid hormone; stimulates absorption of calcium by kidneys and intestines |
| What does erythopoeitin do? | Stimulates production of red blood cells |
| ARF | acute renal failure |
| CRF | chronic renal failure |
| CKD | chronic kidney disease |
| azotemia | an elevation of blood urea nitrogen (BUN) and serum creatinine levels |
| What are the three classifications of ARF? | pre-renal, intra-renal, post-renal |
| Causes of prerenal ARF | Sudden and severe drop in BP (shock) or interruption of blood flow to the kidneys from severe injury or illness |
| Causes of intrarenal ARF | Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood flow |
| Causes of postrenal ARF | Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury |
| Regardless of the cause of ARF, the end results are: | damage to nephrons - loss of function decreased GFR development of uremia/azotemia |
| What are the four phases of ARF? | 1) initiating phase 2) oliguric phase 3) diuretic phase 4) recovery phase |
| What two other chronic diseases are usually associated with CKD/CRF | Diabetic neuropathy and hypertension |
| What type of renal damage is associtated with hypertension? | nephrosclerosis |
| Three parameters of CKD: | Nephrons are slowly destroyed by disease state Presence of kidney damage GFR <60 for 3 months or longer |
| Four signs of a diseased kidney: | ganular surface decreased function smaller size high urine protein |
| Two criteria for defining ESRD: | > 90% of nephrons are destroyed GFR < 15 |
| What are the two treatment options for ESRD? | dialysis or transplantation |
| Oliguria | low urine output |
| s/s of oliguric phase of renal failure on the urinary system: | decrease in GFR fluid volume excess |
| s/s of oliguric phase in waste product accumulation: | uremia/azotemia BUN and Creatinine levels increase urea breakdown occurs in intestinal tract metallic taste in mouth odor of urine on the breath |
| s/s of oliguric phase with regards to neuro disorders: | weakness lethargy seizures stupor coma |
| s/s of oliguric phase with regards to periperal neuopathy: | restless leg syndrome paresthesias motor involvement asterixis |
| metabolic disturbances during the oliguric phase: | defective carbohydrate metabolism (insulin resistance) elevated triglycerides metabolic acidosis |
| electrolyte imbalances seen in the oliguric phase: | sodium can be normal to low dilutional hyponatremia potassium will be elevated |
| What is the danger of potassium levels that are >6mEq/L | dysrhythmias can occur |
| What hematologic disorders are seen in the oliguric phase? | anemia (decreased production of erythropoietin) impaired platelet aggregation changes in leukocyte function |
| What cardiovascular changes may be seen in the oliguric phase? | hypertension CHF dysrhythmias |
| What respiratory changes may be seen in the oliguric phase? | Kussmaul's pleural effusion pulmonary edema |
| What changes may be seen in the GI system during the oliguric phase? | stomatitis, ulcerations metallic taste urine odor of breath anorexia diarrhea/constipation |
| What changes may be seen in the musculoskeletal system during the oliguric phase? | renal osteodystrophy |
| What changes may be seen in the integumentary system during the oliguric phase? | uremic skin color dry skin pruritis petechiae & ecchymosis uremic frost |
| What psychological changes may be seen in the oliguric phase? | personality and behavioral changes significant lifestyle changes |
| What happens to urine output during the diuretic phase? | Urine output increases |
| What changes (with regards to fluid volume) do we see in the diuretic phase? | hypovolemia hypotension dehydration |
| What happens to BUN and Creatinine levels during the diuretic phase? | They remain elevated |
| Are electrolytes gained or lost during the diuretic phase? | lost |
| What happens near the end of the diuretic phase? | acid-base, electrolyte, BUN and Creatinine levels begin to normalize |
| What happens to the GFR during the recovery phase? | it increases |
| What happens to the BUN and Creatinine levels during the recovery phase? | They plateau then decrease |
| How long does the recovery from ARF take? | It can take up to 12 months to stabilize |
| renal failure blood tests: | BUN Creatinine electrolytes CBC |
| renal failure urine studies: | Urinalysis/C&S Specific gravity creatinine clearance |
| renal failure diagnostic tests: | IVP Renal ultrasound Renal arteriogram Renal biopsy |
| Four areas of focus in the care of a renal patient: | fluid balance nutrition electrolyte balance preventing infection |
| What is the objective for collaborative care in the renal patient? | Avoiding conditions that increase the workload of the kidneys. |
| What goals are set for the care team of the renal patient? | preserving existing renal function treating clinical manifestations preventing complications providing comfort |
| What types of drug therapy are used with renal patients | diuretics antihypertensives/ACE inhibitors sodium bicarbonate kayexalate insulin folic acid & iron supplements daily multivitamins |
| How do you calculate fluid restrictions? | Add all loses from the previous 24 hours and add 600mL for insensible losses |
| Should the renal patient eat more or less carbs? | More |
| What do you do about protein intake for the renal patient? | Protein is restricted |
| What do you do about sodium and potassium intake for the renal patient? | Regulate according to blood levels |
| What is dialysis? | Mechanical method of removing waste products and maintaining F&E balance when the kidneys are not functioning |
| What types of vascular access are used in dialysis? | AV shunt or fistula (arteriovenous) |
| What should be heard if the AV fistula is ascultated? | bruit |
| What is the dialyzing membrane used in peritoneal dialysis? | the peritoneum |
| Why is the peritoneum well suited to act as a dialyzing membrane? | Because it is highly vascular, so there are plenty of blood vessels available for exchange. |
| How often is hemodialysis performed? | 3 times a week |
| How often is peritoneal dialysis performed? | daily |
| What type of access is used for peritoneal dialysis? | peritoneal catheter |
| What effect may peritoneal dialysis have on blood glucose levels? | It may cause high glucose levels |
| What effect might hemodialysis have on anemia? | It may contribute to anemia |
| What effect might hemodialysis have on protein? | There is less protein loss with hemodialysis |
| Which type of dialysis has fewer dietary restrictions? | Peritoneal dialysis |
| What effect might hemodialysis have on blood pressure? | Can cause hypotension |
| what effect might hemodialysis have on muscles? | May cause muscle cramps |
| What types of pain are associated with peritoneal dialysis? | abdominal pain lower back pain |
| What is the infection of the peritoneal cavity called? | peritonitis |
| What effect might peritoneal dialysis have on protein? | May lead to loss of protein |
| Pre-operative care for transplant patients | emotional and physical preparation immunosuppressive drugs diagnostics |
| What type of diagnostics would preceed a renal transplant? | EKG CXR blood tests |
| post-transplant care would include monitoring for: | output/fluid retention electrolytes BUN Creatinine CBC |
| What would the nurse observe for in the post-transplant patient? | s/s of rejection s/s of infection |
Created by:
ld23012
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