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renal failure
pn 141 test 2: book: burke pg 784
| Question | Answer |
|---|---|
| what is renal failure | a condition in which the kidneys are unable to remove accumulated waste products from the blood |
| is it acute or chronic or both | both |
| what is it charecterized by | azotemia |
| what is azotemia | a buildup of nitrogenous waste products in the blood |
| what type of imbalances does it lead to | fluid, electrolyte and acid base imbalances |
| ARF: what is it | the rapid decline in renal function w/ an abrupt onset |
| ARF: is it reversible | yes, with prompt Tx |
| ARF: is it common | yes |
| ARF: risk factors | major trauma, surgery, infection, hemorrage, severe ht failure, and Lower urinary tract obstructions |
| AFR: what are Iatrogenic causes of it | nephrotoxic meds and contrast dye used in x rays |
| AFR: what age is at particular risk | older adults |
| AFT: what is the most common cause | ischemia (poor perfusion) of the kidneys and nephrotoxins |
| AFR: what are nephrotoxins | agents that damage the kidney tissue |
| AFR: what are the three ways that the causes are classified | prerenal, intrarenal and postrenal |
| AFR: prerenal failure- causes; | impaired blood supply to kidneys b/c of a sudden and severe drop in blood pressure (shock), |
| AFR: prerenal failure- example | fluid volume deficit, hemmorhage, Ht failure, shock |
| AFR: intrarenal failure- causes; | acute damage to renal tissue and nephrons (*direct damage to the kidneys) or acute tubular necrosis (ATN), abrupt decline in tubular and glomerular function do to either prolonged ischemia and or exposure to nephrotoxins |
| AFR: intrarenal failure- example | acute glomerularnephritis, malignant HTN, ischemia, nephrotoxic drugs or substances, RBC destruction, muscle tissue breakdown due to trauma, heatstroke |
| AFR: postrenal failure- causes | obstruction of urine flow (something beyond the kidneys caused damage) |
| AFR: prerenal failure- example | urethral obstruction by enlarged prostate or tumor, ureteral or kidney pelvis obstruction by calculi |
| AFR: hypovolemia is a common pre, intr or postrenal failure ? | prerenal |
| AFR: the risk for it is high when exposed to both __________ and _________ at the same time | ischemia and nephrotoxins |
| AFR: s/s | oliguria, rising BUN and serum creatinine |
| AFR: def of oliguria | urine output < 400 mL/day |
| AFR: what happens to the GFR | it falls |
| AFR: what happens to tubular cells; | they become necrotic and slogh off |
| AFR: what happens to the nephron | it is unable to eliminate waste effectively |
| AFR: what are the 3 phases of it | initiation, maintenance, recovery |
| AFR: what is the initiation phase | begins with the initiating event and often is recognized only after the pt has moved onto the maintence phase |
| AFR: the maintenance phase- begins when | w/in hours of the initiating event |
| AFR: the maintenance phase- how long does it last | 1-2 weeks |
| AFR: the maintenance phase- what develops; this makes the kidneys unable to do what | oliguria; they connot efficiently eliminate metabolic wastes, water , electrolytes and acids |
| AFR: the maintenance phase- what can azotemia cause | confusion and disorientation |
| AFR: the maintenance phase- what do salt and water retention lead to | fluid volume excess and edema |
| AFR: the maintenance phase- what cardiac issue can develop | HTN and Ht failure |
| AFR: the maintenance phase- hyperkalemia s/s | muscle weakness, N, diarrhea, disrhythmias |
| AFR: the maintenance phase- metabollic acidosis results from what | inadeqaute elimination of hyfrogen ions by the kidneys |
| AFR: what phase does anemia develop | maintenence phase |
| AFR: the maintenance phase- anemia and impaired immune function increases the risk for what | infection |
| AFR: the maintenance phase- what happens what the end of the phase to the urine output | it gradually increases |
| AFR: the maintenance phase- does anything happen to the BUN and creatinine at the end of this phase | no, they both still remain high |
| AFR: The recovery phase- what is it | charecterized by improving kidney function, UO, and blood values, |
| AFR: The recovery phase- how long does it last; why | one year; b/c it takes a while for labs to get back to normal (ppl usually don't follow up in this phase) |
| CRF: what is it | a slow insidious process of kidney destruction |
| CRF: when is the pt said to have end stage renal disease | when the kidneys have too few nephrons to excrete metabollic wastes and regulate fluid and electrolyte blalance adequately |
| CFR: is ESRD increases, if so what age groups | yes, all age groups |
| CFR: who is ESRD highest in | AA, over 70 yo, native americans |
| CFR: what are the leading causes of it | diabetic neuropathy and HTN |
| CRF: as nehprons are destroyed by the disease, what do the remaining nehprons do; why | they hypertrophy; to compensate for lost renal mass |
| CRF: what is the early stage called | decreased renal reserve |
| CFR: decreased renal reserve- does pt have s/s , why or why not | no, b/c the remaining nephrons are able to do the work of the lost nephrons |
| CFR: what is the middle stage of it | renal insufficiency |
| CFR: renal insufficiency - manifestations of it | kindey function is further reduced, BUN and CREatinine rise |
| CFR: renal insufficiency - what percentage of kidney function is in this stage (GFR) | 50-20% |
| CFR: decreased renal reserve-what percentage of kidney function is in this stage (GFR) | 100-50% |
| CFR: renal insufficiency - any further insult to the kidneys ate this stage can cause what | end stage renal failure |
| CFR: end stage renal failure- what percentage of kidney function is in this stage (GFR) | <20% |
| CRF: at what stage does uremia develop | end stage renal failure |
| CRF: def of uremia | urine in blood |
| CRF: it is often not identified until when | uremia develops |
| CRF: early s/s of uremia | N, apathy, weakness, fatigue, V, increasing weakness, lethargy, confusion |
| CFR: the effects of uremia to the endocrine system | hyperparathyroidism, glucose intolerance |
| CFR: the effects of uremia to the respiratory system | pulmonary edema, pleuritis, kussmaul respirations, |
| CFR: the effects of uremia to the urinary system | proteinuria, hematuria, nocturia, oliguria, fixed specific grvity |
| CFR: the effects of uremia to the GI system | Anorexia, N/V, hiccups, GI bleed, uremi cfetor |
| CFR: the effects of uremia to the MS system | osteodystrophy, bone pain |
| CFR: the effects of uremia to the neurologic system | fatigue, depression, irritability, impaired thinking, insomnia, restless leg sundrome, paresthesias |
| CFR: the effects of uremia to the CV system | edema, HTN, CHD, CHF, pericarditis |
| CFR: the effects of uremia to the hematologic system | anemia, impaired clotting, increased risk for infection |
| CFR: the effects of uremia to the reproductive system | amenorrhea, impotence |
| CFR: the effects of uremia to the integumentary system | pallor, uremic skin color, dry skin, pruritus, ecchymoses, uremic frost |
| CFR: the effects of uremia to the metabolic processes | hyperkalemia, acidosis, hyperlipidemia, myperuricemia, malnutrition |
| CFR: preventions | maintaining blood volume, CO, BP is vital to preserve kidney perfusion |
| CFR: what drugs should be avoided | nephrotoxic drugs |
| CFR: diagnostic tests- serum creatinine and BUN: why is it done | monitored to eval the disease process and its Tx |
| CFR: diagnostic tests- creatinine clearence: why is it done | to eval GFR and renal function |
| CFR: diagnostic tests- serum electrolyte and ABGs: why is it done | monitored |
| CFR: diagnostic tests- a UA: why is it done | may show fixed specific gravity at 1.010, and abnormal substances like protein, blood cells, and cells casts |
| CFR: diagnostic tests- what are cell casts | they are protein and debris molded in the shape of the tubular lumen |
| CFR: diagnostic tests- kidney biopsy: why is it done | to identify the underlying disease process |
| diet and fluids: what needs to be restricted when the kidneys cannot effectively regulate fluid and electrolyte balance | fluid and sodium intake needs to be regulated |
| diet and fluids: what are insensible losses; and how much should be calculated in the daily intake | respiration, perspiration, lowel losses; 500 ml |
| diet and fluids: how is the daily fluid intake calculated | 500mL of insensible losses + the previous days urine output |
| diet and fluids: when should a pt notify MD with wt gain | a wt gain >5 lbs |
| diet and fluids: what lytes are regulates | sodium and potassium |
| diet and fluids: why do they needs adequate nutrients and calories | to prevent tissue breakdown |
| diet and fluids: why are proteins minimized | to minimize azotemia |
| diet and fluids: ex of complete proteins | meat, fish, eggs, poultry, cheese, eggs, milk, soy |
| diet and fluids: why are carbs increased | to maintain adequate calorie intake |
| meds: most meds are excreted by what | the kidneys |
| meds: what ones should be avaoided | nephrotoxins |
| meds: an example of nephrotoxins | NSAIDS |
| meds: why are diuretics given | to reduce fluid volume, lower blood pressure, lower serum potassium |
| meds: why are antihypertensives given | to maintain BP |
| meds: why is sodium bicarbonate or calcium carbonate used | to manage the electrolyte imbalances and acidosis accompanying renal failure |
| meds: what is given when serum potassium levels are dangerously high | potassium binding exchange resin such as sodium polystyrene sulfonate |
| meds: why is glucose given | to lower serum potassium levels |
| meds: what is given for anemia | folic acid, iron supplements |
| renal replacement therapies: when is a kidney transplant or dialysis considered | when conservative management is no longer effective to maintain fluid and electrolyte balance and prevent uremia |
| dialysis: what is it | a diffusion of solutes across a semipermeable membrane from an area of higher concentration to one of lower concentration |
| dialysis: what separates the blood from an isotonic dialyzing solution | a semipermeable membrane |
| dialysis: what diffuses across the membrane | water, solutes (urea, creatinine, electrolytes) |
| dialysis: what does it compensate for | for the kidney's inability to eliminate excess water and solues |
| dialysis: does it cure | no, it manages s/s |
| dialysis: what do they have constant s/s of | flulike s/s |
| hemodialysis:what is it | electrolytes, waste products, and excess water are removed from the body by diffusion and filtration |
| hemodialysis: where is the pt blood pumped to | a dialyzing membrane unit where it moves past a semipermeable membrane |
| hemodialysis: what is dialysate | a solution similar to normal extracellular fluid |
| hemodialysis: what happens to the dialysate | it is warmed to body temp and passed along the other side of the membrane |
| hemodialysis: the solutes diffuse through the membrane and go into where | the dialysate |
| hemodialysis: what can be added to the dialysate | meds |
| hemodialysis: water is removed from the blood, and it creates what | higher fluid pressure on the blood side of the membrane |
| hemodialysis: how often do they have sessions, how long does it take | 2-3 times a week, 9-12 hours a week |
| hemodialysis: where is it done | at home or in a hemodialysis center |
| hemodialysis: what is a arteriovenous fistula | it is created for vascular access. often the radial artery and cephalic vein are joined |
| hemodialysis: what does a functioning one have | a palpable pulse and a bruit |
| hemodialysis: what should not be done with a fistula | avoid taking a BP or doing a venipuncture on the arm |
| hemodialysis: what is the most frequant complication with it | hypotension |
| hemodialysis: why does bleeding occur | due to atlerd clotting and the use of heperin |
| hemodialysis: what is pt at increased risk for | infection |
| hemodialysis: what are AV fistula complications | clotting, infection, thrombosis |
| hemodialysis: if a transfusion is given during dyalysis; what are s/s of a transfusion infection | chills, fever, dyspnea, chest, back, or arm pain, urticaria or itching |
| hemodialysis: what are av fistula psychologic impacts | depression, altered self concept |
| continuous renal replacement therapy: what does it allow for | more gradual fluid and solute removal |
| continuous renal replacement therapy: what type of pt is it used for | a pt who is unstable |
| continuous renal replacement therapy: what is done | blood is continuously circulated (artery to vein and vein to vein) and filtered, allowing excess water and solute to drain into a collection device |
| continuous renal replacement therapy: what does the slower process of it reduce the adverse effect what | the adverse effects associated with hemodialysis |
| continuous renal replacement therapy: it requires what | prolonged immobilization |
| peritoneal dialysis: what is it | the highly vascular peritoneum serves as the dialyzing membrane |
| peritoneal dialysis: what happens | , warmed dialysate is installed into the peritoneal cavity through a peritoneal catheter, metabollic waste and electrolytes diffuse into the dialysate while it remains in the abdomen, the diaylsate is then removed |
| peritoneal dialysis: excess water is drawn into the dialysate by what | osmosis (when you have solutes of high molecule weight the particles are attracted to it) |
| peritoneal dialysis: how is the fluid drained | by gravity out of the peritoneal cavity into a sterile bag |
| peritoneal dialysis: is it mroe or less costly then hemodialysis | less |
| peritoneal dialysis: is it commonly used | no |
| peritoneal dialysis: what is the most common form of peritoneal dialysis used today | continusous ambulatory dialsysis |
| continusous ambulatory dialsysis: what is done w/ the cavity | two liters of dialysate are instilled into the peritoneaal cavity and the catheter is sealed. |
| continusous ambulatory dialsysis (CAPD): how often does the peritoneum have to be emptied | every four to six hours |
| continusous ambulatory dialsysis: what is a variation of it; what does it dp | continuous cyclic peritoneal dialysis; a device is used at night allowing home tx at night |
| dialysis: what one is less likely to cause rapid fluid and electrolyte shifts | peritoneal |
| dialysis: what one is less efficient in removing waste products | peritoneal |
| what VS do you want to do daily | wt and I and o |
| kidney transplant: it is the tx of choice for whom | pt w/ end stage renal disease |
| kidney transplant: what percentage of them are from living donars | 30% |
| kidney transplant: how are the kidneys preserved | by hypothermia or continuous perfusion |
| kidney transplant: where is the donar kindey usually inplanted | in the lower abdominal cavity |
| kidney transplant: how is it connected | to arterial and venous blood supplies and its ureter is connected to one of the recipient's ureters or directly to the bladder |
| kidney transplant: what is used to prevent reflux | tunnelling technique |
| kidney transplant: complications of transplant | hemmorrhage, urine leakage into the peritoneal cavity, renal artery thrombosis, infection, rejection |
| kidney transplant: complications- s/s of hemorrhage | swelling at operative site, increased abdominal girth, changes in VS and LOC |
| kidney transplant: complications- s/s of urine leakage into the peritoneal cavity | as indicated by abdominal swelling and tenderness and decreasedurine output |
| kidney transplant: complications- renal artery thrombosis s/s | abrupt onset of HTN and a fall in GFR |
| kidney transplant: complications- s/s of fever | chagne in LOC, cloudy or malodorous urine, purulent drainage from the incision |
| kidney transplant: complications- s/s of rejection | fever, swelling and tenderness over graft site, decreased urine output, declining renal function, drop in BUN serum creatinine, GFR |
| kidney transplant: what med is given to suppress immune response to reject it | immunosuppressive drugs |
| kidney transplant: complications- immunosuppressive drugs increase the risk for what | infections |
| Nx Dx: Excess fluid volume: why should pt be weighed daily | it provides a more accurate reading of fluid volume than I and O especcially with pt with oliguria |
| Nx Dx: Excess fluid volume: why should heart sounds be assessed | b/c excess volume increases the risk for heart failure and pulmonary edema |
| Nx Dx: Excess fluid volume: what s/s indicate heart failure | s3 or s4 gallop rhythm or crackles in the lungs |
| Nx Dx: Excess fluid volume: why does pt need good skin care | edema can lead to skin breakdown |
| NX Dx: imbalanced nutrition < body requirements: why does pt w/ renal failrue have this issue | the manis of uremia and dietary restrictions often effect food intake |
| NX Dx: imbalanced nutrition < body requirements: why is catabolism an issue | it worsens azotemia and uremia |
| what is the diet in regards to carbs and protein | high carb low protein |
| it is not just about what | the pee |
| what are the three stages of acute | initiation, maintenence, recovery |
| early things to do before dialysis: med | diuretics to stimulate the kindeys, higher than a 20 mg dose |
| s/s that lasiks is working | quality of urine and check labs and potassium to reverse issue |
| aRF: is it recognized inthe initiation phase | not |
| AFR: what happens in the neuro system; why | confused; b/c of increased amounts of amonia |
| AFR: why are there arrythmias | k+ is unable to be excreted so levels increase and the k+ stiffens the contractions |
| normal value of k+ | 3.5-5 |
| when there is fluid overlaod, what happens to the lungs | they want to counter this so RR increases |
| why won't the anemia be seen until later | b/c RBCs are good for 120 days |
| Oliguria: what happens to BUN creatinine and k+ and phosferous | they increase |
| oliguria: what happens to calcium bicarbinate and GFR | they decrease |
| oliguria: why is specific gravity fixed at 1.010 | b/c the filtration sytem is not owrking properly and body does not know if it should get rid of fluid or hang on to it (the tubules regulate SG) |
| oliguria: how is fluid resctriction based | upon UO and insensible loss estimate |
| meds: what is used to treat hyperkalemia | layexalate |
| meds: kayexaltae : how is it give n | oral liguid med |
| meds: kayexaltae : what does it do | it pulls k+ from serum to GI system |
| meds: kayexaltae : what adverse effect does it casue | massive diarrhea |
| oliguria: what diuretic should be given | lasix |
| dialysis- CRRT: where does this therapy take place | in the ICU, 24/7 |
| end stage renal disease: def | loss of 90-95% kidney function no balance or maintenence |
| end stage renal disease: what will k+ be | >5 (hyperkalemia) |
| end stage renal disease: wjat will calcium be | <7.5 hypocalcemia |
| norm calcium level | 8-10 |
| hemodialysis: why are Vs monitored q 15 min | b/c there is a big fluid shift |
| why is the diet high in carb and low in protein- what does protein do | it has a biproduct of amonia |
| when amonia cannot be excreted, where does it go | the brain |
| CAPD- pertioneal dialysis: throubleshooting to increase the flow | postion, kinks in tubes, lift bag, lower bag |
| CAPD- pertioneal dialysis: how long in, dwell and out | 20-20-20 min |
| CAPD- pertioneal dialysis: is this procedure sterile or clean | steriel |
| CAPD- pertioneal dialysis: why should the solution be warm | b/c our bodies are warm |
| CAPD- pertioneal dialysis: the solution is clear in, should it be slear out | yes |
| CAPD- pertioneal dialysis: why is the bag weighed b4 and after | to be sure of an even exchange |
| if pt is on dialysis, why might some meds times need to be changed | b/c they will not be absorbed as well if given right b4 dialysis |
| what indicates that dialysis is needed | if BUN is > 70 |
| what is creatinine | a waste product of skeletal muscle breakdown |
| what is the most reliable indicator of kidney function; why | creatinine; b/c it is not effected by diet, hydration, liver function, or metabolism |
| norm creatinine | .5-1.5 |
| twice the norm of creatinine incdicates what | 50% loss of function |
| K+ norm | 3.5- 5 |
| BUn nrom | 10-20 |
| when is pt placed on cardiac monitoring for elevated k+ | when it is more than 6 |
| where are most druggs detoxified | inthe liver |
| where are most drugs excreted | in the kidneys |
| what will drive th gk+ into the cells temporarily when pt is hyperkalemia | IV glucose, insulin or sodium bicarb |
| when calcium is low it will draw more from where; what does this cause | the bones; osteoporosis |
| s/s of hypocalcemia | tingls, muscle twitches, irritability, tetany |
| tx for low calcium | supplements, Vit D, phosfate bingders (tums, oscal, caltrate) |
| meds to avoid when low calcemia; why | magnesium antiacids, maalox, mylantan; it will bind with the calcium |
| what is the connection with calcium phosfate crystals and itching | chronic high levels of BUN and creatinine will crystalize and come out into the skin as phosphate crystals (aka uremic frost) |
| tx for uriemic frost (itching, dry) | non perfumed moisture (they trap moisture), eucerin cream |
| what metabolyte is responsible for N/V, foul breath diarrhea, dietary habits | amonia |
| what drug is used to rid body of excess amonia | lactulose |
| since pt is hypocalcemic, what does the body do to compensate | moves calcium from bones to blood (demineralizing bones) |
| def of metastic calcification: | calcium phoasphate deposits in BV, joints, lungs, muscles, eyes |
| long term goal | health promotion |
| who is the only perfect kidney match | identical twin |
| kidney transplant: where is pt right after surgery | in ICU for 24 hours |
| kidney transplant: what is donar experiencing post op | pain |
| what are the major s/s of rejecting | fever, increaseced BP and pain |
| what immunosuppresant is the least amount a pt is prescribed | a t cell suppressor |
Created by:
jmkettel
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