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212 urinary

physiology of the kidney: it removes ___; regulates ___; it holds onto fluids with what hormone; why does ADH release hang onto fluids; what cells does it produce; how does it maintain Ca homeostasis; why do we lose kidney function as we age waste products; fluids, electrolytes, BP, pH; ADH; b/c there is decrease in urinary output; RBCs; it activates Vit D; b/c of disease and choices
what vit do we need in order to have Ca work in our blood stream Vit D
Renal arterial stenosis can increase or decrease BP increase it
kidney diagnostic tests: BUN- what is norm; overhydration can cause it to be lower or higher; urea is the end product of ___ metabolism; urea is excreted through where; BUN raises with hyper or hypovolemia; high ___ diets raise BUN; 8-23; lower; protein; the kidneys; hypo; protein;
kidney diagnostic tests: BUN- why does starvation raise BUN; does surgery and trauma raise or lower BUN; why does GI bleed raise BUN; with upper or lower GI bleed will BUN be the highest; why is BUN highest with upper GI bleed body begins to break down its own protein; raise; body has to digest the blood products so it goes up; upper; b/c blood is digested for a longer period of time
kidney diagnostic tests: creatinine- what is normal level; is this more or less accurate then BUN for renal function; is affected like BUN with dietary or fluid intake; .6-1.2; more; no;
kidney diagnostic tests: BUN- creatinine ratio- what is normal ratio; is the ratio higher or lower for re-renal causes of ARF; 10:1; higher 20:1;
kidney diagnostic tests: GFR- what is norm; what level is GFR when pt is dialysized; 25; 10
what lab reading is the most accurate for renal function GFR
kidney diagnostic tests: urine- specific gravity- what is norm; measures the kidneys ability to ___ urine; higher indicates concentration or dilution; would DI pt have higher or lower SG 1.020-1.035; concentrate; concentration; lower
kidney diagnostic tests: urine- urine osmolality- norm; what is the most accurate amount of urine a pt should expel in an hour; 300-1300 mOsm/kg; .5 ml/kg in an hour
kidney diagnostic tests: urine spot sodium- is Na decreased of increased in pre-renal ARF; why is Na decreased in pre-renal ARF; is there increased or decreased Na in intra renal ARF; what controls when body holds onto sodium and when body releases it in decreased; due to decreased blood flow to the kidneys; increased; aldosterone
where is aldosterone produced in the adrenal glands
kidney diagnostic tests: creatinine clearance- measures amount of ___ kidneys filter out of plasma; this measurement is in what length of time; creatinine is a product of ___ metabolism; should creatinine be in blood; procedure steps for this test; w creatinine; one min; muscle; no; save all urine for 24 hours, draw fasting blood samples sometime during collection of urine- discard 1st void
def azotemia; what are nitrogen wastes accumulation of nitrogen wastes in blood; BUN and creatinine;
uremic syndrome: this is s/s that result from loss of ___ function; what are the s.s; it affects multiple ___ renal; N/v, weak, irregular HR, seizures, uremic- they can be comatose; body systems
def oliguria urine output is scat <17 ml/hour
def anuria urine output is <100 ml/24 hours
ARF: aka; this is an abrupt loss of what; the abrupt loss of function also causes an accumulation of what; what becomes imbalanced; acute renal failure or acute renal injury; kidney function; waste and fluids; electrolytes
ARF: what happens to GFR; what happens to UO; what increases from baseline; why do these increase from baseline decreases; decreases; BUN and creatinine; they may already have renal disease and now this is a separate acute issue
ARF: what is the most common cause; why does hypotension cause this; why does hypovolemic cause this; why does ischemia cause this hypotension and hypovolemia and ischemia; low perfusion to kidneys; from over diuresing, dehydrated; low blood flow from hypotension and inflammaton
ARF: is it reversible; what is mortality rate yes; high 50%
compare acute vs chronic renal failure: acute- what is onset; are changes dramatic or slow; what is the identifiable trauma; what is rx; sudden hours to days; dramatic- no time for bod to adjust; ex gram - blood, toxic, ischemia, throw a clot; CCU needed;
why no cat scans on kidneys dye would cause acute renal failure
compare acute vs chronic renal failure: chronic- what is the onset; is change gradual or dramatic; what is cause; ex of chronic conditions; what is RX gradual/ progressive over years; gradual bod hs time to adjust and kidneys slowly atrophy; chronic conditions; DM, HTN, glomerulonephritis; out pt tx, dialysis or trasplant
Causes ARF: prerenal- does hypo or hyper volemia cause this; what happens to volume; what happens to CO and PVR; ____ obstruction can cause this; ex of vascular obstruction hypovolemic; volume shifts; decrease; vascular obstruction; hemmorage, shock, increase diuretics
Causes ARF: intra- renal: what is the most frequent cause; ATN is the destruction of ____ cells; what can cause ATN; give ex of meds; acute tubular necrosis ATN; tubular epithelial cells; meds; ACe, nsaids, litium, sulfa drugs, vanco, cat scan dyes;
Causes ARF: post-renal- where does this occur; where in urinary tract in urinary tract; in tubules or urethral meauts
Goals of care in ARF: pre-renal: we want to reinstate ___; prevent necrosis to ___; give what; why dopamine; blood flow and volume; tissue; fluids and dopamine; increases perfusion
Goals of care in ARF: intra-renal: what is given IV; what should be stopped; what should be given; ABX, fluids; meds that are causing issues- change abx dose; sodium bicarb
Goals of care in ARF: post-renal: tx surgery, stents, blast kidney stones
compare pre-renal and intrarenal ARF: pre-renal- what is UO; is urine is concentrated or dilute; why concentrated; what is urine Na; what is serum Na; whatis BUN and creatinine; what is BUN/cre ratio; why is fluid bolus given volume is low; concentrated; high sp gravity and osmolality; low; high; high;> 20:1; to increase urine output
compare pre-renal and intrarenal ARF: intrarenal- what is UO volume; is urine dilute or concentrated; why is urine dilute; what is urine Na; what is serum Na; what is BUN and cr; will there be casts in the urine; what is done first low; dilute; low sp gravity and osmo; high; low; up and norm 10:1; yes; repair internal prob
phases of ARF: onset phase def; what is oliguric/anuric phase; how long is oliguric phase; def diuretic phase' in diuretic phase what happens to k+ and sodium and why from precipitating event to s/s; there is low U/O; 1-8 wks depending on the cause; increase U/o 1-5 liters/day; they are low b/c intracellularly they are dehydrated
phases of ARF: what happens in the recovery phase; how long is the recovery phase labs start to level back to normal and pt goes back to prerenal status; 3-12 mo;
phases of ARF: name the phases in order onset, oliguric, diuretic, recovery
effects of ARF: what is imbalanced; what metabolic imbalance; why metabolic acidosis; Fluid and lytes; metabolic acidosis; kidneys maintain normal pH if tissues have high K+ and low na causes acidosis;
effects of ARF: why is there and increase susceptibility to secondary infections; why is there platelet dysfunction; why is there anemia renal failure changes function of WBCs and we more infections; there is impaired coagulation; kidneys help produces RBCs with EPO
effects of ARF: what are GI complications; what is uremic encephalopathy no real hunger, stomatatitis; change in LOC, thought process if off, tremor, seizure, coma
medical management in ARF: what is primary intervention; why need to recognize what; who is at risk; monitor ___ status; when pt has test with dye give what afterwards prevention; pt at risk; chronic failure, poor renal blood flow, elderly, strep; fluid; fluids lots;
medical management in ARF: promt recognition if ___ has doubled; correct what; early ___ to minimize s/s labs; underlying conditions/cause; dialysis
medical management in ARF; electrolyte balance/replacement- hyper___ happens often and why; hyperkalemia- pt cannot get rid of it through kidneys;
tx hyperkalemia: what does kayexalate; what does 50% glucose and ref insulin do in IV; what does Na HCO3 IV do; pt may need stat __; loses k+ through bowel; lasts 2-6 hours and pushes k+ back into the cells; pushes k+ back into the cell; dialysis
why are renal pt not on k+ and mag protocols high k+ will kill them and kidneys cannot get rid of it fast enough
tx hyperkalemia: how fast does ___ work . . . - kayexalate; Na HCO3; 50% glucose and reg insulin; ?; 2-3 hrs; 2-6 hours;
medical management of ARF: electrolyte replacement- hyponatremia: when do we treat; what is replaced and sometimes restricted; why do we not want value to rise more then 1/2 minomol/hour for lab <130; fluids; this can increase risk for seizures
medical management of ARF: electrolyte replacement- hyperphosphatemia- what do we give to get rid of phosphate phosphate binders;
medical management of ARF: electrolyte replacement- what do we give for hypermagnesemia; physostigmatine
medical management of ARF: correcting metabolic acidosis- give ____; what do we do with breathing to get rid of CO2; with acidosis what do we watch for neurologically bicarb; rapid breathing; seizures
nursing management of ARF: why is there fluid volume deficit; what are causes of fluid volume deficit; when giving bolus what do we monitor for; r/t fluid loss secondary to causes; hypovolemia, food poisoning, overuse diuretics; I&O, labs, pt postural BP and HR;
nursing management of ARF: fluid volume excess- why does this happen; monitor ___ trends; what to do intervention wise; assess what inability of kidneys to produce urine secondary to ARF; 24-48 hr trends of I&O; follow restriction, vs, wts, labs; skin turgo, mm, ls
nursing management of ARF: diet- why is the altered nutrition less then body requirements; what diet is given; treat what; diet depends on what r/t anorexia, and altered metabolic state; high cal, low protein, low k+ and na+', high CHO and fat; N/v; degree of renal function
nursing management of ARF: skin- why at risk for impaired skin integrity; provide what; why is pruritus common; r/t poor cellular nutrition and edem; rom, skin care; uremic frost itchy and uncomfortable
nursing management of ARF: infection- why at risk for infection; avoid what; monitor what labs r/t lowerd resistance; caths; T and WBCs
nursing management of ARF: anxiety- why anxiety; what interventions r/t unknown of disease process; give frequent, careful explanation of treatment, emotional and psych support, involve family in care
peritoneal dialysis: how is it done; def ultrafiltration; def diffusion; both diffusion and ultrafiltration occur across a __ membrane through ultrafiltration and diffusion; removal of fluid from blood by use of either osmotic or hydrostatic pressure to produce necessary gradient; passage of particles from area of high concentration to area of low concentration; semipermeable;
peritoneal dialysis: osmotic pressure is determined by % of ___ in PD; for stable or acute pt; what 3 things does pt need to be able to do in order to be successful with this solution; stable; stick to schedule, functioning membrane, dexterity in their hands
peritoneal dialysis: goals- what do we want to remove; maintain safe concentration of what; correct what; remove excess what; end products of protein metabolism; serum electrolytes; acidosis and replenishment of blods bicarb buffer system; fluid
peritoneal dialysis: technique- what is inserted; what should be warmed; what should be flushed; what is the fluid called; what is the normal concentration; the higher the % the higher ___; what needs to be monitored; catheter; dialysate; tubing; impersol; 1.25-4.4%; osmotic pull; glucose b/c there is glucose in the solution;
peritoneal dialysis: technique- when removing fluid what should be monitored; sterile or clean; why sterile technique; what should not be in removed dialysate; how often is it done intermittantly the amount of fluid removed with each cycle; sterile; high risk for eritinitous; blood, feces, pus- should look like urine; q4h
peritoneal dialysis: this is less stressful then what; this maintains a more stable what; who should not get this; ex of poor peritoneal membrane hemodialysis; fluid and electrolyte balance; poor condition of peritoneal membrane, obese, frequent infections; abdom surgery, hernia repair, cancer, central obesity, ulcerative colitis
peritoneal dialysis: continuous ambulatory- what is done; exchange every 4 hours 4x/day- instill new bag, pach and carry empty bag, drain and instill again
peritoneal dialysis: automated- requires ___ machine; aka; done when cycling; continuous cyclic peritoneal dialysis; hs
peritoneal dialysis: complications- what is biggest one; how does peritonitis occur; s/s peritonitis; peritonitis; bacteria enters peritoneal cavity thru contaminated dialysis fluid, contaminated catheter lumen or catheter insertion site; temp, dialysis, product pussy and infected;
peritoneal dialysis: complications- what are cath related complications is cath in the right spot, does fluid leak from cath
peritoneal dialysis: complications- why is there pain; why can hypotension occur; why overhydration; why hypoalbuminemia; why hyperglycemia; why resp difficulties shouldn't be but couldbe if it is admin too fast or if it is not warmed; too much fluid it pulled; not enough fluid pulled; not getting enough protein in diet; obsorption of glucose from dialusate; pressure on diaphram
peritoneal dialysis: nursing dx: why fluid volume excess or deficit; why risk for infection; risk for ineffective breathing pattern; why knowledhe deficit; r/t fluid shifts between blood and dialysate; r/t presence of indwelling peritoneal cath and instillation of dialysate; r/t pressure of dialysate during peritoneal dialysis; r/t peritoneal dialysis and its impact
kidney transplant: this is done when and how; prolongs what; frees pt from restriction from what; surgical implantation from compatable donar done for irreversible kidney failure; life; dialysis and manis of uremia;
kidney transplant: recipient criteria- age; they need to be free of what; what else is assessed less then 70yo; infection and disseminated malignancy; psych -social concerns
kidney transplant: donars- why is a compatable living donar; what else is assessed for donor; what antigen needs to be matched; twin, sibling, parent and child; willing, emotionally stable, compatibility of specific tissue antigens; human leukocyte antigen histo-compatibility;
kidney transplant: what happens to "bad" kidneys after transplant they stay in and new one is grafted
histo-compatibility testing: there is better tissue compatibility between donor and recipient if ____ typing is similar; how many HLA antigen should match; crossmatch should be negative for _____; there should be low %% of what HLA; 6; preformed, cytotoxic antibodies to the donor; PRA- panal ofreactive antibodies;
histo-compatibility testing: what is the most important thing about histocompatibility; the human leukocyte antigen;
kidney transplant: surgery- where is it placed in body; what happens with the renal artery; when does it function; what is performed until good function of new kidney extraperitoneally in the iliac foassa; isanastomosed to recipient's hypogastric artery and the renalveinto recipients iliac vein; immediately; dialysis
kidney transplant: complications- what is the major post-op complication; graft rejection;
graft rejection- hyperacute- when does it happen; why does it happen; with in minutes- hours; host bod develops antibodies and organ necroses b/c it is not compatable
graft rejection- acute-when does it develop; what WBC attacks; what can counteract this; first 3 months; T cytotoxic lymphocytes; immunosuppresent meds;
graft rejection- chronic: def; what meds are added to this type; pt eventually needs what; slow progressive develops over years; prograf and cellcept; transplant
kidney transplant: tx- there is a long term use of what; what does iuron and cell cept do; what monoclonal abx is given; side effects of meds; immunosuppressive therapy; protects kidney and immunosuppress; zenapax; increases suscept. to infection, increases risk of malignancy, liver or renal toxicity
kidney transplant:complications- pt at high risk for what; what is infection is common; why does UTI need to be treated more aggresively infection; UTI; b/c pt is immunosuppressed
kidney transplant: complications- why are there heart issues; what GI complications meds can worsen CAD causing ht failure and dysrhythmias; peptic ulcer disease bc of steroids
kidney transplant: what is the mortality rate 2 years post transplant 10%
kidney transplant: what are nursing interventiosn maintain hydration and fluid balance, I&O, monitor for CV and resp complications, prevent infection, watch for s/s rejection
Lasix: what is IV onset of action; what is iv peak; what is duration; what is oral onset; what is oral peak 5 min; 20-60 min; 2 hours; 30-60 min; 60-70 min;
bumex: generic name; 40 times the diuretic then ___; what is IV onset; what is IV duration; whatis oral onset; what is oral duration bumetanide; Lasix; 5 min; 2-3 hrs; 1/2 hour; 4 hours
HCTZ: oral or iv; what is onset; what is peak; what is duration oral only; 2 hrs; 4 hrs; 6-12 hours
protect the kidneys nursing responsibilities: pay close attention to drop in what; monitor what pts closely; when on nephrotic meds what should be pushed; pt UO and report; surgical pt. trauma, seriously ill pt; fluids;
kidney transplant: what are s/s rejection decrease in UO, wt gain, edema, HN, malaise, fever, increase BUN and CR, graft tenderness
Renal failure: what causes hyperkalemia; what is the cause of sodium decrease; if severe what iv fluids are given ; what is given orally; decreased excretion from the kidneys, breakdown of cellular protein, bleeding; it is usually dilutional b/c water is retained also; IV glucose; kayexalate;
renal failure: what ABG does this cause ; why does this cause metabolic acidosis; metabolic acidosis; kidneys cannot excrete acid load and it is responsible for making bicarb and it cannot do that very well anymore;
renal failure: anemia- what causes this; what does erythropoetin do (EPO); sufficient __ stores are needed for erythropoiesis; are renal pts iron levels ok; they require what for iron; decreased production of EPO; stimulated the precursor celsl in the bone marrow to produce RBcs; iron stores; no; oral supplements;
renal failure: bleeding tendencies- what causes this; there is defective platelet function;
renal failure: what happens to BP; why is BP elevated; it becomes elevated; this is due to sodium retention and increased extracellular fluid volume;
renal failure: what type of breathing can occur from resp acidosis; what does this type of breathing do; kusselmaul; blow off CO2;
renal failure:what does skin look like and why; why is skin itchy yellow/gray- skin like urine pigments and gra from anemia; calcium deposits on the skin and sensory neuropathy;
renal failure: diet- what is given with in an hour of each meal; iron supplements cannot be taken with what phosphate binders to excrete it in the stool; phosphate binders b/c it binds the iron to and prevents absorbtion
renal failure: lack of excretion of what drugs is main concern; why is demerol never given to these pts; what over the counter meds should pt not take; dig, ABx, pain meds; the liver metabolises it into normedinine and if kidneys cannot excrete it it will result in seizures; NSAIDS
diet: why is protein restricted; what lytes are restricted'; what are foods high in phosphate; bc urea nitrogen and creatinine are the end product of metabolism of the 2; sodium and k+; dairy, ;
Created by: jmkettel