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renal failure

From the powerpoint posted on D2L

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