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AHIV - ch 63
| Question | Answer |
|---|---|
| Kidney anatomy | - Filter - RAAS - Erythropoetin - Urine - Acid-base - Regulates fluid - Electrolyte balance - Metabolizes phosphorus - Calcitrol |
| Acute renal failure | Enlarges kidney; Prerenal -> intrarenal ->postrenal |
| Prerenal | Think perfusion; caused by either an obstruction that keeps the kidneys from being properly oxygenated, low blood pressure, or low cardiac output |
| Intrarenal | Causes: contrast, antibiotics (“it’s a sin to give - mycin”), creatinine over 1.3 |
| Post renal | Kidney stones, tumor, & BPH (“Big Prostate Holds back urine”) |
| Acute renal failure key assessments | - Creatinine over 1.3 - BUN over 20 - Urine output less than 30 mL/hr - Metabolic acidosis (pH below 7.35) |
| Best indicator of good renal function | 1500 mL urine in 24 hours |
| 4 stages of acute kidney failure | 1) Onset of injury (initiation) 2) Oliguric phase (*less than 400 mL in 24 hours is BAD*) 3) Diuresis phase (AKI treatment is diuretics to rid buildup) 4) Recovery phase |
| Normal BUN | 10 - 20 |
| Normal creatinine | 0.5 - 1.3 |
| Normal GFR | Over 90 mL/min |
| 5 stages of chronic kidney disease | 1) 90+ GFR 2) 89 - 60 GFR 3) 59 - 60 GFR 4) 29 - 15 GFR 5) 15 or less GFR (End stage kidney disease) |
| Chronic kidney disease causes | Uncontrolled diabetes, high BP, & autoimmune disorders; old age, infection, PKD, & acute kidney failure that’s worsened |
| Kidney size in chronic kidney disease | Smaller |
| Chronic kidney disease S/S | Oliguria |
| Chronic kidney disease complications | - Stroke, heart attack, & kidney damage - *Hypertensive crisis (s/s: headache, nausea & vomiting, & mental status changes) - Waste (acidosis, urea, uremic frost, & pruritus) - HIGH electrolytes (sodium, phosphorus, **potassium) |
| Priority treatment for high potassium | 1) IV calcium gluconate (when dysrhythmias are present) 2) IV 50% dextrose + regular insulin (to pull potassium from the blood & into the cells; first step if dysrhythmias aren’t present) 3) Kayxalate (polystyrene sulfonate) 4) Dialysis |
| Interventions for chronic kidney disease | - Daily weights - Avoids NSAIDS, milk of magnesia (antacid), antibiotics, & contrast - Diet |
| Diet | - Sodium (canned/packaged foods & processed meats) & potassium (spinach or bananas) restriction - Low phosphorus (no dairy) - Low protein (except for while on dialysis) - High iron (anemia) |
| Expected labs in end stage renal failure | - Elevated BUN + CRT - Elevated K+ - Decreased GFR - Decreased RBC + H&H - Increased Phosphorus (3 - 4.5) - Decreased calcium (9 - 11) |
| Diagnostics for chronic kidney disease | Creatinine clearance test (do not collect first morning urine) |
| Treatment for chronic kidney disease | Dialysis & kidney transplant |
| Hemodialysis | Functions/filters like a kidney; through the blood (fistula); 3 - 4 times a week; before: assess fluid status & fistula & hold meds (antihypertensives, antibiotics, digoxin, & water-soluble vitamins) |
| Complications of hemodialysis | Dialysis disequilibrium syndrome (DDS); s/s: restless & disoriented, vomiting, & headache; intervention: stop or slow infusion & call HCP; infection, clotting, & hypotension (pulling too much fluid) |
| 5 P’s to look out for during hemodialysis | - Pallor - Paresthesia - Pulses diminished - Poor cap refill - Pain (distal to shunt) |
| Fistula no-nos | Restrictive clothing or watches, BP on affected arm, sleeping on arm, creams or lotions, & lifting over 5 lbs |
| Peritoneal dialysis | |
| Through the abdomen; dialysate is inserted & then filtered through; output should be greater than what was put in; warm dialysate beforehand; sterile technique; complications: peritonitis & constipation | |
| Insufficient outflow during peritoneal dialysis interventions | 1) Assess patient for distention or constipation 2) Check for kinks & obstructions in the catheter 3) Reposition the patient (side-lying) |
| What can be added/given during dialysis? | Heparin if fibrin is present & antibiotics to prevent infection |
| Kidney transplant candidate criteria | - Free of problems that might raise procedural risk - Certain conditions preclude kidney transplant - Waiting list once GFR < 20 |
| Kidney transplant donor criteria | - Tissue match between donor & candidate - Physical criteria must be met |
| Kidney transplant preoperative care | - Immunologic studies - Dialysis 24 hrs before - Blood transfusion 24 hrs before |
| Kidney transplant operative procedures | - Failed kidneys stay in place (unless enlarged or infected - causing pain) - Procedure varies |
| Kidney transplant postoperative care | - Urologic management - Assess hourly output x 48 hrs - Complications: thrombosis, rejection, renal artery stenosis - Immunosuppressive drug therapy |
Created by:
tatianalopez03
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