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renal failure

pn 141 test 2: book: burke pg 784

QuestionAnswer
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