212 urinary
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| 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
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| what vit do we need in order to have Ca work in our blood stream | Vit D
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| Renal arterial stenosis can increase or decrease BP | increase it
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| 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;
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| 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
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| 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;
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| 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;
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| kidney diagnostic tests: GFR- what is norm; what level is GFR when pt is dialysized; | 25; 10
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| what lab reading is the most accurate for renal function | GFR
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| 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
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| 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
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| 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
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| where is aldosterone produced | in the adrenal glands
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| 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
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| def azotemia; what are nitrogen wastes | accumulation of nitrogen wastes in blood; BUN and creatinine;
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| 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
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| def oliguria | urine output is scat <17 ml/hour
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| def anuria | urine output is <100 ml/24 hours
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| 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
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| 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
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| 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
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| ARF: is it reversible; what is mortality rate | yes; high 50%
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| 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;
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| why no cat scans on kidneys | dye would cause acute renal failure
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| 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
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| 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
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| 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;
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| Causes ARF: post-renal- where does this occur; where in urinary tract | in urinary tract; in tubules or urethral meauts
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| 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
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| 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
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| Goals of care in ARF: post-renal: tx | surgery, stents, blast kidney stones
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| 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
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| 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
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| 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
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| 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;
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| phases of ARF: name the phases in order | onset, oliguric, diuretic, recovery
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| 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;
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| 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
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| 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
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| 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;
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| medical management in ARF: promt recognition if ___ has doubled; correct what; early ___ to minimize s/s | labs; underlying conditions/cause; dialysis
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| medical management in ARF; electrolyte balance/replacement- hyper___ happens often and why; | hyperkalemia- pt cannot get rid of it through kidneys;
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| 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
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| why are renal pt not on k+ and mag protocols | high k+ will kill them and kidneys cannot get rid of it fast enough
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| tx hyperkalemia: how fast does ___ work . . . - kayexalate; Na HCO3; 50% glucose and reg insulin; | ?; 2-3 hrs; 2-6 hours;
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| 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
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| medical management of ARF: electrolyte replacement- hyperphosphatemia- what do we give to get rid of phosphate | phosphate binders;
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| medical management of ARF: electrolyte replacement- what do we give for hypermagnesemia; | physostigmatine
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| 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
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| 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;
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| 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
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| 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
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| 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
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| nursing management of ARF: infection- why at risk for infection; avoid what; monitor what labs | r/t lowerd resistance; caths; T and WBCs
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| 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
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| 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;
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| 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
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| 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
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| 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;
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| 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
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| 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
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| 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
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| peritoneal dialysis: automated- requires ___ machine; aka; done when | cycling; continuous cyclic peritoneal dialysis; hs
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| 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;
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| peritoneal dialysis: complications- what are cath related complications | is cath in the right spot, does fluid leak from cath
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| 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
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| 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
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| 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;
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| 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
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| 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;
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| kidney transplant: what happens to "bad" kidneys after transplant | they stay in and new one is grafted
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| 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;
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| histo-compatibility testing: what is the most important thing about histocompatibility; | the human leukocyte antigen;
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| 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
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| kidney transplant: complications- what is the major post-op complication; | graft rejection;
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| 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
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| graft rejection- acute-when does it develop; what WBC attacks; what can counteract this; | first 3 months; T cytotoxic lymphocytes; immunosuppresent meds;
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| graft rejection- chronic: def; what meds are added to this type; pt eventually needs what; | slow progressive develops over years; prograf and cellcept; transplant
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| 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
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| 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
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| 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
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| kidney transplant: what is the mortality rate 2 years post transplant | 10%
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| 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
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| 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;
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| 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
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| HCTZ: oral or iv; what is onset; what is peak; what is duration | oral only; 2 hrs; 4 hrs; 6-12 hours
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| 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;
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| kidney transplant: what are s/s rejection | decrease in UO, wt gain, edema, HN, malaise, fever, increase BUN and CR, graft tenderness
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| 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;
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| 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;
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| 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;
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| renal failure: bleeding tendencies- what causes this; | there is defective platelet function;
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| renal failure: what happens to BP; why is BP elevated; | it becomes elevated; this is due to sodium retention and increased extracellular fluid volume;
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| renal failure: what type of breathing can occur from resp acidosis; what does this type of breathing do; | kusselmaul; blow off CO2;
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| 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;
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| 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
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| 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
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| 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, ;
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| jmghghj |
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