Chapter 47-Acute & Chronic Renal Disease
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| What is Azotemia? | Accumulation of nitrogenous waste products (measured by BUN & Creatinine)
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| What is Uremia? | Renal function declines and causes systemic symptoms
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| What is Oliguria? | <400mL urine in 24 h
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| Three types of acute kidney injury | Pre-renal: before blood gets to kidney; hypovolemia, hypotension, no profusion to kidney (i.e., code pt.)
Intrarenal: direct damage to renal tissue by medications (nephrotoxins), renal artery stenosis, CT dye
Post renal: obstr to urine (kidney stone)
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| What is Acute Tubular Necrosis? | Tubules in kidney become necrotic, sloth off and block tubes
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| What is the initiating phase of acute kidney injury? | time of insult until S&S appear
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| When does the oliguric phase of acute kidney injury occur? | 1-7 days onset, can last 2 wks or longer
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| What urinary chgs take place in oliguric phase? | Fixed specific gravity (1.010); casts in urine (tubular necrosis, sloughing off)
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| What FVE symptoms occur in oliguric phase? | edema, jugular venous distention (JVD), crackles, HTN
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| Why does Metabolic Acidosis occur in oliguric phase? | kidneys producing decrease amount of bi carb
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| How to treat Na balance and K excess in oliguric phase? | Na may be normal or decreased (may be diluted b/c of fluid retention)
Treat K is >6 or if pt symptomatic
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| What hematologic disorders occur in the oliguric phase? | Anemia, altered WBC function--puts at risk for infection
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| What neurological disorders in oliguric phase? | fatigued, decreased concentration, can lead to seizures and coma
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| What is the diurectic phase? | "getting better" phase; gradual increase in urine output, kidneys can excrete waste, but cannot concentrate urine--putting out 1-3L/day
Watch for hypovolemia, decrease bp, can last 1-3 wks
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| What is the recovery phase? | increase GFR, renal function may take up to 12 mos to stablize; kidneys are very finicky...do not recover quickly
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| What are diagnostics for Acute Renal Failure? | Depend of precursors--if pre-renal, pt may be dehydrated, push fluids & see if kidneys respond
Intrarenal: UA-look for casts, proteins, WBC, RBC, Na; can do renal biopsy, CT, ultrasound
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| What is collaborative care for acute renal failure? | 1)need to manage bp; if kidneys are failing they will be hypertensive, but if cause is pre-renal, they may be hypotensive. If fluids don't work at first, pull back and put on fluid restriction 2)treat hyper K, 3) dialysis
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| What are indications for dialysis? | Volume overload: not producing enough urine, need cardiac or pulmonary compromise
Hyper K: meds not working; getting EKG chgs
Bi carb of <15-metab acidosis
BUN >120
Chg in mental status
Cardiac issues, hx cardiac issues to get volume off & cleanse b
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