13

Question 1

Glomerular Filtration Rate

Answer 1

120 to 125 ml/minute

Best overall indicator of kidney function

Question 2

Blood urea nitrogen

Answer 2

approx. 8-18 mg/dL

Measures effectiveness of kidney excretion of BUN

Liver metabolism of protein

Elevation is not specific to kidney problems

Question 3

Creatinine

Answer 3

approx. 0.6 – 1.2mg/dL

No common pathologic condition other than kidney disease increases creatinine. Watch creatinine trends, rather than individual levels

Question 4

azotemia

Answer 4

an accumulation of nitrogenous waste products (ureanitrogen, creatinine) in the blood

Question 5

aki vs ckd

Answer 5

Most common cause:

AKI: Acute tubular necrosis
CKD:Diabetic nephropathy

Dx criteria:

AKI: Acute urine output reduction and/or elevation in creatinine
CKD: GFR under 60mL/min for over 3 months and/or kidney damage over 3 months

Reversibility:

AKI: potentially
Ckd: no

Question 6

Prerenal causes of AKI

Answer 6

reduce systemic circulation,
causing a reduction in renal blood flow. The decrease in blood flow
leads to decreased glomerular perfusion and filtration of the kidneys.

In prerenal oliguria there is no damage to the kidney
tissue (parenchyma)

Question 7

Intrarenal causes of AKI

Answer 7

prolonged ischemia, nephrotoxins (e.g., aminoglycoside antibiotics,
contrast media), hemoglobin released from hemolyzed red blood cells
(RBCs), or myoglobin released from necrotic muscle cells.

Acute tubular necrosis (ATN) is the most common intrarenal cause
of AKI in hospitalized patients.

Question 8

Postrenal causes of AKI

Answer 8

benign prostatic hyperplasia (BPH), prostate cancer, stones,
trauma, and extrarenal tumors. Bilateral ureteral obstruction leads to
hydronephrosis (kidney dilation), increase in hydrostatic pressure, and
tubular blockage, resulting in a progressive decline in kidney
function

Question 9

The most common initial manifestation of AKI

Answer 9

oliguria, a reduction
in urine output to less than 400 mL/day. Oliguria usually occurs
within 1 to 7 days of the injury to the kidneys

Question 10

electrolyte to watch AKI

Answer 10

Potassium

Question 11

AKI multisystemic effects

Answer 11

AMS from uremia (elevated urea)–>ammonia

Azotemia causes n/v

Urea causes mucosal inflammation

Anemia

Question 12

AKI Interventions

Answer 12

Fluid restrictions (600ml plus previous 24hr fluid loss)
•Dietary restrictions (potassium, phosphate, sodium)

Question 13

AKI phases

Answer 13

• Onset
• Oliguric
• Diuretic
• Recovery

Question 14

AKI phase highest risk of death

Answer 14

Diuretic (electrolyte loss/dehydration)

Question 15

esrd

Answer 15

GFR is less than 15 mL/min. At this point, RRT (dialysis or

transplantation) is required to maintain life

Question 16

HD long term vascular access

Answer 16

Arteriovenous Fistula
Preferred
Radial or brachial in non dominant arm ideally
Cannot use right away
–Time to “mature”(2 to 6 weeks)–Veins dilate and toughen

AV Graft
Synthetic graft  between artery and vein
•Variety of materials...teflon, etc
–Used when pt’s own vessels not suitable
–Can be used quicker (24 hr to 10 days)
–Usually in arm 
–Infection and thrombosis common complications

Question 17

HD Nursing Implications

Answer 17

Meds to be held until after dialysis

Protect Fistula/Graft arm

Question 18

Post HD Complications

Answer 18

Sepsis: d/t infection of VAD

Disequilibrium Syndrome:
–Complication
–Rapid change of fluid composition
–High osmotic gradient in brain = cerebral edema
–n/v , confusion, restlessness, H/A, twitching

–Treat: •stop or slow dialysis•May give mannitol

Question 19

Peritoneal dialysis

Answer 19

Slower process

Must be able or have able caregiver

•Involves catheter placement into abdominal cavity for infusion of dialysate

3 phases:
–Fill
–Dwell
–Drain

Question 20

Types of Peritoneal dialysis

Answer 20

Intermittent
•Example: q 2 hours
–Usually 3 or 4 /day for a stable patient
–12 to 24 for a very ill patient

Continuous ambulatory peritoneal dialysis (CAPD)
•4 to 5 exchanges/day (could be ac and hs)

Continuous cyclic peritoneal dialysis (CCPD)
Over night
•4 to 8 exchanges during night

Question 21

Peritoneal dialysis

Answer 21

Peritonitis is most common

Unresolved = cath removal = hemodialysis
•After approx 1 month, can replace cath
•Strict sterile technique is necessary

Question 22

CRRT

Answer 22

Used for patients too unstable with hypotension for traditional hemodialysis: in ICU settings

• Does not cause rapid fluid shifts
• Requires access to circulation
• Specialized training for nurses to perform
• Blood passes through a hemofilter that contains semipermeable membrane

Question 23

Kidney transplant pt compliance/risk

Answer 23

Immunosuppressive agents are given

Will be on some dose for life time of kidney* = risk of infection

Question 24

Post op Kidney transplant

Answer 24

Assessment of urine output hourly for 48 hr

Notify provider of hypotension or excessive diuresis: maintain perfusion priority

Question 25

s/sx of hyperacute, acute, and chronic rejection Post op Kidney transplant

Answer 25

``` Oliguria/Diuresis Edema Fever Hypertension Weight gain Swelling/tenderness/pain at incision May be no s/sx except rising BUN & creatinine ```