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aa Orgo > 4092 2 Chronic Renal failure > Flashcards

4092 2 Chronic Renal failure Flashcards

1
Q

CRF Causes

A
  • Diabetic Nephropathy
  • High Blood Pressure
  • Glomerular Diseases
  • Inherited and Congenital Kidney Diseases (Polycystic kidney disease)
  • Poisons
  • Trauma
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2
Q

CRF: Stage 1

A
  • Signs of mild kidney disease but with normal or better GFR (greater than 90% kidney function)
  • Usually few or no physical symptoms
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3
Q

CRF: Stage 2

A
  • Signs of mild kidney disease with reduced GFR (indicating 60% to 89% kidney function).
  • Usually few or no physical symptoms
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4
Q

CRF: Stage 3

A

Signs of moderate chronic renal insufficiency (where the GFR indicates 40% to 59% kidney function)

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5
Q

CRF: Stage 3 symptoms

A
  • High Serum creatinine.
  • Tiredness
  • Edema (puffiness)
  • Back pain
  • Appetite/sense of taste changes
  • Urine changes
  • HTN
  • Poor digestion
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6
Q

CRF symptoms: puffiness is first noted around the

A

eyes

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7
Q

CRF: in stage 3, why might the urine be exceptionally clear

A

because the kidneys aren’t filtering anything. This is also why proteinuria etc can “improve” at this point

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8
Q

CRF: stage 4 symptoms

A

same as stage 3

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9
Q

CRF: stage 4

A

Signs of severe chronic renal insufficiency (where the GFR indicates 15% to 29% kidney function)

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10
Q

CRF: stage 5

A

Signs of end stage renal failure (where the GFR indicates less than 15% kidney function).

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11
Q

CRF: stage 5 symptoms

A
  • Anemia
  • Easy bleeding and bruising
  • Headache
  • Fatigue
  • Mental symptoms
  • N/V/D
  • Thirst
  • Muscle cramps/twitching
  • Nocturia
  • Itchy skin, itchy eyes
  • Skin color changes
  • Difficulty breathing
  • Decreased sexual interest
  • Changes in menstrual cycle (and difficulty getting pregnant)
  • Decreased urine output
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12
Q

Medication that can cause HTN to occur in the early stages of CRF (HTN normally doesn’t occur until later stages)

A

IgAN

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13
Q

Even in ESRD some patients might have clear urine because

A

the kidneys get rid of water but not wastes

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14
Q

CRF: Investigate reports of chest pain and whether or not it is intensified by deep inspiration and supine position. What’s the rationale?

A

half of CRF patients on dialysis develop pericarditis, potentiating risk of pericardial effusion or tamponade.

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15
Q

CRF: Presence of sudden hypotension, paradoxic pulse, narrow pulse pressure, diminished or absent peripheral pulses, marked jugular distension, pallor, and a rapid mental deterioration indicate

A

tamponade (which is an emergency)

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16
Q

CRF: a dx test that is useful in identifying developing cardiac failure or soft-tissue calcification.

A

chest x ray

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17
Q

CRF: You may need to decrease the accumulation of fluid within pericardial sac with this procedure:

A

pericardiocentesis

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18
Q

CRF: 2 meds that prevent having to strain to defecate

A

Stool softener

Bulk laxative

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19
Q

azotemia

A

high build up of wastes (e.g. urea, creatinine)

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20
Q

Why might change in LOC indicate the need for dialysis

A

LOC can mean azotemia (build of waste)

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21
Q

CRF: Provide skin care. Restrict use of

A

soaps

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22
Q

___ ___, ___ baths decrease itching

A

Baking soda, cornstarch

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23
Q

_____ and _____ may be desired to relieve dry, cracked skin

A

Lotions and ointments

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24
Q

rather than scratching pruritic areas

A

Recommend patient use cool, moist compresses to apply pressure

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25
Q

To prevent scratching skin with fingernails encourage use of

A

gloves during sleep if needed

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26
Q

CRF patient should wear

A

loose-fitting cotton garments

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27
Q

The mattress should be

A

foam or flotation

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28
Q

Nursing Dx for a patient that has chemical irritation, conversion of urea in saliva to ammonia

A

Risk for Impaired Oral Mucous Membrane

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29
Q

Offer frequent mouth care and rinse with 0.25% ____ ____ solution

A

acetic acid

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30
Q

dental hygiene: avoid 3 things

A
  1. dental floss
  2. lemon or glycerine products
  3. mouthwash containing alcohol
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31
Q

Administer medications as indicated such as antihistamines: cyproheptadine (Periactin). What is the purpose?

A

Itch relief

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32
Q

Home Dialysis – Peritoneal. What are the benefits

A
  • Fewer diet and fluid restrictions
  • Portable for ease of travel
  • Needle-free treatments
  • Dialyze while you sleep
  • Fewer peaks and valleys
  • Doctor visits and labs performed once a month at a clinic
33
Q

Home Dialysis – Peritoneal. What are the drawbacks

A
  • Increased risk of peritonitis (abdominal infection)
  • Requires space for supplies
  • Potential weight gain
  • Plastic tube from abdomen may be hindrance
34
Q

the 2 types of Peritoneal dialysis

A 
Continuous Ambulatory 
Continuous Cycling (this one involves a machine)
35
Q

Home Dialysis – Hemodialysis. What are the benefits

A
  • Flexible treatment time
  • Doctor visits and labs only once a month
  • Nocturnal allows dialysis while you sleep
36
Q

Home Dialysis – Hemodialysis. What are the drawbacks

A
  • Requires modifications to home electrical and plumbing
  • Care partner required for needle insertion
  • Must order and have room for supplies
  • May have problems with fistula, AV graft not working
37
Q

In Center Hemodialysis- Benefits

A
  • Dialysis centers are found all over the country
  • Skilled health care providers with you at all times
  • Don’t have to put in own needle
  • Get to know other dialysis patients
  • Immediate access to emergency care if needed
  • Do not need to store supplies in your home
  • Frequent access to your health care team
  • Nocturnal dialysis allows more time for activities
38
Q

In Center Hemodialysis- Drawbacks

A
  • Fistula or AV graft surgically inserted
  • Must travel to a center
  • Disrupts work schedule due to fixed schedule
  • Less privacy (Sleep with other patients for nocturnal)
  • More ups and downs in how you feel
  • Must maintain a strict diet and fluid restriction
  • Must follow centers rules regarding food, visitors, cell phones etc.
39
Q

Compatible Living Related Donor

Kidney Transplant. Benefits

A
  • May be able to be transplanted prior to start of dialysis
  • Shorter wait time for transplant
  • Better genetic match lessens risk of rejection
  • Transplant takes place at a convenient time for both donor and recipient
  • Kidney usually functions immediately
  • Improved health with more active lifestyle
40
Q

Compatible Living Related Donor

Kidney Transplant. Drawbacks

A
  • Psychological stress of having a family member involved
  • Time involved for evaluation and testing process
  • May be responsible for travel expenses, wages lost
41
Q

Compatible Deceased Donor

Kidney Transplant. Benefits

A
  • No longer need dialysis

* Improved health with more active lifestyle

42
Q

Compatible Deceased Donor

Kidney Transplant. Drawbacks

A
  • Wait time for kidney may be years
  • Kidney may not function immediately
  • Rejection rate higher
  • May be responsible for travel expenses, wages lost
43
Q

Compatible Living Paired Donation Kidney Transplant. Benefits

A
  • You receive a compatible kidney from a living donor other than a family member
  • Kidney usually functions immediately
  • May find a younger donor or a perfect 6-antigen match
  • Multiple recipients can benefit with NEAD (Never Ending Altruistic Donation) paired transplant
  • Shortens time on dialysis
  • More recipients transplanted, less on waiting list
  • Improved health with more active lifestyle
44
Q

Compatible Living Paired Donation Kidney Transplant. Drawbacks

A
  • Your family can donate, but not directly for you
  • Will need to wait on dialysis while finding a match
  • Not all transplant centers can handle multiple simultaneous transplants
  • Complicated process
45
Q

Incompatible Blood or Tissue Type Kidney Transplant. Benefits

A
  • Positive cross matched patients are now able to receive a transplant
  • Improved health with more active lifestyle
  • Shortens time on dialysis
46
Q

Incompatible Blood or Tissue Type Kidney Transplant. Drawbacks

A
  • Not all transplant centers will accept highly sensitized patients
  • More procedures (plasmapheresis, immune globulin therapy) are needed
47
Q

Which stage: kidney damage with normal or increased GFR

A

1

48
Q

Which stage: kidney damage with mild or decreased GFR

A

2

49
Q

Which stage: moderate decrease in GRF

A

3

50
Q

Which stage: severe decrease in GRF

A

4

51
Q

Which stage: kidney failure

A

5

52
Q

Goal: Preserve renal function and delay d____

A

dialysis

53
Q

dialysis complication: something to do with the heart

A

Cardiac dysrhythmias

54
Q

dialysis complications of the GI system

A

Hemorrhage and gastric ulcers

55
Q

dialysis complications of the musculoskeletal system

A

Restless legs syndrome and muscle cramps

56
Q

3 things to give for constipation

A

Bran
bulk laxative
stool softener

57
Q

3 interventions for the dx “Fatigue related to anemia/altered metabolic state”

A

Iron for the anemia
rest
exercise

58
Q

2 interventions for Impaired skin integrity

A

avoid soap

use oils

59
Q

CRF patient’s breath may smell like

A

ammonia

60
Q

Hemodialysis does have a risk for ___ loss

A

blood loss

61
Q

Hemodialysis does not have a risk for ___ loss

A

protein loss

62
Q

What medication is needed for hemodialysis patients

A

heparin

63
Q

Hemodialysis: watch out for these blood born pathogens

A

Hep B and C

64
Q

Continuous arteriovenous hemofiltration is limited to

A

inpatient use, not home use

65
Q

Does Continuous arteriovenous hemofiltration cause blood loss

A

It shouldn’t, but this can happen if the filter ruptures

66
Q

Something important that is lost in peritoneal dialysis

A

protein

67
Q

Something that is Not required in peritoneal dialysis

A

heparin

68
Q

Complication of peritoneal dialysis: perforation of the ___ or ___

A

bowel or bladder

69
Q

The major difference between the dialysate used for peritoneal and hemodialysis is the amount of

A

glucose (peritoneal is much higher in glucose)

70
Q

Because of the high glucose content, if peritoneal dialysate is left in the body too long you can get

A

hyperglycemia

71
Q

Upon assessment, phosphorus and magnesium will be

A

increased

72
Q

CRF diet should be low p____, s____, p____, p____

A

protein
sodium
potassium
phosphate

73
Q

Ensure the patient eats a lot of calories because

A

this way their body doesn’t have to use up its protein

74
Q

Epogen is aka

A

erythropoietin

75
Q

do not give antacids that are ___ based

A

magnesium based

76
Q

For patients unable to excrete phosphate, give

A

phosphate binders

77
Q

With CRF, how much fluids are they allowed to have

A

the amount voided yesterday plus 500 ml

78
Q

sodium polystyrene sulfonate is aka

A

Kayexalate

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