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NURS254 Peds > Acute and Chronic Renal failure > Flashcards

Acute and Chronic Renal failure Flashcards

1
Q

what is acute renal failure

A
  • inability for kidneys to excrete wastes, concentrate urine, and conserve electrolytes
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2
Q

3 causes of acute kidney failure

A
  • prerenal (decrease kidney perfusion)
  • intrinsic renal (damage to kidney structures: glomeruli, tubules, vasculature)
  • postrenal (obstruction)
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3
Q

what are the prerenal causes of kidney failure

A
  • dehydration (hypovolemia) from V/D
  • DM
  • surgical shock, trauma, burns
  • accidental poisoning
  • prolonged anesthesia
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4
Q

what are the intrinsic renal causes of kidney failure

A
  • ingestion of nephrotoxic medications
  • hemolytic uremic syndrome, acute glomerulonephritis
  • ischemia
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5
Q

what are the postrenal causes of kidney failure

A
  • kidney stones
  • tumors
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6
Q

what are the principle features of acute renal failure

A
  • oliguria, azotemia ( increased urea and creatinine) -> leading to metabolic acidosis, electrolyte disturbances
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7
Q

s/s of acute renal failure

A
  • oliguria (<1mL/kg/hr)
  • abrupt diuresis: sudden strong urge to urinate
  • edema (pulmonary)
  • circulatory collapse
  • cardiac arrhythmia: hyperkalemia
  • seizures: hyponatremia, hypocalcemia (tetany)
  • tachypnea: metabolic acidosis
  • CNS: from oliguria
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8
Q

lab/diagnostics for acute renal failure

A
  • electrolyte imbalances
  • kidney panel: decreased urine creatinine, GFR, increased BUN
  • metabolic acidosis
  • anemia: low Hgb, Hct
  • azotemia, increased blood creatinine
  • EKG
  • IVP (intravenous pyelogram: xray and contrast) & MRI for kidney function
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9
Q

meds for acute kidney failure: hyperkalemia

A
  • calcium gluconate
  • sodium bicarbonate
  • glucose and insulin IV
  • sodium polystyrene sulfonate
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10
Q

meds for acute kidney failure: antihypertensives

A
  • labetalol or sodium nitroprusside
  • hydralazine, clonidine, or verapamil
  • captopril, minoxidil, propranolol, nifedipine, furosemide

vasodilators, beta blockers, ace inhibitors, loop diuretic

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11
Q

treatment procedures for acute kidney failure

A
  • dialysis (hemo or peritoneal)
  • hemofiltration/ultrafiltration
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12
Q

when does acute kidney failure becomes chronic

A
  • diseased kidneys can’t maintain body needs
  • half of renal capacity destroyed
  • irreversible damage to nephrons, leading to uremia (toxin build up)
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13
Q

potential causes of chronic kidney failure

A
  • <5yrs: congenital, kidney & urinary tract malformations and vesicoureteral reflux
  • 5+: VUR associated with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis
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14
Q

pathophysiology of chronic kidney failure

A
  • waste products accumulate
  • water & Na retention and decreased urine excretion -> edema
  • high K, P
  • low Na, Ca (P & Ca inverse relationship)
  • decreased hydrogen secretion & bicarb reabsorption -> metabolic acidosis
  • decreased erythropoietin from kidney, shortened PRBC lifespan -> anemia
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15
Q

s/s of chronic kidney failure

A
  • lethargy, fatigue
  • pallor, bruising of skin
  • delayed growth
  • anorexia, N/V
  • decreased urine output
  • uremic odor from breath
  • muscle cramps
  • puffy face
  • bone or joint pain
  • amenorrhea
  • circulatory overload: HTN, CHF, pulmonary edema
  • neuro: tremors, twitching, confusion, seizures, coma
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16
Q

lab/diagnostics for chronic kidney failure

A
  • eGFR: decreased maybe
  • electrolytes: high K, P, low Na, Ca
  • CBC: anemia
  • blood creatinine & BUN: high
  • ABG: metabolic acidosis
17
Q

medications for chronic kidney disease

A
  • nephrocaps: vitamins
  • calcium carbonate: increase Ca, decrease PO4
  • sodium bicarbonate: metabolic acidosis
  • iron supplements, vit D, folic acid, erythropoietin: anemia
  • growth hormone
  • ace inhibitors “pril”
  • lasix
18
Q

diet education for chronic kidney disease

A
  • adequate calories and proteins for growth
  • restrict: Na, K, protein, water
  • take: folic acid, iron
19
Q

treatment for end stage chronic kidney disease

A
  • dialysis
  • transplant
  • hemofiltration
20
Q

what are acute s/s of transplant rejection

A
  • fever
  • malaise
  • decreased urine output
  • tachycardia, tachypnea
  • weight gain
  • poor appetite
21
Q

what are the 3 types of dialysis that can be used for kidney failiure

A
  1. peritoneal dialysis
  2. hemodialysis
  3. hemofiltration (CRRT: continuous renal replacement therapy)
22
Q

what type of dialysis is preferred for children? how does it work?

A

peritoneal dialysis: can be managed at home
- warmed solution enters peritoneal cavity and remains for period of time before removal
- abdominal cavity acts as semipermeable membrane for filtration

23
Q

how does hemodialysis work

A
  • requires vascular access
  • best for children that can be in facility 3x a week for 4-6hrs
  • achieves rapid correction of fluid & electrolytes
24
Q

when is hemofiltration used (CRRT)

A
  • continuous for pts that can’t tolerate large volumes of fluid removal
  • done in ICUs only

NURS254 Peds (6 decks)

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