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Nursing > Acute and Chronic Renal Failure > Flashcards

Acute and Chronic Renal Failure Flashcards

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1
Q

Functions of the kidney

A
  1. Excretion of waste products
  2. Urine formation
  3. Water and salt balance
  4. Acid-base balance
  5. Hormone secretion
  6. Control of blood pressure
  7. Erythropoietin production (RBC)
  8. Synthesis of vitamin D to active form ( low Ca)
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2
Q

Renal failure results in:

A

– Altered fluid balance
– Electrolyte imbalance
– Acid-base imbalance

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3
Q

Causes of kidney failure include:

A

– Hypertension

– Diabetes

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4
Q

Kidney failure may be:

A

Acute or chronic

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5
Q

Acute renal failure (ARF)

A

• Rapid decrease in kidney function
• Leading to the collection of metabolic wastes in the body
• Potentially reversible condition
Lasts < 3 months

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6
Q

Etiology/Types of ARF:

A

– Prerenal failure
– Intrarenal/intrinsic renal failure
– Post renal failure

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7
Q

Prerenal failure

A

decreased blood flow to the kidneys - ischemia in the nephrons;prolonged hypoperfusion can lead to tubular necrosis and ARF.

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8
Q

Prerenal failure: causes

A
  1. Conditions that cause decreased cardiac output.
  2. Shock
  3. HF
  4. Pulmonary embolism
  5. Anaphylaxis
  6. Pericardial tamponade
  7. Sepsis
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9
Q

Intrarenal/intrinsic renal failure

A

actual tissue damage to the kidney caused by inflammatory or immunologic process or from prolonged hypoperfusion.

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10
Q

Intrarenal/intrinsic renal failure:causes

A
  1. Acute interstitial nephritis
  2. Exposure to nephrotoxins
  3. Acute glomerulonephritis
  4. Vasculitis
  5. Hepatorenal syndrome
  6. ATN
  7. Renal artery or vein stenosis/thrombosis
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11
Q

Post renal failure

A

obstruction of the urine collecting system anywhere from calyces to urethral meatus; obstruction of the bladder must be bilateral to cause post renal failure unless only one kidney is functional

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12
Q

Post renal failure: causes

A
  1. Urethral or bladder cancer;
  2. Renal, ureteral or bladder stones;
  3. Atony of bladder
  4. Prostatic hyperplasia or cancer;
  5. Cervical cancer;
  6. Urethral stricture (narrowing)
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13
Q

Acute tubular necrosis

A
  • Syndrome of abrupt and progressive decline in tubular and glomerular function
  • Most intrarenal failure is from ATN
  • Etiology: Nephrotoxic substances
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14
Q

Potentially Nephrotoxic Substances/ Drugs

A 
– PCN, Vancomycin, NSAIDs
– Radiocontrast dyes
– Heavy metals 
– Snake bites 
– Pesticides
– Transfusion reaction
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15
Q

Phases of ARF

A
  1. Onset
  2. Oliguric
  3. Diuretic (high output)
  4. Recovery
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16
Q

Onset phase

A

until oliguria develops; accumulation of nitrogenous wastes may be noted (BUN, serum creatinine); hours - several days.

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17
Q

Oliguric phase

A

100-400 / 24 hours urine output that does not respond to fluid chalenges or diuretics; 1-3 weeks; SC and BUN up; K, P, Mg up ; Ca down ; Na up but masked by water retention ;bicarbonate deficit - acidosis ;

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18
Q

Diuretic phase ( hight output phase)

A

2-6 weeks after oliguric; sudden onset ; urine flow increased over several days; 10 L /day of dilute urine ; electrolyte losses; BUN down; normal renal tubular function .

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19
Q

Recovery phase (convalescent phase)

A

Recovery may take up to 12 months; pt has lower energy level; residual renal insufficiency may be noted through renal monitoring; renal function may never return to pre illness level; but renal function likely good for healthy life.

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20
Q

ARF: management

A

1.Fluid challenges
2. Diuretics (Lasix)
3. Calcium channel blockers
4. Diet therapy
5. Renal replacement therapy
– Peritoneal dialysis
– Hemodialysis
– Hemofilteration

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21
Q

Cardiac glycosides: Digoxin ( Lanoxin)

A

Increases ventricular contraction, stroke volume, cardiac output; teach pt to take pulse before taking the drug ( below 60 call !); Digoxin toxicity: blurred vision; changes in color vision; sensitive eyes; halos around bright lights; changes in mental status; chest pain or palpitations. Not to take antacid within 2 hours (prevent drug absorption). Listen to apical for 1 full minute.

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22
Q

Vitamins and Minerals: Folic acid and Ferrous sulfate (iron)

A

Replacement needed because of dialysis; Take drug after dialysis; Take iron with meals ( reduce N&V); Take stool softener ( oral iron causes constipation); Iron change the color of the stool.

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23
Q

Synthetic erythropoietin: Epoetin alfa (Epogen, Procrit)

A

Prevents anemia by stimulating RBC growth and maturation in the bone marrow; Side effects: chest pain, difficulty breathing, high BP, rapid weigh gain,( risk for MI infarction); Hemoglobin levels monitored weekly ( blood viscosity increases - high BP - risk for MI ).

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24
Q

Phosphate binders: Aluminium hydroxide gel (Amphojel, Nephrox)

A

High Phosphate levels cause hypocalcemia and osteodystrophy; Drug lowers P levels by binding P present in food; Take with meals ( binding in food) ; Take Digoxin separately but at least 2 hr ; Take stool softener ( constipation) ; Report: muscle weakness, slow or irregular pulse, confusion - hypophosphatemia.

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25
Q

Fluid challenges

A

500mL- 1L of NS over 1 hour
– Patient may respond to the fluid challenge by producing urine soon after the initial bolus
– Lasix may be prescribed along with fluid bolus
– If oliguric renal failure is diagnosed fluid bolus and diuretics are
discontinued

26
Q

Calcium channel blockers

A
  • Used to treat ARF resulting from nephrotoxic ATN
  • Prevent the movement of calcium into kidney cells
  • Maintain kidney cell integrity and improve the GFR rate
  • Thereby improving renal blood flow
27
Q

Nursing interventions: monitor

A 
Monitor/maintain F&E balance
 Monitor for:  
– Signs of ARF and its complications
– Alteration in fluid volume
Promote optimal nutritional status
28
Q

Nursing interventions: prevent and provide

A 
Prevent:
– Complications from impaired mobility
– Fever/infection
Provide: 
– Care for the client receiving dialysis
– Client teaching and discharge teaching
29
Q

ARF: nursing diagnosis

A
  • Excess Fluid Volume
  • Potential for Pulmonary Edema
  • Potential for Electrolyte Imbalances
30
Q

Chronic renal failure CRF

A
  • Progressive irreversible kidney damage
  • Damage continues until nephrons are replaced by scar tissue
  • Kidney function does not recover
  • Complication : End-stage renal disease: When kidney function is too poor to sustain life
31
Q

CRF: Etiology

A

Two main causes of ESRD
– Diabetes Mellitus (43.4%)
– HTN (25.5%)

32
Q

CRF: Etiology

A 
Infection and genetic kidney disease
– Glomerulonephritis (8.4%) 
• Diseases that contribute to CRF
– Pyelonephritis
– Urinary tract obstruction
– Renal cell carcinoma
33
Q

CRF: S/S

A
  1. sallow yellow discoloration ; pruritus + uremic frost
  2. CNS depression , peripheral neuropathy
  3. high BP- CHF- ASHD- pericarditis
  4. anorexia, N&V
  5. GI bleeding, peptic ulcer disease
  6. Constipation
  7. Hyper - glycemia; - lipidemia;
  8. Depression
  9. Anemia
  10. Hypeparathyroid
  11. Amenorrhea, infertility, impotence
  12. Gout
  13. GFR less than 10 %
  14. Renal osteodystrophy
34
Q

Progression of Kidney Disease

A

Kidneys fail in organized fashion involving five stages based on estimated glomerular filtration rate (GFR) .
> 90 - Kidney damage : normal or increased GFR
< 15 or dialysis : kidney failure

35
Q

Amenorrhea

A

absence of menstruation

36
Q

ASHD

A

arteriosclerotic heart disease

37
Q

CRF: laboratory profile

A 
Serum creatinine (0.5-1.2) - 15-30
BUN (10-20) - 180-200
Increased Na, K, P, Mg; Low Ca;
Metabolic acidosis 
H&H decreased
38
Q

Dietary restrictions

A

Protein, Fluid, K, Na, P.

39
Q

Uremia

A

Prerenal azotemia is an abnormally high level of nitrogen waste products in the blood.

40
Q

Foods high in P:

A

milk, yogurt, cheese, dried beans, meat, poultry, fish and seafood;
** The phosphorus content is the same for all types of milk – skim, low fat,
and whole! Patients need to take a phosphate binder if and when they eat any
high-phosphorus foods.

41
Q

Foods low in P:

A

1/2 cup of milk products limit; ricotta cheese, non dairy whipped topping, cream cheese, butter.

42
Q

Foods high in K:

A

oranges, prunes, bananas, mangos, cantaloupe

43
Q

Foods low in K:

A

apples, berries, grapes, watermelon, pineapple

44
Q

CRF: nursing interventions

A 
Assess for: 
• Signs of Uremia
• Changes in mental function
• Orient client to person, place, and time
• Monitor serum electrolytes
45
Q

Promote ultimate GI function:

A
  • Assess and provide care for stomatitis
    • Monitor for N/V/anorexia; administer antiemetics as ordered
    • Assess for signs of GI bleeding
46
Q

CRF: interventions

A

• Monitor prevent alteration in F/E balance
• Assess for:
– Hyperphosphatemia
– Uremic frost
• Assess/provide care for pruritus (itching)
• Promote maintenance of skin integrity
• Monitor for bleeding complications
– Prevent injury to client
• Promote/maintain maximal cardiovascular function
• Provide care for client receiving hemodialysis

47
Q

Uremic frost

A

a pale frostlike deposit of white crystals on the skin caused by kidney failure and uremia.

48
Q

Nursing diagnosis

A 
– Imbalanced nutrition
– Excess fluid volume
– Decreased cardiac output
– Risk for infection
– Fatigue
– Anxiety
49
Q

Additional nursing diagnoses

A 
– Diarrhea
– Constipation
– Impaired oral mucus membrane
– Social isolation
– Sexual dysfunction
– Disturbed thought process
– Deficient knowledge
50
Q

Creatinine

A

Protein and muscle breakdown 0.5-1.2

51
Q

BUN

A

Renal excretion of urea nitrogen 10-20

52
Q

Anuria

A

Less than 100 ml in 24 hr

53
Q

Dysuria

A

Painful urination

54
Q

Frequency

A

Need to void often; small amounts

55
Q

Hesitancy

A

Trouble initiating urine flow , sensation present

56
Q

Urgency

A

sudden onset to void ; NOW

57
Q

Nocturia

A

waking in the night to empty bladder; e: don’t give Lasix at nigh !

58
Q

Oliguria

A

100-400 ml in 24 hr/ decreased urine output

59
Q

Polyuria

A

> 2000 ml in 24 hr; increased urine output

60
Q

Uremia

A

symptoms of renal failure

61
Q

ESKD: most common causes

A
  1. Hypertension

2. Diabetes mellitus

Nursing (18 decks)

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