ACUTE RENAL Flashcards

Question

Oligura phase

Answer 1

Some forms of kidney failure are “non-oliguric” meaning have accum of N wastes but still producing normal amounts of urine (2L or more) mainly in people exposed to nephrotoxic drugs + burns

Answer 2

- gradual inc in urine output - signs that filtration has begun to recover - lab values stabilize + dec - output increases but still may be sig kidney abnormalities - nurse to watch carefully for signs of dehydration (will inc uremic symptoms)

Answer 3

may take 3-12 months improvement in renal fx; lab values return to normal

Answer 4

* Almost every system affected * Critically ill, lethargic * Skin + mucous membranes dry d/t dehydration * CNS: Drowsiness, muscle weakness, twitching ``` Complications: Hypertension & Fluid Overload Azotemia --> Uremia Hyperkalemia Anemia Hyperphosphatemia & Hypocalcemia Metabolic Acidosis ```

Answer 5

``` All systems!! History Vital Signs Weight CNS CVS Respiratory GI Fluid balance -FVE -FVD Integumentary ```

Answer 6

Urine output varies from scanty to normal, possible hematuria, urine w low specific gravity

Answer 7

U/S critical – renal sonogram, CT, MRI show changes

Answer 8

result of dec erythropoietin production, uremic GI lesions, reduced RBC life span, blood loss

Answer 9

•High risk of hyperkalemia w dec GFR, oliguria, anuria; protein metb results in release of K+

Answer 10

• Possible inc in phosphate levels - dec in Ca levels d/t dec absorption in GI tract, and as compensatory mech for inc P in blood; Ca2+ also excreted when acidosis occurs From class: HyperP can affect thyroid, also factor in metb acidosis

Answer 11

Elevated BUN Elevated Serum Creatinine GFR

Answer 12

Pericarditis Protein bound uremic toxins

Answer 13

* Careful hx to detect nephrotoxic agents + meds * Those taking nephrotoxic meds (gentamicin, aminoglycosides, vancomycin, etc) monitored carefully for change in renal fx – BUN + creatinine baseline, 24hrs after inititiating tx and twice weekly after

Answer 14

• Radiocontrast-introduced nephropathy (RIN) major cause of hospital-acquired ARF hydration most effective prevention of this

Answer 15

* ½ of those with ARF during hospitalization >50yrs * Etiology of ARF in elderly incl dehydration, nephrotoxic agents (meds, contrast agents), complications of major sx * Further dehydration d/t lack of thirst, confusion, enforced bed rest, lack of access to drinking H2O

Answer 16

Yes, remarkably well!

Answer 17

restore normal chemical balance, prevent complications until repair of renal tissue and restoration of renal fx can occur • Eliminate cause, maintain fluid balance (avoid excess), provide renal replacement tx • Shock + infection treated prompty if present

Answer 18

Prerenal (hypoperfusion)

Answer 19

1) Understand and ensure Cause treated 2) Monitor Fluid/electrolyte: Daily weights, Ins/outs, Strict care with fluid restrictions, possible dialysis/CRRT 3) Vital signs: know FVE and FVD 4) Lab values: K+,BUN, Cr, GFR 5) Dec metb rate:bed rest, tx fever + infection promptyl 6) Promote pulm fx – assist to turn, take deep breaths, cough 7) Skin Care 8) Nutrition 9) Support: Psychological and hemodynamic 10) Catheter Care 11) Short term dialysis if treatment unsuccessful? 12) Education to prevent CKD

Answer 20

Hyperkalemia - pt monitored for serum K, ECG changes, changes in clinical status. May see irritability, cramping, diarrhea, paresthesia, generalized muscle weakness (slurred speech, difficulty breathing, etc.)

Answer 21

will correct biochemical abn, allow liberalization of fluid, protein and sodium intake, diminishes bleeding tendencies + promotes healing

Answer 22

Continuous Replacement Therapies = used to replace normal kidney fx by circulating blood through hemofilter

Answer 23

o Treated w cation-exchange resins orally or retention enema: Kayexalate (works by exchanging sodium for potassium ions in GI tract o Colon is major site of K+ exchange (why use enema) o Sorbitol in combo with this to induce diarrhea o If hemodynamically unstable, may give IV dextrose 50%, insulin + calcium replacement to shift K+ back into cells o Salbuamol sulfate (Ventolin HFA) by neb can lower plasma K+ o Temporary changes, so need dialysis on emergent basis

Answer 24

* Must adjust drugs as hard on kidneys, esp aminoglycosides, digoxin, ACE inhibitors, etc * Diuretics often used for fluid balance but not shown to improve recovery from ARF * ABGs and serum bicarbonate monitored for severe acidosis – might need sodium bicarbonate tx or dialysis * Resp support measures if necessary * Phosphate-binding agents to control serum phosphate levels

Answer 25

nausea + vomiting, impaired glucose use + protein synthesis, inc tissue catabolism

Answer 26

* Exact therapy depends on cause, comorbidities, nutritional status, etc * Replacement of dietary proteins individualized to min uremic symptoms * High calories to promote protein sparing * Foods + fluids containing K+ and P minimized * Following diuretic phase, pt placed on high calorie, high protein diet to resume activities gradually

Answer 27

family may be hesitant to touch + talk to pt during dialysis, PD, CRRT but should be encouraged to do so

Answer 28

may be dry d/t edema, itchy + excoriation d/t deposit of irritating toxins in tissues → can bath in cool water, turn frequent, keep skin clean + moisturized, fingernails traimmed to avoid excoriation

Answer 29

* Pt’s undergoing urologic testing are often apprehensive – can be embarrassing * Voiding in presence of others causes guarding = natural reflex that inhibits voiding with situational anxiety * Nurse can help by providing privacy + thorough explanation of procedure

Answer 30

* Provides info on kidney function and helps diagnose conditions like DM * Determines bacteria, strains, and concentration – can determine what antibiotics to follow with

Answer 31

``` o Colour o Clarity and odour o Urine pH and specific gravity o Proteins o Glucose o Ketone bodies o Microscopic exam for: hematuria, pyuria (WBC’s in urine), cylinduria (casts), crystals (crystalluria), and bacteria (bacteriuria) ```

Answer 32

Hematuria d/t acute infection (cystitis, urethritis, prostatitis), renal calculi and neoplasm, bleeding disorders, malignant lesions, meds such as warfarin + heparin

Answer 33

* Measures density of solution compared with density of water, which is 1.000 * Altered by presence of blood, proteins, casts * Normal range = 1.010 to 1.025 * Dehydration will raise specific gravity * Those with kidney disease have “fixed” sg = sg doesn’t change with fluid intake * Disorders causing decreased: diabetes insipidous, glomerulonephritis, sever renal damge * Disorders causing inc: DM, nephritis, fluid deficit

Answer 34

* Most accurate measure of kidney’s ability to dilute + concentrate urine * = # of solute particles in kg of H2O * Serum + urine osmolality measured simultaneously to assess fluid status * Normal serum = ~300 mmol/L * Normal urine = ~300-1100 mmol/kg

Answer 35

end product of muscle energy metabolism. In normal, level of creatinine which is regulated by kidneys, will remain relatively constant

Answer 36

urea is nitrogenous end product of protein metabolism. Test values affected by protein intake, tissue breakdown, and fluid volume changes

Answer 37

BUN to creatinine ratio

Answer 38

detects and evals progression of renal disease. Test measures volume of blood cleared of endogenous creatinine in 1 min, which provides approx of GFR. Sensitive indicator of renal diseae used to follow progression of renal disease

Answer 39

1) Kidney, Ureter, and Bladder Studies (KUB) • X ray of abdomen or kidneys, ureter + bladder (KUB) may be performed to delineate size, shape, position 2) General Ultrasonography • Sound waves used to detect abnormalities: fluid accum, masses, congenital malformations, changes in organ size, obstructions • Requires full bladder • Is sensitive test – has replaced many others as initial diagnostic procedure 3) Bladder U/S • Used to measure urine vol 4) CT + MRI And many more....

Answer 40

- Most common method of dialysis - Used as short-term, long-term or permanent form of therapy - Dialyzer = artificial kidney - Serves as a synthetic semi-permeable membrane

Answer 41

1) seizures, confusion 2) Shock, arrhythmias 3) compensation (for acidosis). fluid overload/pulmonary edema? JVD? 4) Cost-vertebral angle (CVA) tenderness

Answer 42

Particles found during routine U+A (urinalysis) or R+M (routine + microscopic), whole bunch of different types; muddy brown casts are indication of ATN

Answer 43

Want to treat underlying cause but first want to: inc head of bed, put on O2, give meds o Mannitol. Is osmotic diuretic – inhibits reabsorption of sodium and water; works by expanding plasma volume and inc blood flow to kidney • Is safer because less of effect on electrolytes (confirm this?) – will use this if very worried about electrolytes o Lasix is loop diuretic, acts on ascending loop of henle; can inc BUN + creatinine levels + cause potassium shifts so more risky for lyte imbalances (but generally used more than mannitol)

Answer 44

Inc resp rate, dec sats, cyanosis, anxiety, crackles, venous distension

Answer 45

1) Kayexalate 2) Dextrose/Insulin/Calcium 3) Ventolin

Answer 46

gets rid of potassium; causes diarrhea for days; not first line defense for those who are really sick

Answer 47

can use CaCl or Ca gluconate to inc threshold potential…restores normal threshold potential, onset 3-5min, lasts 30-60min, given IV o 50ml D50 first (to prevent hypoglycemia) o Then insulin, which will lead to shift of K+ ions into the cells; takes a few hours so may need to be repeated

Answer 48

lowers blood levels of K+ in serum my promoting uptake into cells; can cause side effect of inc HR, which is concen for pt with hyperkalemia!