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Critical Care Final > Acute Renal Failure > Flashcards

Acute Renal Failure Flashcards

1
Q

Functional unit of the kidney

A

Nephron

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2
Q

Percentage C.O

A

up to 20%

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3
Q

Renal structure
1- outer layer
2- inner layer

A
  • cortex

- medulla

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4
Q

how many liters of filtrate per day

A

180 L

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5
Q

how much concentrated urine

A

1-2 L

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6
Q

GFR

A

125 ml/min

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7
Q

Acute Kidney Injury

A
  • decline of GFR in 48 hrs or less
  • fluid retention
  • Retention of waste products normally filtered out
  • can turn into acute renal failure
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8
Q

why is UO not always a reliable indicator of GFR

A

because of diuretic treatment

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9
Q

what is not excreted by injured kidneys

A

Creatinine

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10
Q

Other S/S of injured kidneys

A
  • unbalanced I/O
  • weight gain
  • crackles in lungs
  • edema
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11
Q

RIFLE Criteria

A 
R-risk
I-Injury
F-Failure
L-Loss
E-End-stage kidney dz
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12
Q

AKIN Criteria for renal failure

A
  • Serum Cr increased by 0.3 mg/dl
  • more than 50% incr. creatinine level
  • UO 6hr
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13
Q

Lab draws how many times

A

2 x in 48 hrs

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14
Q

Factors on the prognosis

A
  • depends on cause
  • depends how quickly treatment is started
  • how sick pt is
  • length of stay
  • mortality 15-60%
  • can lead to permanent dialysis
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15
Q

Pre-Renal Causes

A
  • hypoperfusion

* blood loss and dehydration

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16
Q

Pre-Renal S/S

A
  • GFR decreases
  • UO decreases
  • AZOTEMIA: build up of protein
  • can be fixed quickly if caught early
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17
Q

Intra-Renal Causes

A

Acute Kidney tissue is damaged

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18
Q

Intra-Renal S/S

A
  • harder to treat than pre-renal
  • ATN- acute tubular necrosis
  • Infection
  • antibiotics
  • kidney failure
  • contrast
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19
Q

Post-Renal Causes

A

OBSTRUCTION

  • tumor
  • ureter
  • bladder
  • abdominal
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20
Q

Post-Renal Causes

A

urine cant leave the ureters

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21
Q

Functions of the Kidney

A
  • Waste Removal
  • BP regulation
  • RBC production (erythropoietin)
  • Vitamin D activation
  • Prostaglandin synthesis
  • Acid base balance (buffer system)
  • Fluid balance
  • Electrolyte imbalance
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22
Q

Systemic Effects of Renal Failure:

-CARDIOVASCULAR

A
  • excess fluid
  • edema and HTN
  • BP regulation: renin: HTN , stroke, organ damage
  • Arrythmias-solutes in blood (K+) irritate the heart
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23
Q

Systemic Effects of Renal Failure:

-HEMATOPOIETIC

A

no erythropoietin –> anemia

24
Q

Systemic Effects of Renal Failure:

-RESPIRATORY

A

fluid overload–>crackles, dyspnea

Rapid Respirations-> acid/base imbalance

25
Q

Systemic Effects of Renal Failure:

-GASTROINTESTINAL

A

-can alter GI motility d/t electrolyte imbalance (nausea/vomiting)

26
Q

Systemic Effects of Renal Failure:

-NEUROMUSCLULAR

A
  • electrolyte imbalances
27
Q

Systemic Effects of Renal Failure:

-INTEGUMENTARY

A
  • edema –> stretched, weak tissue

- uremic crystals

28
Q

Systemic Effects of Renal Failure:

-ENDOCRINE

A

Renin (RAAS) erythropoietin- kidney damage = no secretion

-no prostaglandin release to regulate renal blood flow: vascular permeability

29
Q

Systemic Effects of Renal Failure:

-SKELETAL

A
  • impaired Ca++ absorption

- weak bones, impaired blood clotting

30
Q

Values that DECREASE

A

Albumin- moves extracellular
Na- dilutional hyponatremia
Ca- d/t phosphorus increasing
Hct- d/t fluid retention and anemia of kidney disease

31
Q

what to be aware of when taking labs

A

Be aware of meds pt is taking

32
Q

Medical Management:

-FLUIDS

A
  • replacement for early pre-renal AKI treatment
  • Restriction -prevent complications
  • Removal-dialysis if kidneys not functioning
33
Q

Medical Management:

-medications

A

d/c or reorder with renal dosing

  • diuretics
  • phosphorus binders
  • electrolyte replacement/ removal
34
Q

Renal Failure Nutrition:

A
  • low K diet
  • low phos diet
  • fluid restrictions
35
Q

Renal Failure medication education

A
  • tell them about the mechanism of action

- EX) phosiov binds with phosphorus in food so eat with meds

36
Q

Hemodialysis:

-tonocity

A

Osmolality- measures the number of particles in a solution

37
Q

Hemodialysis:

-hydrostatic pressure

A

movement from an area of high pressure to low pressure

38
Q

Hemodialysis:

-Osmotic pressure

A

movement of fluid from an area of low particle concentration to high concentration
-or fluid staying in high concentration

39
Q

Hemodialysis:

-blood pushed in one direction

A

+ hydrostatic pressure

40
Q

Hemodialysis:

-dialysate pushed in opposite direction

A
  • hydrostatic pressure
41
Q

Hemodyalisis Access:

-Temporary

A
  • IJ
  • subclavian
  • femoral
  • emergency HD
  • failed access or ARF
42
Q

Hemodialysis Access:

-tunneled catheter

A
  • not permanent but long term

- internal jugular but looks subclavian

43
Q

Hemodialysis Access:

-AV fistula

A
  • artery and vein connected
  • needs time to ripen
  • bruit and thrill
  • NO BP or blood draws
44
Q

Hemodialysis Access:

-AV GRAFT

A

-synthetic material between vein and artery

_NO BP OR LABS

45
Q

Continuous Renal Replacement CRRT

A

continuous hemodialysis
removes large amounts of fluids
** removed in 24 hrs rather than 4 which is better for patients hemodynamically

46
Q

Slow continuous Ultrafiltration SCUF

A

FLUID REMOVAL ONLY

-used in fluid overlaod pts , HF, not responding to diuretics

47
Q

Continuous Venous hemofiltration CVVH

A

REMOVES FLUID BUT NO COUNTER CURRENT

  • takes out LARGER MOLECULAR WEIGHTS
  • CONVECTION
48
Q

CVVH

how many liters removed

A

5-20 ml/min (7-30 L/24 hrs)

49
Q

Continuous Venovenous Hemodialysis CVVHD

A

REMOVES FLUIDS & COUNTERCURRENT

  • takes out LOW MOLEC. WEIGHT (urea, cr, K)
    • DIFFUSION
50
Q

CVVHD

-how long

A 
24 hr (2-10 days)
hemodynamically safer to use
51
Q

Continuous Venous Hemodiafiltration CVVHDF

A

COMBO
*CONVECTION AND DIFFUSION
maximal fluid and solute removal

52
Q

CVVHDF
pre-filter
countercurrent

A
  • increases + hydrostatic pressure

- neg hydrostatic pressure

53
Q

Problems with dialysis

A

-infection
-clots
-acid base imbalance
-blood loss: dislodge catheter
-air embli
cardiac arrest d/t E/I imbalance

54
Q

PERITONEAL dialysis

  • who uses it
  • location
  • how does it drain
A
  • chronic KF
  • abdomen and dwell time
  • drains by gravity
55
Q

PERITONEAL high risk

A 
peritonitits
incr temp
abdominal tender
cloudy fluid in drain 
site red and oozing

Critical Care Final (5 decks)

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