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Med-Surg > Adult Renal > Flashcards

Adult Renal Flashcards

1
Q

How do you assess the patency of a arteriovenous (AV) graft in the forearm ?

A

auscultate the site for a bruit

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2
Q

What are the functions of the kidney ?

A
  • regulate the volume and composition of extracellular fluid
  • excrete waste
  • control BP
  • produce erythropoietin (building block of RBCs, decreased kidney function can lead to anemia)
  • activate vitamin D (important to absorb calcium)
  • regulate acid-base balance
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3
Q

What is Azotemia ?

A

loss of renal function/ increase of metabolic waste products
- aka buildup of waste products

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4
Q

What is Oliguria ?

A

decrease in urinary output
- < 400 mL/day

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5
Q

How suddenly does acute renal failure (injury) occur ?

A

develops over hours/days
- with elevation of BUN & serum Creatinine

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6
Q

What will the lab values in acute renal failure look like ?

A
  • decreased glomerular filtration rate
  • increased serum creatinine
  • increased creatinine clearance (24 hr urine)
  • increased BUN
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7
Q

What is the best indicator of renal failure ?

A

serum creatinine
- represents how much irreversible damage has already occured

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8
Q

What lab value do we use to diagnose chronic kidney disease/ implementation of dialysis ?

A

glomerular filtration rate

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9
Q

What is the best indicator of renal function ?

A

creatinine clearance (24 hr urine)
- represents the degree of seriousness and how well the kidneys are functioning

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10
Q

What does the BUN measure ?

A

the amount of urea nitrogen in the blood
- represents an indirect measurement of renal function and the GFR

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11
Q

What is the best indicator for fluid balance ?

A

daily weights

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12
Q

What does Prerenal causes of acute renal failure mean ?

A

factors that reduce the systemic circulation/perfusion
- heart and blood vessels
- anything that causes decreased perfusion of kidneys and blood flow
- causing reduction in renal blood flow and leading to hypotension/hypovolema
- Ex.) severe blood loss, low BP, sepsis, injury, dehydration,

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13
Q

What does Intrarenal causes of acute renal failure mean ?

A

conditions that cause direct damage to the renal tissue
- kidney
- resulting in impaired nephron function and tubular necrosis
- problem with the kidney itself
- Ex.) med toxicity ischemia, prolonged dehydration/sepsis, nephrotoxic meds (NSAIDS, metformin, vancomycin)

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14
Q

What does Postrenal causes of acute kidney failure mean ?

A

causes involve mechanical obstruction of urinary outflow
- ureters and bladder
- some blockage or injury to downstream flow of kidney
- body detects that the urine isn’t going down so the kidneys will just stop producing that waste
- Ex.) prostatic hypertrophy (enlarged prostate which is very common in older men

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15
Q

What are the 4 phases of Acute Renal Injury (ARI) ?

A
  • initiating (whatever caused the injury)
  • oliguric (kidneys have no perfusion so they stop/decrease urine production until there is enough perfusion)
  • diuretic (tx which is giving fluids or maybe diuretic so kidneys start working again)
  • recovery (can be months and its when the kidneys and labs stabilize)
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16
Q

How long does the oliguric phase last of ARI ?

A

1-7 days

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17
Q

What are some characteristics of the Oliguric phase of ARI ?

A
  • <400 mL/day of urine
  • metabolic acidosis (kidneys can’t excrete acid products of metabolism)
  • hyperkalemia (kidneys can’t excrete potassium) and hyponatremia
  • increased BUN and creatinine
  • hematologic disorders (anemia)
  • fatigue and malaise (sick feeling)
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18
Q

What are some characteristics of the Diuretic phase of ARI ?

A
  • gradual increase in urine output (1-3 L/day to 3-5 L/day)
  • hypovolemia, dehydration
  • hypotension
  • nephrons are still not fully functioning
  • uremia may still be severe, as seen in labs (may look bad for about a few days but should get better gradually)
  • BUN and creatinine begins to normalize
  • persistent S&S
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19
Q

What are some characteristics of the Recovery phase of ARI ?

A
  • begins when GFR increases
  • BUN and creatinine levels plateau (even out) and then decrease
  • renal function can take up to 12 months to stabilize
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20
Q

What causes the hyponatremia in the oliguric phase of ARI ?

A

the damaged tubules can’t conserve sodium
- if left uncontrolled or water excess then it can lead to cerebral edema

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21
Q

Why are hematologic disorders associated with ARI ?

A

impaired erythropoietin production and platelet abnormalities leading to bleeding

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22
Q

Why may a pt have low serum Ca+ in the oliguric phase of ARI ?

A

inability of the kidneys to activate Vitamin D
- may be on Ca+/Vita. D supplement
- when hypocalcemia occurs the parathyroid secretes PTH which stimulates bone demineralization which releases Ca+ from the bones

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23
Q

Why may a pt have elevated serum Phosphate levels in the oliguric phase of ARI ?

A

phosphate is also released when the parathyroid secretes PTH
- pt may be on phosphate binders

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24
Q

How long does the diuretic phase of ARI last ?

A

1-3 weeks

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25
Q

How long does the recovery phase of ARI last ?

A

3-12 months

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26
Q

What are some indications for Renal Replacement Therapy/Dialysis ?

A
  • volume overload
  • elevated serum Potassium level
  • metabolic acidosis
  • BUN level >120 mg/dL (43 mmol/L)
  • significant change in mental status
  • pericarditis, pericardial effusion, or cardiac tamponade
  • clinical status of patient
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27
Q

Why may someone in the recovery phase of AKI need therapy or counseling ?

A

it’s because this phase takes 3-12 months so it can be mentally draining and can cause financial hardships
- also if your kidneys never recover you will need dialysis which is a significant lifestyle change

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28
Q

What is a common cause of AKI ?

A

acute tubular necrosis

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29
Q

What is a common cause of CKD ?

A

diabetic nephropathy

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30
Q

How much urine should you excrete per hour ?

A

80 mL per hr

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31
Q

What is Chronic Kidney Disease (CKD) ?

A

progressive, irreversible loss of kidney function

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32
Q

What is the main diagnostic value when wanting to diagnose CKD ?

A

Glomerular Filtration Rate (GFR)

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33
Q

What are the leading causes of CKD ?

A
  • diabetes (50%)
  • HTN (25%)
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34
Q

Can Vancomycin cause Nephrotoxicity ?

A

yes because if you have impaired kidneys, it can cause delayed and decreased elimination which can lead to accumulation of drugs and the potential for drug toxicity
- doses and frequency have to be adjusted according to severity of kidney disease

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35
Q

Why does pruritus happen in CKD ?

A

the buildup of urea causes the itchiness

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36
Q

When on dialysis, do all patients still produce urine ?

A

after being on dialysis for a while it’s not uncommon for the pt’s to develop anuria/no urine output

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37
Q

What are some S&S of CKD ?

A
  • uremia
  • oliguria (as CKD worsens) & anuria
  • metabolic acidosis (breathe may have uric scent to it because they are trying to breathe it off)
  • anemia
  • infection
  • respiratory system
  • pleural effusion
  • predisposition to respiratory infection
  • dyspnea
  • pulmonary edema
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38
Q

How do we stage chronic kidney disease ?

A

based on decrease in the Glomerular Filtration Rate (GFR)
- normal is 125 mL/min which is reflected by urine creatinine clearance

39
Q

What is the GFR for the last stage of kidney failure ?

A

End-Stage Renal Disease (ESRD) is when GFR <15 mL/min
- needs dialysis

40
Q

How do we diagnose CKD ?

A
  • renal biopsy
  • renal ultrasounds
  • renal scan
  • CT scan
41
Q

What are the most accurate indicators of kidney function ?

A

serum creatinine and 24-hr urine creatinine clearance

42
Q

AS GFR decreases what happens to BUN and serum creatinine ?

A

they will both increase

43
Q

How is carbohydrate metabolism affected by CKD ?

A

have altered carbohydrate metabolism
- pt’s with diabetes who develop uremia may requires less insulin then before onset of CKD
- excretion of insulin is dependent on kidneys

44
Q

How are the triglycerides affected by CKD ?

A

elevated due to alteration of lipid metabolism

45
Q

How are Potassium levels affected by CKD ?

A

hyperkalemia is most prevalent
- will cause fatal dysrhythmias and will want to put on a heart monitor

46
Q

What is the most serious electrolyte disorder in kidney disease ?

A

Hyperkalemia

47
Q

How are Sodium levels affected by CKD ?

A

can be elevated, normal, or low
- because of impaired excretion, Na with water is retained
- dilutional hyponatremia can occur (low sodium due to excess water): S&S are edema, HTN and heart failure

48
Q

How are Calcium levels affected by CKD ?

A

decrease in Vitamin D which causes a decrease of Calcium to be absorbed from the intestine which means there is a decrease of serum Ca+ levels
- Ca must be present for activation of Vita. D to occur

49
Q

How are Phosphate levels affected by CKD ?

A

it builds up in the blood cause of kidney failure
- leads to musculoskeletal disorders

50
Q

How are Magnesium levels affected by CKD ?

A

elevated levels aren’t a problem unless they ingest Mg containing products
- like milk of magnesia, magnesium citrate, antacids with Mg

51
Q

What are some S&S of hypermagnesemia ?

A
  • absence of reflexes
  • decreased mental status
  • cardiac dysrhythmias
  • hypotension
52
Q

What are some neurological manifestations of CKD ?

A

neurologic system starts to deteriorate when the nitrogenous waste products increase
- restless leg syndrome
- muscle twitching
- irritability
- decreased ability to concentrate
- peripheral neuropathy
- altered mental ability
- seizures
- coma

53
Q

What are some GI issues caused by CKD ?

A

every part of GI is affected
- mucosal ulcerations
- stomatitis (mouth ulcerations)
- uremic fetor (urinous odor to breath due to metabolic acidosis)
- GI bleeding
- anorexia, N/V

54
Q

What are some skin issues caused by CKD ?

A
  • pruritus (dry skin, calcium-phosphate deposition in skin, sensory neuropathy) due to urea levels
  • itching can be so intense that it can lead to bleeding or infection secondary to scratching
  • uremic frost (crystalized urea deposits that can be found on the skin of those affected by chronic kidney disease)
55
Q

What are some musculoskeletal manifestations in CKD ?

A

mineral and bone disorders
- decreased activation of Vita. D so impaired calcium absorption in the gut
- causes decreased serum Ca which causes a increase in PTH (parathyroid hormone)
- PTH causes bone demineralization to occur which causes the a increase of Ca and also phosphate

56
Q

What is collaborative care measures for CKD ?

A
  • correction of extracellular fluid volume overload or deficit
  • nutritional therapy
  • erythropoietin therapy
  • calcium supplementation, phosphate binder
  • antihypertensive therapy
  • measures to lower potassium
  • adjustment of drug dosages to degree of renal function
57
Q

What is a pharmacologic therapy method for Hyperkalemia ?

A

IV insulin
- IV glucose to monitor hypoglycemia
- the IV insulin will help draw K+ into the cells when it’s given & the IV glucose is given concurrently to prevent hypoglycemia
- when effects of insulin diminish the K+ shifts back out of cells

58
Q

What is some HTN therapy methods ?

A
  • weight loss
  • lifestyle changes
  • Na and fluid restriction
  • Antihypertension Meds like Diuretics- Lasix
59
Q

What is some information about the medication Lasix ?

A

loop diuretic
- can cause electrolyte imbalances like hypokalemia (can cause dysrhythmias) and dehydration (increases urine output)
- if given IV push fast then it can cause ototoxicity (ringing in ears or hearing loss)
- monitor I&Os, BP, K+ levels

60
Q

What is a side effect of EPO therapy ?

A

development of iron deficiency resulting from increased demand for iron to support erythropoiesis

61
Q

What are some side effects of Iron supplement ?

A
  • gastric irritation, constipation
  • may make stool dark in color
62
Q

What is the goal of Dyslipidemia ?

A
  • lowering LDL (bad cholesterol) below 100 mg/dL
  • triglyceride level below 200 mg/dL
63
Q

What is nutritional therapy for sodium, potassium, phosphate for CKD ?

A
  • Na: restrict from 2-4 g depending on degree of edema, and HTN
  • K: 2-3 g and high Potassium foods should be avoided
  • Phosphate (dairy) : 1000 mg/day
64
Q

What foods are high in Potassium ?

A
  • bananas
  • spinach
  • potatoes and tomatoes
  • oranges
65
Q

Why do CKD pt’s go on a protein restriction ?

A

when protein is ingested then it’s broken down and it creates creatinine
- the unhealthy kidneys lose the ability to remove protein waste and it builds up
- based on stage of kidney disease, nutrition status, and body size

66
Q

What are some conditions that put you at risk for CKD ?

A
  • hx of renal disease
  • HTN
  • DM
  • repeated UTI
67
Q

Which serum laboratory value indicates to the nurse that the client’s CKD is getting worse ?

A

decreased calculated glomerular filtration rate (GFR)

68
Q

What is dialysis ?

A

movement of fluid/molecules across a semipermeable membrane from one compartment to another
- used to correct fluid/electrolyte imbalances and to remove waste products in renal failure
- tx drug overdoses

69
Q

What is diffusion ?

A

movement of solute from an area of greater concentrations to an area of lesser

70
Q

What is osmosis ?

A

movement of fluid from an area lesser to an area of greater concentration of solute

71
Q

Why does a pt get dialysis ?

A

when pt’s uremia can no longer be adequately managed conservatively
- when GFR <15 mL/min

72
Q

What are the 2 types of dialysis ?

A
  • peritoneal dialysis: peritoneal membrane is a filter
  • hemodialysis: goes through the blood and it goes through a external filter and clean blood goes back in
73
Q

Where does the catheter go into in Peritoneal dialysis ?

A

into the peritoneal cavity
- usually done via surgery

74
Q

What is the solution/concentrations of the peritoneal dialysis liquid ?

A
  • 1 to 2 L bags with glucose concentrations of 1.5, 2.5, and 4.25%
  • electrolyte composition similar to plasma
  • solution is warmed to body temp to prevent cramping and pain
75
Q

What are the 3 phases of peritoneal dialysis cycle ?

A

an exchange
- inflow (flow)
- dwell (equilibration)
- drain

76
Q

What happens in the inflow phase of PD ?

A
  • prescribed amount of solution infused through established catheter over about 10 mins
  • after solution infused, inflow clamp closed to prevent air from entering tubing
77
Q

What happens in the dwell phase of PD ?

A
  • diffusion and osmosis occur between pt’s blood and peritoneal cavity
  • duration of time varies, depending on method
78
Q

What happens during the drain phase of PD ?

A
  • 15 to 30 mins
  • may be facilitated gently by massaging abdomen or changing position
  • Goal is to take fluid off (should have more out than put in)
  • like urine, output should be clear and yellow with no cloudiness or dark
79
Q

What is Automated Peritoneal Dialysis ?

A
  • cycler delivers the dialysate
  • times and controls fill, dwell, and drain
  • at night
80
Q

What is continuous ambulatory peritoneal dialysis (CAPD) ?

A

manual exchange
- during the day

81
Q

What are some peritoneal dialysis (PD) complications ?

A
  • exit site infection & peritonitis (can lead to sepsis)
  • hernias
  • lower back problems
  • bleeding
  • pulmonary complications
82
Q

What are the best places to put a fistula or graft ?

A
  • upper arm or forearm
  • leg is the last resort
83
Q

What is a Arteriovenous (AV) fistula ?

A

directly connecting an artery to a vein
- fistula causes extra pressure by increasing the blood flow into the vein, making it grow larger and stronger and providing easy access to the blood vessels.

84
Q

What is a Arteriovenous (AV) graft ?

A

synthetic tube implanted under the skin that connects between the artery and the vein
- providing needly placement access for hemodialysis

85
Q

Why is a AV fistula the “gold standard” ?

A
  • less likely to clot
  • reduces infection risk
  • lasts longer
  • need to palpate for a thrill and listen for a bruit at the site
86
Q

What are some risk factors of AV fistulas ?

A

can cause distal ischemia (no perfusion to peripheral body parts) and aneurysms
- can lead to tissue death, loss of function or loss of limb
- S&S: pain distal to access site, numbness or tingling of fingers, poor capillary refill

87
Q

Why don’t we want to put pressure on AV fistulas or grafts ?

A

can cause it to clot
- no BP, IV lines, or venipunctures on that arm

88
Q

Where is a temporary vascular access port for hemodialysis usually ?

A

internal jugular or femoral vein
- double lumen
- for blood removal and return
- risks: high infection, dislodgement, and malfunction

89
Q

Why do regular RN’s not mess with the dialysis catheters ?

A
  • only for Dialysis RN’s
  • in these catheter’s they put large amounts of heparin after hemodialysis to prevent clotting
  • if you were to flush this catheter then all this Heparin enters their body and it can cause bleeding
  • Dialysis RN’s pull the Heparin out before they use the lumen’s
90
Q

In what direction does dialysate flow in hemodialysis ?

A

in the opposite direction of the blood

91
Q

How is Hemodialysis done ?

A

2 needles placed into fistula or graft
- 1 needle is closer to fistula or red cath lumen pulls blood from pt
- it’s moved through the dialyzer by a blood pump (Heparin is infused as a bolus to prevent clotting)
- dialysate is pumped in and flows in the opposite direction of the blood
- the dialyzed blood is returned to the pt through a 2nd needle or blue cath
- old dialysate is drained and discarded
- needles removed and light pressure

92
Q

Once they come back from hemodialysis, what is the most important vital sign ?

A

Blood pressure
- take lots of fluid from body and want to ensure they didn’t take too much

93
Q

What are some complications from hemodialysis ?

A
  • Hypotension: result from rapid removal of vascular volume (hypovolemia), decreased cardiac output, and decreased systemic intravascular resistance
  • Muscle Cramps: associated with hypotension, hypovolemia, high ultrafiltration rate, and low sodium dialysis solution
  • Blood Loss: blood not being completely rinsed from the dialyzer with saline, accidental separation of blood tubing, dialysis membrane rupture or bleeding after the removal of needles at the end of dialysis

Med-Surg (16 decks)

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