CCRN: Renal Flashcards
acute renal failure or chronic renal failure has a higher mortality rate?
acute renal failure - (40%)… acute is secondary to something else… ex. sepsis, mi
whats the best dialysis schedule for someone in acute renal failure?
daily
whats the primary etiology of hyperphosphatemia?
renal failure
whats the relationship between calcium and phosphate?
inverse
bradycardia, tremors, and twitching muscles are associated with which electrolyte disorder?
hyperkalemia!!
treatment for hypercalcemia
fluids and diuretics… flush the calcium out of the kidneys because it could block them.
use for amphogel?
decreases high phosphate
hyponatremia is usually associate with…?
fluid overload
what can cause hypernatremia?
too much normal saline, diuretics, dehydration
best diagnostic test to eval renal trauma?
CT…. evaluates outside of kidney
which of the following would NOT cause renal failure? sepsis, shock, hypertension, bladder tumor
hypertension
causes of pre-renal failure?
low cardiac output, shock, renal artery stenosis…… a decrease flow to kidneys ->decrease pressure in renal artery->decrease filtration-> decrease GFR.. kidney response is vasoconstriction… end result is ischemic damage to kidney
intra-renal failure is caused by…
glomerulonephritis, antibiotics, myoglobinemia, diabetes…. damaged filter
which type of renal failure is caused by damage to filter (glomerulus)?
intra-renal kidney failure
post-renal failure
complete obstruction in urine flow
causes of post-renal failure?
bladder cancer, BPH, urethral calculi, urethral stricture, neurogenic bladder
during diuretic phase what happens to electrolytes?
dumps K and Na… but not filtering waste products so still might need dialysis
when you have diabetes and hypertension, you are at risk for 10x the risk of what?
renal failure
acute renal patients dont use peritoneal dialysis because….
if we infect the peritoneal membrane, it will be lost and we wont be able to use it later on if he becomes a chronic renal failure patient
hollow organs fair better in trauma than solid organs. T or F
True
best diagnostic test for kidney trauma
CT scan
what happens in diabetic ketoacidosis?
nsulin insufficient - leaves too much glucose in blood…pH acidotic so it takes potassium out of cell and into the blood and d/t concentration of K+ and glucose, body diureses - - lose your potassium storage - always check potassium after correcting sugar in DKA patient
too much potassium and you will see…
bradycardia, tremors/twitching, n/v, EKG changes (increased potassium supresses SA node)
why give Ca++ along with HCO3?
when moving towards alkalosis, potassium goes back into cell and can stimulate the heart… Ca++ stabilizes the heart
what to look for in hyperkalemia?
bradycardia, tremors/twitching/ n/v, peaked t-waves, shortened ST-segment, falttened P-wave, Long PR interval, blocks, PVC, Ventr. arryhthmias
Digoxin and low potassium can cause what?
Dig. Toxicity
when Calcium comes out of bone… it splits in half and does what?
half binds to albumin, and the other half is free ionized calcium
with Hypercalcemia, look at …
central nervous system (coma), peripheral nervous system (flaccid muscles), heart (EKG changes: short ST, short QT, steep drop off of T-Wave, anorexia, n/v, ARF…. treat with fluids and lasix and phosphate
causes of hypercalcemia…
hyperparathyroidism, paget’s disease, excessive vitamin D
Chvostek’s sign (hypocalcemia)
tap the facial nerve just below the temple and a twitch of the lip or nose is a positive sign
Trousseau’s sign (hypocalcemia)
contraction of the hand or fingers when arterial flow is occluded for 5 mins
causes of hypocalcemia…
malabsorption, acute pancreatitis, renal failure, vit. D deficiency, hypoparathyroidism
signs of hypocalcemia…
hypotension, hyperactive reflexes, trousseau’s sign, chvostek’s sign, laryngeal spasm, seizures/muscle cramps, EKG changes: prolonged QT, flat ST, small T-wave
relationship between pH and ionized calcium
inverse
magnesium is needed to help absorb other electrolytes so give it first if you have to choose replacements. T or F
true
calcium causes the heart and the vasculature to do what?
contract
magnesium allows the heart and vasculature to do what?
relax and vasodialate
hypomagnesium occurs with what conditions?
CRF, pancreatitis, hepatic cirrhosis, GI losses, alcoholism, treatment of DKA
magnesium and insulin sensitivity
hypomagnesium decreases insulin sensitivity… in DKA, insulin will lower magnesium levels causing hypomag.
hypomagnesium symptoms….
increased relfexes, +chvosteks, +trouseaus, tachycardia, EKG changes: PR & QT prolongation, widened QRS, ST depression, T-wave inversion, decreased levels of K+,Ca++, PO4 d/t absorption related to hypomag.
Phosphorus is extremely important for the…
respiratory system (ATP used up by the lungs then builds up lactic acid.
only concern with hyperphosphatemia is…
the inverse relationship with Ca++.
sometimes you will see Diabetes Insipidus in patients with…
head traumas because it can effect the hypothalamus where ADH (Anti-Diuretic Hormone) is released, or tumor or infection
severe hyponatremia (Na<110) symptoms
coma, seizures, death, replace with hypertonic 3% or NS, do not increase serum Na+ by more than 1 mEq/L/h or 10 a day.
free water deficit formula…
(kg. wt. x 0.6) x [(Na/140) - 1]
serum osmolality formula…
2 x Na + Glu/18 + BUN/ 2.8
