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MS2 Exam 1 > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

CRF

A

chronic renal failure

  • slow
  • progressive
  • irreversible loss in kidney function
  • GFR = 60 mL/min for 3 months or longer
  • occurs in stages
  • results in uremia or end-stage renal disease
  • hypervolemia (kidneys unable to excrete Na+ and H20)
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2
Q

Progression of Chronic Kidney Disease (CKD)

A

Stage 1: at risk, normal kidney function, GFR >90mL/min

Stage 2: mild CKD, GFR 60-89 mL/min

Stage 3: moderate CKD, GFR 30-59 mL/min

Stage 4: Severe CKD, GFR 15-29 mL/min

Stage 5: ESKD, GFR

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3
Q

CKD Causes

A
  • AKI
  • DM and other metabolic disorders
  • chronic HTN
  • chronic urinary obstruction
  • recurrent infections
  • renal artery occlusion
  • autoimmune disorders
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4
Q

Activity Intolerance

A
  • fatigue results from anemia and buildup of wastes from diseased kidneys
  • provide adequate rest periods
  • teach client to plan activities
  • admin mild CNS depressants as prescribed to promote rest
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5
Q

Anemia

A

Decreased secretion of erythropoietin by damaged nephrons leading to decreased production of RBC’s

-Monitor for decreased HgB and HCT

-Administer:
epoetin alfa, folic acid (vit b9), iron orally, stool softeners, blood transfusions

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6
Q

GI bleeding

A
  • urea broken down by intestinal bacteria leading to ammonia leading to irriated GI mucosa leading to ulceration leading to bleeding
  • monitor HgB and HCT, stool for occult blood
  • avoid ASA
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7
Q

What to monitor for Hyperkalemia

A
  • BP
  • apical HR
  • serum K+ level
  • continuous cardiac monitoring is highly recommended
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8
Q

What to Administer for Hyperkalemia

A
  • electrolyte binding and electrolyte excreting meds (Kayexalate)
  • 50% dextrose and insulin
  • Calcium gluconate
  • NaHCO3
  • loop diuretics
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9
Q

What to avoid with Hyperkalemia

A
  • High K+ foods

- K+ sparing meds

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10
Q

What would you potentially need to prepare the patient for with Hyperkalema

A

-peritoneal or hemodialysis

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11
Q

Hypermagnesemia Causes

A

Mg is Regulated by the kidneys and necessary for cardiac function

caused by renal patients receiving magnesium supplements

decreased renal excretion of magnesium

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12
Q

Hypermagnesemia clinical manifestations

A
  • depresses CNS

- cardiac dysrhythmias (PVC’s and VF)

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13
Q

What to administer for hypermagnesemia

A
  • loop diuretics

- calcium

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14
Q

What to avoid with hypermagnesemia

A
  • antacids
  • laxatives
  • enemas
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15
Q

Phosphate

A
  • major role in nerve, RBC, and muscle function
  • maintains acid base balance
  • kidneys excrete phosphate
  • inverse relationship with calcium
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16
Q

Phosphate has an inverse relationship with…

A

Calcium

17
Q

Hyperphosphatemia causes

A

chronic renal failure and/pr excessive Vit D intake

18
Q

Hyperphosphatemia Effects

A
  • decreased serum calcium levels

- Tetany

19
Q

Increased phosphorus levels leads to….

A

decreased Ca+ levels which leads to stimulation of parathyroid hormone with leads to bone demineralization

20
Q

What to administer with Hyperphosphatemia

A
  • TUMS (phosphate binders)
  • calcium acetate (PhosLo)
  • Sevelamer (Renagel) with meals
  • Stool softeners because phosphate binders are constipating
21
Q

What to avoid with Hyperphosphatemia

A

-aluminum hydroxide preps

22
Q

Hypocalcemia causes

A
  • CRF
  • vit D deficiency
  • loop diuretics (Lasix)
  • increased phosphate levels
23
Q

Hypocalcemia effects

A
  • stimulate PTH to release Ca+ from bone
  • Chovstek’s sign
  • Trousseau’s
  • Tetany/seizures
24
Q

What to administer for Hypocalemia

A

-calcium supplements and activated Vit D

25
Q

Metabolic Acidosis

A

-kidneys unable to excrete hydrogren ions

OR

-manufacture bicarb resulting in acidosis

26
Q

What to administer for Metabolic Acidosis

A

-NaHCO3 (alkalizers)

27
Q

CRF patients adjust to ….

A

low HCO3 levels and do not become acutely ill

28
Q

HTN

A
  • failure of kidneys to maintain BP homeostasis
  • Monitor BP
  • Maintain fluid and electrolyte restrictions as prescribed
29
Q

What to admin for HTN

A

-Admin diuretics and anti-hypertensives

30
Q

Neurological changes

A
  • confusion
  • impaired decision-making
  • peripheral neuropathy
  • restless leg syndrome
31
Q

Uremic Syndrome

A
  • accumulation of nitrogenous waste products in the blood
  • oliguria
  • protein, RBC’s, casts in urine
  • increased levels of urea, uric acid, K+ and Mg in urine
  • hypo/hyper tension
  • change in LOC
  • electrolyte imbalances
  • stomtitis, N/V
  • Diarrhea/Constipation

**Uremic Frost on face

32
Q

Primary Prevention of CRF

A
  • early detection and tx
  • monitor BP and detect elevations
  • proper dx and tx of diabetes
  • treat hypertension appropriately and aggressively

MS2 Exam 1 (13 decks)

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