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Adult health II final > Exam 2: care of pts with renal disorders and acute and chronic kidney problems > Flashcards

Exam 2: care of pts with renal disorders and acute and chronic kidney problems Flashcards

1
Q

Polycystic kidney disease genetics

A

Inherited disorder: fluid-filled cysts develop in nephrons

  • Dominant
  • Recessive
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2
Q

Polycystic kidney disease interventions

A
  • Acute and chronic pain
  • Constipation
  • Infection
    antibiotics
  • Hypertension
    Ace inhibitors, CCB, Beta blockers
    Low sodium diet

Treatment for renal failure

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3
Q

Acute Kidney Injury: RIFLE classification criteria: Risk-

A
  • GFR Criteria: Increased creatinine x1.5 or GFR decrease > 25%
  • Urine output criteria: UO < 0.5 mL/kg/hr x 6hrs
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4
Q

Acute Kidney Injury: RIFLE classification criteria: Injury-

A
  • GFR criteria: Increased creatinine x2 or GFR decrease > 50%
  • Urine output criteria: UO < 0.5 mL/kg/hr x 12hrs
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5
Q

Acute Kidney Injury: RIFLE classification criteria: Failure-

A
  • GFR criteria: Increasedd creatinine x3 or GFR decrease > 75%
  • Urine output criteria: UO < 0.3 mL/kg/hr x 24hr or Anuria x 12hrs
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6
Q

Acute Kidney Injury: RIFLE classification criteria: Loss-

A

Persistent Acute renal failure = complete loss of kidney function > 4 weeks

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7
Q

Acute Kidney Injury: RIFLE classification criteria: End stage Kidney disease

A

> 3 months

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8
Q

Phases of Acute kidney injury: Prerenal-

A
  • Decrease in renal blood flow caused by decreased circulating volume secondary to dehydration, hypotension, decreased CO, embolism, sepsis.
  • Prolonged hypotension
  • Prolonged low cardiac output
  • Prolonged volume depletion
  • Renovascular thrombosis
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9
Q

Phases of Acute kidney injury: Intrarenal-

A
  • Due to disturbances within the glomerulus or renal tubules
  • Commonly called “Acute Tubular Necrosis”
  • Actual nephron damage with decreased glomerular filtration.
  • Kidney ischemia
  • Endogenous toxins
  • Exogenous toxins
  • Infection
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10
Q

Phases of Acute kidney injury: Postrenal

A

Obstruction to urinary outflow from kidneys

- caused by obstructions such as Stenosis, Renal Calculi, Prostate disease, Bladder Obstruction or Infection.

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11
Q

Prerenal management

A
  • Fluid bolus
  • Monitor
  • MAP
    Medication
  • Consult
  • Renal artery obstruction
  • Renal toxins
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12
Q

Intrarenal management

A
  • Fluid
  • Monitor
  • Dialysis
  • Assess
  • Medications
  • Care & Comfort
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13
Q

Postrenal management

A
  • Treat the cause

- Alleviate the obstruction

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14
Q

Chronic kidney injury: assessment/stages: Stage 1-

A
  • At risk, normal kidney fxn, some structural or genetic trait point to kidney disease
  • Estimated GFR: > 90 mL/min
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15
Q

Chronic kidney injury: assessment/stages: Stage 2-

A
  • Mild CKD, reduced GFR

- Estimated GFR: 60-89 mL/min

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16
Q

Chronic kidney injury: assessment/stages: Stage 3-

A
  • Moderate CKD

- Estimated GFR: 30-59 mL/min

17
Q

Chronic kidney injury: assessment/stages: Stage 4-

A
  • Severe CKD

- Estimated GFR: 15-29 mL/min

18
Q

Chronic kidney injury: assessment/stages: Stage 5-

A
  • End stage kidney disease

- Estimated GFR: < 15 mL/min

19
Q

Hemodialysis assessment

A
  • BUN > 90 mg/dl
  • Serum creatinine > 9 mg/dl
  • Hyperkalemia
  • Metabolic acidosis
  • Fluid overload (intravascular/extravascular)
  • Uremia
  • Pericarditis
  • GI bleeding
  • Mental changes
20
Q

Hemodialysis Nursing care

A
  • Collaborate with Dialysis nurse and MD regarding medications to be held during procedure
    AV access devices
  • Verify subclavian VAS cath access with x-ray
  • Monitor femoral access for excessive bleeding

AV access devices

  • Assess patency:
  • Palpate thrill
  • Auscultate bruit
  • Ensure hemostasis following needle withdrawal
  • Apply firm pressure after needle withdrawn
  • Monitor s/s infection
  • Avoid taking BP or IV sticks in arm with fistula
21
Q

Hemodialysis complications

A
  • Hypotension
  • Thrombus
  • Infection
  • Bleeding
  • Skin erosion
  • Vascular steal syndrome
  • Disequilibrium Syndrome
  • Hemodynamic Instability
  • Hepatitis
22
Q

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemofiltration (CVVH/CAVH)

A
  • Rate: 500-800 ml/hr

Fluid replacement
- Pre and postdilution (calculating an hourly net loss)

  • Method of solute removal: Convection

Indication
- Fluid removal, moderate solute removal

23
Q

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemodialysis (CVVHD/CAVHD)

A
  • Rate: 500-800 ml/hr

Fluid replacement
- Pre and Postdilution, (subtracting the dialysate & then calculating an hourly net loss)

Method of solute removal: Diffusion

Indication
- Fluid removal, maximum solute removal

24
Q

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemodiafiltration (CVVHDF)

A
  • Rate: 500-800 ml/hr

Fluid replacement
Pre and Postdilution, (subtracting the dialysate & then calculating an hourly net loss)

Method of solute removal: Convection & Diffusion

Indication:

  • Maximum fluid removal
  • Maximum solute removal
25
Q

Peritoneal Dialysis

A
  • Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate

Types:

  • Continuous ambulatory (CAPD)
  • Automated
  • Intermittent
  • Continuous-cycle

Adult health II final (14 decks)

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