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Adult III > Exam 2- Renal > Flashcards

Exam 2- Renal Flashcards

1
Q

Azotemia

A

Retention of metabolic waste (BUN/CREATININE)

May be reversible

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2
Q

Uremia

A

TOXIC accumulation of metabolic wastes leading to multi-system alterations
-urea, creatinine, uric acid, and other wastes

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3
Q

Acute Renal Failure

A

rapid decline in renal function resulting in accumulation of BUN, Creatinine, fluid & electrolyte imbalances and acid-base disturbances.
-may rapidly present as a life-threatening situation but is potentially reversible

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4
Q

Oliguria

A

Urinary output < 400-500ml/24hrs

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5
Q

Anuria

A

Urinary output <100mL/24hrs

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6
Q

GFR

A

Normal = 80-125mL/min

Producing 180L of filtrate/day when map >80-90

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7
Q

Prostaglandins - Blood pressure regulation

A

Cause:

  • vasodilation
  • Increase renal blood flow
  • Promote Na+ excretion
  • Decrease BP by decreasing SVR (dilate)
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8
Q

ADH - Blood pressure regulation

A

required for water reabsorption.

-stimulated by elevated serum osmolarity and decreased blood volume

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9
Q

Aldosterone

A

.

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10
Q

Renin

A

Released in response to decreased arterial pressure, renal ischemia, low serum Na+

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11
Q

Prerenal azotemia

A
  • RENAL HYPOPERFUSION, usually with ATN
  • fluid volume losses, SHOCK/hemorrhage, 3rd spacing from burns, diuretics
  • systemic vasodialtion, SEPSIS
  • Decrease CO
  • Renal vascular disorders

BUN/Creatine ratio > 20:1
Urine Na+ < 20mEq/L
Elevated Specific gravity, normal sediment or hyaline/granular casts

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12
Q

Intrinsic (Intrarenal) Renal Disease

A

-Usually GLOMERULAR DISEASE
-Direct damage to the kidneys by:
Reduced blood supply/ischemic injury;
**ACUTE TUBULAR NECROSIS (ATN)- MOST COMMON
Inflammation, glomerulonephritis
Toxins
Drugs
Infection (pancreatitis, peritonitis, gram (-) sepsis)
Rhabdomyolysis

BUN/Creatinine ration 10:1
Urinary Na+ > 20mEq/L
Low specific gravity, RBC casts & cellular debris in urine

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13
Q

Drugs that cause Nephrotoxic Injury

A
  • Antibiotics (Gentamycin)
  • Antineoplastics
  • Diuretics
  • NSAIDS
  • Contrast Agents/dyes
  • Heavy metals
  • Organic Solvents (carbon tetrachloride)
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14
Q

Postrenal azotemia

A

-OBSTRUCTION
Sudden obstruction of urine flow d/t:
enlarged prostate, kidney stones, bladder tumor, or injury

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15
Q

Rhabdomyolysis (myoglobin)

A 
Is the breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) into the bloodstream and the kidneys filter it out of the body. The myoglobin breaks down into potentially harmful compounds that may block the structures of the kidney causing damage such as ATN or Kidney failure. 
 Caused by:
-Trauma
-Seizures
-Exertion (marathon running)
-"Long lie down"

*INTRARENAL

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16
Q

Acute Tubular Necrosis

A

.

17
Q

ATN - Initial/Onset Phase

A
  • From insult to cell injury
  • Lasts hours to 2 days
  • May be reversed w/aggressive care: prevent hypotension, keep hydrated
18
Q

ATN- Oliguric/Anuric Phase

A

Decreased U/O <400mL/day leads to FVE

  • Lasts 1-2 weeks
  • Decreased GFR:
    • Hyperkalemia
    • Hypocalcemia & Hyperphosphatemia
    • Metabolic acidosis
    • Accumulation of BUN, Creatinine
  • Infection Risk
19
Q

ATN - Diuretic Phase

A

Lasts 1-3 weeks

  • Gradual increase in U/O, up to 5L/day
  • Hyponatremia, Hypovolemia
  • Hypokalemia
  • Osmotic diuresis from high urea
  • Tubules lack ability to concentrate urine
  • Begin to excrete wastes; BUN & Cr
20
Q

ATN - Recovery Phase

A

Lasts 6 months to a year

  • Slow return of renal function
  • Chronic renal insufficiency may remain
21
Q

What to watch for with Dialysis

A

Hypovolemia and hypotension

22
Q

Assessment of ARF - ONSET

A
  • Oliguria
  • Aztoemia
  • HyperKalemia
  • Metabolic Acidosis
23
Q

Assessment of ARF - CARDIAC

A
  • Fluid overload (CHF)
  • HTN w/FVE
  • Hypotension w/diuresis
  • Peripheral, periorbital and sacral edema
  • Pericarditis
  • Arrhythmias
24
Q

Assessment of ARF - HEMATOLOGIC

A
  • Anemia

- Bleeding disorders (bruise easily)

25
Q

Assessment of ARF - Respiratory

A
  • Pulmonary edema
  • Pleural effusions
  • Kussmaul’s respirations
  • Respiratory Alkalosis
26
Q

Assessment of ARF - GI

A
  • N/V/A
  • Diarrhea, constipation
  • Stomatitis
  • Uremic halitosis
  • Gastritis
  • GI bleeds
27
Q

Assessment of ARF - Neuromuscular

A
  • Lethargy
  • Asterixis (flapping hands, Inc.’d ammonia)
  • Chvosteks sign = +
  • Trousseau’s sign = +
  • Tremors, twitching, parasthesias
  • Confusion, memory deficits
  • Watch for seizures
28
Q

Chvostek’s Sign

A

Tap on cheek and observe for facial twitch, twitch = (+) sign, indicating the pt has hypocalcemia

29
Q

Trousseau’s Sign

A

Inflate BP cuff and watch for carpal spasm, spasm = (+) sign, indicating hypocalcemia

30
Q

Assessment of ARF - SKIN

A
  • Pallor
  • Jaundice
  • Dry, itchy skin
  • Bruising
31
Q

Best measure of renal function

A

Creatinine Clearance: estimates GFR

Adult III (14 decks)

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