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ARCHIVED: Assessment > Exam 2: Renal and Heme > Flashcards

Exam 2: Renal and Heme Flashcards

1
Q

Voluntary avoidance of these foods is a subtle sign of renal disease:

A

High protein

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2
Q

Voluntary avoidance of these foods is a subtle sign of renal disease:

A

High protein

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3
Q

Normal GFR:

A

125 ml/min

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4
Q

Blood flow to the kidney:

A

25% of CO

95% to cortex, 5% to medulla

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5
Q

Conditions requiring dialysis:

A 
GFR 10-15% of normal
Hyperkalemia
Fluid overload
Oliguria
Severe acidosis
Metabolic encephalopathy
Pericarditis
Coagulopathy
Refractory GI symptoms
Drug toxicity
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6
Q

Vessels used for AV fistula:

A

Cephalic vein

Radial artery

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7
Q

Pre-op timing of dialysis:

A

Day of or day before surgery

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8
Q

Expected weight drop post-dialysis:

A

2-4%

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9
Q

Post-dialysis serum K+ should be:

A
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10
Q

Drugs cleared by dialysis:

A

Low molecular weight
Water-soluble
Non-protein-bound

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11
Q

S/s of uremic encephalopathy:

A 
Asterixis
Myoclonus
Lethargy
Confusion
Seizures
Coma
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12
Q

Describe disequilibrium syndrome:

A

Transient CNS disturbance after rapid ↓ in ECF osmolarity (relative to ICF) due to dialysis
Dementia-like
Associated with rapid change from acidotic to alkalotic

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13
Q

Typical hgb in renal failure:

A

6-8 g/dL

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14
Q

Effect of renal failure on bones:

A

↓ VitD production leads to ↓ Ca++ absorption
↓ Ca++ leads to ↑ PTH
Bone marrow replaced with fibrous tissue
More prone to fracture

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15
Q

Factors causing rightward shift in renal failure pts:

A

Metabolic acidosis

↑ 2,3-DPG

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16
Q

Factors causing impaired platelet function in renal failure:

A

↓ platelet factor 3

↓ adhesiveness/aggregation

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17
Q

Normal GFR:

A

125 ml/min

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18
Q

Blood flow to the kidney:

A

25% of CO

95% to cortex, 5% to medulla

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19
Q

Conditions requiring dialysis:

A 
GFR 10-15% of normal
Hyperkalemia
Fluid overload
Oliguria
Severe acidosis
Metabolic encephalopathy
Pericarditis
Coagulopathy
Refractory GI symptoms
Drug toxicity
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20
Q

Vessels used for AV fistula:

A

Cephalic vein

Radial artery

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21
Q

Pre-op timing of dialysis:

A

Day of or day before surgery

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22
Q

Expected weight drop post-dialysis:

A

2-4%

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23
Q

Post-dialysis serum K+ should be:

A

K

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24
Q

Drugs cleared by dialysis:

A

Low molecular weight
Water-soluble
Non-protein-bound

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25
Q

S/s of uremic encephalopathy:

A 
Asterixis
Myoclonus
Lethargy
Confusion
Seizures
Coma
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26
Q

Describe disequilibrium syndrome:

A

Transient CNS disturbance after rapid ↓ in ECF osmolarity (relative to ICF) due to dialysis
Dementia-like
Associated with rapid change from acidotic to alkalotic

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27
Q

Typical hgb in renal failure:

A

6-8 g/dL

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28
Q

Effect of renal failure on bones:

A

↓ VitD production leads to ↓ Ca++ absorption
↓ Ca++ leads to ↑ PTH
Bone marrow replaced with fibrous tissue
More prone to fracture

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29
Q

Factors causing rightward shift in renal failure pts:

A

Metabolic acidosis

↑ 2,3-DPG

30
Q

Factors causing impaired platelet function in renal failure:

A

↓ platelet factor 3

↓ adhesiveness/aggregation

31
Q

Factors causing impaired platelet function in renal failure:

A

↓ platelet factor 3

↓ adhesiveness/aggregation

32
Q

Hematologic problems in renal failure:

A

Impaired platelets
Impaired WBC function
Defective vWF
Hypocomplementemia d/t dialysis

33
Q

CV changes in renal failure:

A 
↑ CO compensating for anemia
HTN --> Na+ retention, RAAS activation
LV hypertrophy
CHF w/ pulmonary edema when compensatory limits reached
Ca++ deposition into conduction system/valves
Arrthymias
Uremic pericarditis
Accelerated CAD/PVD
34
Q

Fluids to use in renal patients:

A

NO LR: K+ in it
NO D5: most are diabetic
Use NS - small bag - microdrip

35
Q

Pulmonary changes in renal failure:

A

Minute ventilation increased to compensate for metabolic acidosis
Interstitial edema –> widened alveolar/arterial O2 gradiant
Butterfly wings on CXR 2/2 inc capillary permeability

36
Q

Ventilatory considerations in renal failure:

A

Don’t use NO

Use 100% FiO2

37
Q

Endocrine changes in renal failure:

A

Insulin resistance/poor glucose tolerance
Hyperparathyroidism
Abnormal lipid metabolism/accelerated atherosclerosis
Increased circulating hormones/proteins

38
Q

GI/liver changes in renal failure:

A

GI hemorrhage (10-30%)
Anorexia
N/V
Hypersecretion of gastric acid, delayed emptying

39
Q

Anesthesia considerations with GI/liver changes:

A

RSI

Hold off on transfusions unless critical to minimize antigens (transplant potential)

40
Q

Examples of drugs contraindicated in renal failure:

A

Gallamine
Phenobarbital
LMWH
Succinylcholine

41
Q

NMB of choice in renal failure:

A

High dose roc; give it 60-90 seconds

42
Q

Lab tests for patients in renal failure:

A 
Chemistry panel
Osmolarity
BUN/Cr + GFR
Creatinine clearance (24 hr)
Urine SG/osmo
43
Q

Normal BUN:

A

10-20 mg/dL

44
Q

BUN indicative of ↓ GFR:

A

50 mg/dL+

45
Q

Non-renal causes of abnormal BUN:

A

High protein diet
GI bleed
Febrile illness

46
Q

Lag time between ∆ GFR and ↑ Cr:

A

8-17 hr

47
Q

Source of Cr:

A

Skeletal muscle

48
Q

Cr levels in elderly:

A

Tend to stay normal d/t ↓ muscle mass and GFR both

49
Q

Best indicator test for renal function:

A

24-hr creatinine clearance

50
Q

Interpreting CrCl:

A 
Normal 100-120 ml/min
↓ Renal Reserve 60-100 ml/min
Mild Renal Impairment 40-60 ml/min
Moderate Insufficiency 25-40 ml/min
Renal Failure
51
Q

Electrolyte derangements in renal failure:

A 
Hyponatremia 
Hyperkalemia 
Metabolic acidosis
Hypermagnesemia
Hypocalcemia 
Hypoalbuminemia 
Hyperglycemia
52
Q

Five treatments for hyperkalemia:

A 
Calcium gluconate 10%
Sodium bicarbonate
Glucose + insulin
Dialysis
Ion exchange resin
53
Q

Describe calcium gluconate for hyperkalemia:

A

Ca gluconate 10% 10-20ml IV
Antagonizes K+ effects on cardiac muscle
Immediate onset, brief duration
Avoid with digoxin

54
Q

Describe sodium bicarb for hyperkalemia:

A

50-100 mEq IV
Shifts K+ into cells
Prompt onset but short duration
Can cause Na+ overload

55
Q

Describe glucose + insulin for hyperkalemia:

A 
50ml of D50 + 10U regular insulin
Shifts K+ into cells
Prompt onset, 4-6 hr duration
Best option for urgent case!
Can cause glucose derangement
56
Q

Describe dialysis for hyperkalemia:

A

Removes K+ from body
Immediate effect
Need vascular access, though

57
Q

Describe ion exchange resins for hyperkalemia:

A

Removes K+ from body
Onset 1-2 hours
Can cause Na+ overload

58
Q

Normal Hct:

A

40-54% male

38-47% female

59
Q

Normal Hgb:

A

13.5-18 g/dL male

12-16 g/dL female

60
Q

Normal WBC:

A

5,000-10,000

61
Q

Transfusion indications for renal patients:

A

Hgb

62
Q

Normal plt:

A

150,000 - 400,000

63
Q

Regional anesthesia usually not done on renal patients due to:

A

Coagulopathies

Peripheral neuropathies

64
Q

Treatment for coagulopathy in the renal patient:

A

Desmopressin 0.3 - 0.4 mg/kg IV over 30 min

Cyro 10 units IV over 30 min

65
Q

CaO2 =

A

Hgb * 1.39 * SaO2 + (PaO2 * 0.003)

66
Q

Factors that increase oxyhemoglobin affinity:

A 
Alkalosis
↓ PCO2
↓ temperature
↓ 2,3-DPG
Carboxy-/methemoglobin
Abnormal hgb
67
Q

Factors that decrease oxyhemoglobin affinity:

A 
CADET, face right!
↑ CO2 
Acidosis
↑ 2,3-DPG
↑ temperature
68
Q

Major compensatory mechanism for anemia until

A

Increase in 2,3-DPG which causes a right shift and decreased affinity/increased O2 delivery

69
Q

Other compensation for anemia:

A 
↓ SVR
↑ HR/CO
↑ plasma volume
Redistribution of blood flow to organs with higher extraction ratio
↑ extraction ratio in vascular beds
70
Q

Anemia risk factors:

A 
GI bleeding
Heavy menses
Cancers (esp. bone)
Chronic infections
Nutritional deficiency
71
Q

Factors to consider in anemic patients when deciding what Hbg/Hct is acceptable:

A 
Duration of the anemia
Etiology
Fluid volume status
Urgency of surgery
Anticipated blood loss
Co-existing disease

ARCHIVED: Assessment (11 decks)

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