[Exam 3] Show Me: Kidney Function Video Flashcards
Acronym to remember function of the kidney?
A Wet Bed
Function of Kidney: (A) Wet Bed
Acid/Base Balance
Function of Kidney: A (W)et Bed
Water Balance Regulation
Function of Kidney: A W(e)t Bed
Erythropoiesis
Function of Kidney: A We(t) Bed
Toxin removal
Function of Kidney: A Wet (B)ed
Blood Pressure Regulation
Function of Kidney: A Wet B(e)d
Electrolyte Balance
Function of Kidney: A Wet Be(d)
Vitamin D Activation
Function of Kidney: What does Acid-Balance refer to??
The Hydrogen Ion = Acid . Can excrete more Hydrogen to retain acid.
Can also excrete BiCarb, the buffer
Function of Kidney: How can you tell the fluid status of a renal patient?
By their weight. 1lb of fluid = 500 ml.
Function of Kidney: What is Erythropoiesis?
Red blood cell production. EPO release. Need this for RBC production
Function of Kidney: Patients that have chronic kidney problems have low what
red blood cell production so they have low hgb/hct
Function of Kidney: How does anemia affect body?
They will be fatigued, have lower oxygen levels. Very important to keep in mind bc of reduced rbcs.
Function of Kidney: How does toxin removal work?
Waste is eliminated through urea formation. Also urine formation.
Function of Kidney: What are the three steps of urine formation?
Kidney filters blood
Reabsorbs
And then secretes Urea.
Function of Kidney: How does the system regulate blood pressure?
Through the RAAS System.
Function of Kidney: How does the RAAS system work?
Activated when kidneys are not perfused. Causes the cascade to occur.
Function of Kidney: What electrolyte imbalance do kidney patients run into?
Hyperkalemia (3.5-5).
Function of Kidney: What does Vitamin D help with?
This is needed for calcium absorption. Without it, kidney patients are at big risk for injury, particularly like osteoporosis.
Renal Labs: What does the Serum test consist of?
Through blood draw. Includes:
Creatinine
BUN
GFR
24 Urine
Renal Labs: Normal Creatinine Level?
0.6 - 1.2
Renal Labs: What is Creatinine?
End product of muscle energy metabolism. Measures the effectiveness of renal function.
Renal Labs: Normal BUN level?
7-18
Renal Labs: What is BUN?
THe urea end product of protein metabolism.
Renal Labs: Normal GFR range?
> 125
Renal Labs: What is GFR?
Glomerular Filtration Rate
Renal Labs: What happens when GFR decreases?
You see the progression of chronic kidney disease
Renal Labs: What happens when you get to GFR > 90.
Start to see Stage I kidney disease.
Renal Labs: How long does a 24 hour urine last?
24 hours
Renal Labs: How does a 24 hour urine test work?
DEtects and evaluates the progression of renal disease.
Renal Labs: What consideration must be made for 24 hour urine test?
It must be protected from light, so it must go in a brown or orange jug
Also needs to be on ice, so bacteria doesn’t grow.
Renal Labs: What problem may occur with a 24 hour urine test?
Nursing may forget and dump the void on accident. The whole process then has to start over.
Renal Labs: How to make sure no problems result with 24 hour urine test?
Mark off the toilet, and make sure its in their chart
Renal Labs: What is oliguria?
0.5 mL/kg/hr.
Renal Labs: What is anuria?
< 50 mL / day
Renal Labs: What happens to urine production once they are in end stage kidney disease?
They are in anuria, and are now making 50 mL/day.
Renal Labs: How much urine should a patient produce per hour
30 Ml /hour
Renal Labs: Percentage of kidney function in stage 1?
> 90%. Kidney damage normal function
Renal Labs: Percentage of kidney function in stage 2?
89-60%. Kidney damage mild loss of function
Renal Labs: Percentage of kidney function in stage 3?
59-30%. Moderate to severe loss of function
Renal Labs: Percentage of kidney function in stage 4?
29-15%
Severe loss of function
Renal Labs: Percentage of kidney function in stage 5?
< 15%.
Kidney failure, need treatment to live
Chronic Kidney Disease: What is the definition for this?
Chronic kidney disease where there has been a decline in function that has been going on for at least 3 months.
Chronic Kidney Disease: How is the kidney in stage 5?
Not working, will need to go on dialysis.
Chronic Kidney Disease: What can cause this?
Glomerular Disease
Nephrosclerosis (Hardening of walls of the small arteries and arterioles)
Chronic Kidney Disease: How will this be monitored?
With labs
Chronic Kidney Disease: What changes will we see in the patient as this progresses?
Increased Creatine levels
Patients will begin to retain fluid
Chronic Kidney Disease: What acid-base imabalnce will they be in?
Metabolic Acidosis, because they lost the ability to manage the acid-base balance
Chronic Kidney Disease: What metabolic imabalance do COPD patients live in?
Respiratory Acidosis
End Stage Kidney Disease -> Dialysis: How if the patients GFR in stage 5?
< 15
End Stage Kidney Disease -> Dialysis: At what level GFR do patients start dialysis?
When GFR is less than 15
End Stage Kidney Disease -> Dialysis: What are the different types?
Hemodialysis
End Stage Kidney Disease -> Dialysis: What is Hemodialysis
They need to have access to run this. Can include permacath or a permanent access
End Stage Kidney Disease -> Dialysis: What is a permacath
Can be tunneled, or permanently tunneled in chest.
End Stage Kidney Disease -> Dialysis: What is a permanent access that is placed for hemodialysis?
This is either a fistula or a graft.
End Stage Kidney Disease -> Dialysis: How does the fistula work?
They take an artery and a vein and combine them. Wait for them to future. By putting them together, the vein becomes bigger.
End Stage Kidney Disease -> HemoDialysis: Why does the vein become bigger over time?
Become the machines have to run at a high rate
End Stage Kidney Disease -> HemoDialysis: What is a Synthetic Vascular Graft?
They have a synthetic piece of tubing connecting the artery and vein.
End Stage Kidney Disease -> HemoDialysis: What is the important thing to keep in mind when using fistula or graft?
You have to assess them for a thrill and bruit.
End Stage Kidney Disease -> HemoDialysis: What is a thrill?
You have to feel for a thrill. Will feel the vibration, will be pulsating
End Stage Kidney Disease -> HemoDialysis: What is a Bruit?
You have to listen for this. Turbulent blood flow
End Stage Kidney Disease -> HemoDialysis: What happens if they don’t have thrill or bruit?
Notify physician immediately because patient will not be able to run on dialysis
End Stage Kidney Disease -> Hemodialysis: What nursing intervention and precaution must you take for this patient?
There can be no peripheral sticks in that extremity. No blood draws, IVs, or blood pressure.
End Stage Kidney Disease -> Hemodialysis: Why should you not take blood pressure on the affected extremity?
It will damage the fistula or graft
End Stage Kidney Disease -> Hemodialysis: How does Dialysis work?
Removed blood for cleaning -> Blood Pump with Anticoagulant -> Dialysis Machine -> Airtrap and Air Director -> Clean blood infused
End Stage Kidney Disease -> Hemodialysis: What type is usually seen in a patient?
Permacath or a Graft. The problem with fistula is that they take a few weeks to fully form and mature. They may also have bad vascular access.
End Stage Kidney Disease -> Hemodialysis: What occurs inside of the dialysis machine?
Diffusion and Osmosis takes plce here. Toxins removed. Extra fluid removed. It is basically an artificial kidney
End Stage Kidney Disease -> Peritoneal Dialysis: What is this?
Good option for patients that don’t want to do hemodialysis. Can do this at home.
End Stage Kidney Disease -> Peritoneal Dialysis: What was the older school method before cycler was developed?
Simply drain solution into peritoneal cavity. That dwells within cavity and then pulls out extra fluid and toxinx. And then drained through drainage bag.
End Stage Kidney Disease -> Peritoneal Dialysis: What should be seen within drainage bag?
White to straw like color. DOn’t want to see cloudy because they indicates infection. Don’t want to see brown because that indicates that catheter may have possibly punctured bowel..
End Stage Kidney Disease -> Peritoneal Dialysis: Where is the catheter placed?
Within the peritoneal cavity and that stays there permanently after placement.
End Stage Kidney Disease -> Peritoneal Dialysis: WHat happens when patients choose to do their dwelling?
Solution bag is hooked up and hung down so that it can drain.
End Stage Kidney Disease -> Peritoneal Dialysis: How does this work in simple terms?
They fill, dwell, and drain sequence for those patients.
End Stage Kidney Disease -> Peritoneal Dialysis: Where is the dialysis bag and drainage bag placed?
Dialysis is hung up high so it can drain into peritoneum
Drainage bag is hung low so fluid can flow out. Is effluent because its mixed with toxins and fluid
End Stage Kidney Disease -> Peritoneal Dialysis: How to tell when they are done?
Patient will notify nurse and then nurse will disconnect. Nurse will be notified when they are ready to be hooked up again.
End Stage Kidney Disease -> Peritoneal Dialysis: What is the method seen now?
The cycler. Patients hook themselves up to this at night and it cycles all night.
AKI: What is this?
There has been injury to kidney. And acute. There is a rapid loss of renal function due to damage to kidneys
AKI: What was this called before?
Acute renal failure
AKI: What changes occur in the body because of this?
Metabolic Acidosis
Fluid/Electrolyte Imbalance
AKI: This process is usually related to what?
A specific cause
AKI: What are the three main types of causes?
Pre-Renal
Intra
Post
AKI: What does Pre-Renal refer to?
Anything that is impairing blood flow getting ot the kidney. HEart cannot get blood flow down to the kidney
AKI: What can cause blood flow to not get to kidneys?
Patient can be hypotensive, volume depleted (hypovolemic, dehydrated), shock, sepsis, impaired cardiac function.
Something is going on within heart/body.
AKI: What happens in the body when the kidneys are dehydrated?
The kidneys aren’t getting the blood that they need. That is what cuases this injury
AKI: What does Intra-Renal refer to?
Damage to the glomeruli or kidney tubules within the nephron of the kidney. Happening inter-renally.
AKI: What medications can cause problems to the kidney?
Antibiotics, aminoglycosides, NSAIDSs .
AKI: What other problems can cause intra-renal problems?
Infections, Crush Injury because myoglobulins get released
AKI: Example of crush injury?
Arm got caught in a press. Have brutal injury to arm but muscle release the myoglobulin enzyme which goes to the kidney and plugs in the renal .
AKI: What diagnostic exam can occur in hospital that can cause this?
CT with contrast. Contrast is a really big nephrotoxic agent. Can cause neuropathy.
AKI: What can we do as nurses during intra-renal stage?
Make sure we hydrate them to help them buffer kidneys like bicarb.
AKI: Patient at risk during intra-renal when creatinine is at what level?
2
AKI: What occurs during Post-Renal AKI?
This pertains to anything that happens after kidneys.
AKI: What problems does Post-Renal occur?
Kidney stone past kidney that blocks urine flow. Have back flow into kdiney
BPH, causing black flow
UTI, patient may not be able to empty bladder
AKI: In simple terms, what is happening in post-renal
there is an obstruction that is causing pressure on the kidney and decreases GFR.
AKI: How many phases are there for this
4
AKI: What occurs in the first phase?
Initiation - The initial assault
AKI: What is the second phase
Oliguria period. Urine starts to drop. 0.5mL/kg per hour. Kidney starts to lose some of function
AKI: What serum changes occur in second phase
Serum Creatinine increased
BUN Increased
Potassium increased
Electrolyte Imbalance and hold onto toxins.
AKI: What changes will we see on tele for high potassium?
Peaked T waves ,
AKI: What should we be doing during second phase?
Treat whatever is causing this. If hypotensive, give fluids. If on antibiotics, take antibiotic away.
If post-renal cause like UTI, antibiotic to treat UTI
AKI: What occurs in the third phase?
Diuresis. We start to have gradual increase in urine output. GFR recovers, potassium starts to go to normal,
Patient is starting to correct
AKI: What must we do during third phase?
Monitor this patient closely.
AKI: During third phase, how do we treat high potassium?
Can give Kayexalate . Can be given orally or rectally.
AKI: How does Kayexalate work>
Reduces the content of potassium. Basically binds to stool and patients poop it out.
AKI: At what level could you give kayexalate ?
When potassium is at like 5.7, 5.8. Not showing EKG changes yet and can give this to lower it.
AKI: What to do with Potassium is at 6.5 and they are starting to have PVCs, dysrhythmias
You will give them insulin. It will push potassium back into cell and lowers the potassium level within body.
AKI: What must you give with insulin?
D50 as well. This is so you don’t bottom the patients blood sugar.
AKI: What occurs in the fourth phase?
Recovery phase, patient is recovering.
Lab values returned to normal
AKI: How long may fourth phase take?
3-12 months to recover. And they may still have a little drop in their GFR.
ESKD - Meds, Hemodialysis: How will there lab values be the day of dialysis?
Worse than what is was the day before. Typically dialyzes 3x per week
ESKD - Meds, Hemodialysis: What levels will you see on the day of dialysis?
Elevated Potassium, BUN, Creatine, and Phosphorus
ESKD - Meds, Hemodialysis: Why would Phosphorus be elevated?
They are opposite of Calcium. As phosphorus goes up, calcium goes down.
ESKD - Meds, Hemodialysis: What will be done since phosphorus is elevaed?
Will be given phosphorus and calcium binders. One being PhosLo.
ESKD - Meds, Hemodialysis: When is PhosLo given?
With a meal. Allows medication to be most effective.
ESKD - Meds, Hemodialysis: Why are calcium supplements given?
Like tums, it will bring calcium levels up and phosphorus levels down.
ESKD - Meds, Hemodialysis: What is Renvela?
This is used to prevent hypocalcemia that has been caused by high phsophorus levels. Gets phorphorus levels down.
ESKD - Meds, Hemodialysis: What is important to know with phosphorus binders?
They must be given with meals.
ESKD - Meds, Hemodialysis: Why may EPO be given??
TO help stimulate RBC production.
ESKD - Diet - Hemodialysis: What type of diet will they be on?
Low protein diet because protein is hard for the kidneys to process.
ESKD - Diet: What type of protein can they can?
High biologic protein. Like dairy, meat, because that’s what necessary for nutrition.
ESKD - Diet: How can we monitor their nutiriton status?
By their albumin level
ESKD - Diet: What is a normal albumin level?
3.5 - 5
ESKD - Diet: What does it mean if albumin is in the 2’s
?
Patient is not geting enough protein
ESKD - Diet - PD: What do these patients lose a lot of?
Protein
ESKD - Diet - PD: What will their diet consist of?
Higher protein diet. They don’t have same restriction as hemodialysis patient
ESKD - Diet - PD: What should you educate on?
Fluid they can take in.
ESKD - Diet - PD: How much fluid can these patients take in?
They can take 500-600 more mLs in per day + what their previous urine output was.
ESKD - Diet - PD: What is the patient had 100 mL of output yesterday, how much fluid would they take in today?
They can have 700 mL of fluid to drink.
Nursing Diagnosis: Decrease RBC production leads to what
Fatigue
Nursing Diagnosis: As toxins build up, this leads to what
AMS
Nursing Diagnosis: RF would include what?
Electrolyte imbalance.
