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Adult II > Exam 4- kidneys > Flashcards

Exam 4- kidneys Flashcards

1
Q

Normal BUN

A

10-30mg/dL

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2
Q

Elderly BUN

A

8-21mg/dL

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3
Q

Possible Renal damage BUN

A

greater than 25mg/dL

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4
Q

Normal creatinine level

A

0.6-1.5mg/dL

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5
Q

elderly creatinine levels

A

less than 0.6 possibly, decreased

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6
Q

early renal failure creatinine levels

A

1.5-2mg/dL`

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7
Q

moderate renal failure creatinine levels

A

2.1-6.5mg/dL

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8
Q

advances renal failure creatinine levels

A

6.6-12 mg/dL

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9
Q

end stage renal failure creatinine levels

A

greater than 12mg/dL

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10
Q

how does a creatinine clearance work

A

it is a 24 hour urine collection, discard first sale, save all urine and must have a current serum creatinine level during that 24 hour period

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11
Q

normal creatinine clearance for en and women

A

97-137 mL/min and 88-128 for women

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12
Q

a low creatinine clearance indicates

A

kidney disease

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13
Q

what are some conditions that cause impairment of renal perfusion

A

decreased CO, dehydration, shock

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14
Q

prerenal can lead to

A

intrarenal

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15
Q

what are some causes of infrarenal disease

A

polycystic kidney disease, neoplasms, ischemia

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16
Q

what are common nephrotoxic agents

A

radiologic contrast dye, ACE inhibitors (inhibits potassium), chemotherapeutic agents, NSAIDS, heavy metals, antibiotics

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17
Q

what are post renal causes

A

conditions that cause obstruction in the lower urinary tract such as prostatic hyperplasia, kidney stones, misplaced Foley catheter

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18
Q

T?F post renal are hard to reverse

A

false, as long as we catch them they are easy to reverse

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19
Q

what is rifle and what does it stand for

A

Risk, Injury, Failure, Loss, End-stage disease; used to describe and standardize the stages of AKI

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20
Q

what are the phases of AKI

A

Oliguric, diuretic, and recovery

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21
Q

what does the oliguric phase of AKI look like

A

less than 400mL per day, elevated Bun and creatinine, metabolic acidosis, hyperkalemia, hyponatreia, and hypocalcemia

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22
Q

T/F the oliguric phase may not appear for up to 7 days

A

true

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23
Q

what are manifestations of the oliguric phase?

A

– Mental disturbances, lethargy, coma
– Dry, itchy skin
– Fluid retention
– Nausea & vomiting
– Dysrhythmias
- edema in legs and anywhere dependent in their lungs

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24
Q

what are nursing implementations during the oliguric phase

A
  • Monitor status
  • Restrict fluids (calculate fluid replacement based on output + insensible loss)
  • Diuretic therapy
  • High calorie, low protein, low Na+, low K+ diet
  • Dialysis
  • Education/support/communication
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25
Q

fluid replacement therapy equation

A

all lost fluids from the day before plus 600L

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26
Q

diuretic phase Uo

A

1-3L per day, BUN and creatinine may still be elevated

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27
Q

what is the leading cause of death in AKI

A

infection

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28
Q

what are the indications for dialysis

A
  • Volume overload
  • Elevated potassium level with ECG changes
  • Metabolic acidosis
  • Significant change in mental status
  • Pericarditis, pericardial effusion, or cardiac tamponade.
  • Chronic Kidney Disease (CKD)
  • If potassium gets too high then they will go into cardiac arrest.
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29
Q

T/F chronic kidney disease is reversible

A

false

30
Q

what are primary renal diseases

A

Glomerulonephritis, Pyelonephritis, Polycystic kidney disease

31
Q

what systemic diseases cause CKD

A

DM#1, HTN#2, and lupus

32
Q

what are the stages of CKD

A
  • Stage 1: Kidney damage with normal or increased GFR (GFR > 90)
  • Stage 2: Kidney damage with mild decrease in GFR (GFR 60-89)
  • Stage 3: Moderate decrease (GFR 30-59)
  • Stage 4: Severe decrease (GFR 15-29)
  • Stage 5: End Stage Renal Disease (ESRD)
    (GFR <15= dialysis)
33
Q

what is renal insufficiency and what are the manifestations

A

the kidneys ability to concentrate urine is impaired and leads to polyuria, manifestations include
– Specific gravity of urine becomes fixed
– Mild azotemia
– Mild anemia

34
Q

what are manifestations of later stages of CKD

A
  • 90% nephron loss
  • Manifestations:
    – severe azotemia
    – acidosis
    – severe anemia- because they can’t tell the bone marrow to make RBC?
    – oliguria
    – electrolyte imbalances
  • Azotemia (Uremia)
  • Multisystem effect throughout the body
  • GFR <15mL/min
    – Fatigue, lethargy, and pruritus are symptoms associated with progression of kidney dysfunction.
    – Hypertension is both a cause and a consequence of CKD.
    – Hyperglycemia, hyperinsulinemia, dyslipidemia, & abnormal glucose tolerance
35
Q

what are the clinical manifestations of CKD

A
  • Electrolyte imbalances
  • Musculoskeletal changes
  • Metabolic changes
  • Cardiovascular changes
  • Hematological changes
  • GI changes
  • Neurological changes
  • Skin changes
  • Immunological changes
  • Psychosocial changes
36
Q

how do you treat hyperkalemia

A

give insulin and glucose at the same time to drive the potassium back into the cell, sodium bicarbonate, calcium gluconate, dialysis, kayexalate,
* Veltassa (patiromer) and Lokelma (sodium ziroconium cyclosilicate)- oral meds for NON- emergent hyperkalemia

37
Q

what are some nutritional therapies when not on dialysis for CKD patients?

A
  • Protein restriction 0.6-1.0 g.kg/day
  • Potassium restriction (monitor lab values)
  • Sodium restriction 1-3 g/day
  • Phosphate restriction 1.0-1.8 g/day
  • Calcium although not dairy D/T high levels of phosphorous
  • Low phosphorous diet
  • Phosphate binders take within 30 min of meal
38
Q

1 lb increase is approximately how much fluid

A

500mL

39
Q

if fluid retention becomes a problem reduce fluid intake by

A

100-1500mL/day

40
Q

what is a musculoskeletal change as a result of CKD

A

renal osetodystrophy- subtypes are osteomalacia and osteoporosis

41
Q

what are cardiovascular changes due to renal failure

A
  • HTN
  • Edema
  • Heart failure
  • Pulmonary edema
  • Pericarditis
  • Dysrhythmias–related to potassium imbalance
  • Twave shrinks and inverts, enlarged U waves, and prolonged Q-TU intervall
42
Q

what is the treatment for anemia related to CKD

A

epogen, folic acid, iron, PRBCs

43
Q

what are the hematological changes due to CKD

A

anemia anad bleedign tendencies such as epistaxis, GI bleeding, and bruising of the skin

44
Q

what GI changes come from CKD

A

anorexia, N/V, slaty or metallic taste in mouth, and ulceration and bleeding of GI mucosa

45
Q

what near changes result from CKD

A

uremic encephalopathy, decrease in alertness and awareness, late signs include delirium, coma, and seizures.
peripheral neuropathy
unsteady gar/asterixis

46
Q

what are metabolic changes with CKD

A

azotemia, metabolic acidosis, and adverse drug reaction

47
Q

skin changes with CKD

A

pruritus, pale or yellow appearance, brittle hair and nails, precipitate of urea crystals-late sign

48
Q

what is the treatment plan for someone with CKD

A

drug therapy to reduce the damaging effects of proteinuria and HTN, erythropoietin and iron replacement, statins, restrict dietary protein, once the patient starts dialysis protein is usually increased, water intake depends on the daily urine output

49
Q

what are the goals of dialysis

A

remove excess protein waste products, normalize electrolyte concentrations, and remove excess fluid from the body

50
Q

where is blood removed from a person during hemodialysis

A

the artery, then returned through a vein

51
Q

T/F dialysis si a lifelong commitment

A

true

52
Q

what is the most common way we gain vein access

A

AV fistula

53
Q

can you take BP in the arm with a fistula?

A

no

54
Q

what are some complications of hemodialysis

A
  • Hypotension- main problem so you often have to bump up the vasopressors
  • Muscle cramps
  • Blood loss
  • Hepatitis- don’t have to worry about this too much now
  • Sepsis
  • Disequilibrium Syndrome
55
Q

what is the treatment of disequilibrium syndrome

A

The treatment of disequilibrium after it has developed is aimed at reducing the intracranial pressure of the patient. Standard maneuvers are to give mannitol or hypertonic saline to raise the blood osmolality and to hyperventilate the patient

56
Q

T/F nurses may have standing orders to get NS or albumin to tolerate the CRRT

A

true

57
Q

what are the phases of peritoneal dialysis

A

inflow, dwell, drain

58
Q

what are some contraindications for CAPD

A
  • History of multiple abdominal surgeries or abdominal wall pathology
  • Recurrent hernias
  • Obesity
  • Chronic back problems
  • Severe COPD
  • Need a healthy peritoneal space so they may not get it If they have
59
Q

what are some complications of peritoneal dialysis

A
  • Infections (exit site or peritonitis)- most common. Most peritonitis cases can be treated on an out patient basis with antibiotics.
  • Abdominal pain
  • Outflow problems
  • Hernias
  • Lower back problems
  • Pulmonary complications
  • Bleeding
  • Metabolic complications
60
Q

what do you give for muscle cramps

A

Quinien Sulfate

61
Q

give___ 4X a day for __ for CAPD

A

antacids, phosphorus binding

62
Q

how often should you give epogen injections for dialysis patients

A

1-3 times a week

63
Q

can you use nsaids while on dialysis

A

no

64
Q

what kind of diet are you on for CAPD

A

high protein

65
Q

what are the contraindications for a kidney transplant

A
  • Disseminated malignancies
  • Refractory or untreated cardiac disease
  • Chronic respiratory failure
  • Extensive vascular disease
  • Chronic infection
  • Unresolved psychosocial disorders.
66
Q

what is required prior to kidney donation from a brain dead donor

A
  • Permission from the donor’s legal next of kin is required after brain death is determined even if the donor carried a signed donor card.
67
Q

what is the first priority after transplant

A

maintenance of fluid and electrolyte balance

68
Q

when does rejection of the kidney typically occur

A

within the first 6 months of transplant

69
Q

what kind of prophylactics do kidney recipients usually receive

A

antifungals

70
Q

what is one of the first manifestations of AKI

A

drop in urine output

Adult II (4 decks)

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