Fluids and Electrolytes Flashcards
Renin
Regulates BP by controlling blood volume
Erythropoietin
Stimulates RBC production
Normal glomerular filtration rate (GFR)
90-120
Normal urine output
0.5-1 ml/kg/hr
Oliguria
<400 ml/24 hr
Anuria
<200 ml - no output/24 hr
Polyuria
Excessive output
Azotemia/uremia
Accumulation of nitrogenous wastes
Causes of AKI (3)
- Reduced perfusion to kidneys
- Damage to kidney tissue
- Obstruction
Prerenal failure
Damage before the kidneys
Causes of pre-renal failure
Decreased volume/perfusion to the kidneys
Intra-renal failure
Damage in the kidneys
Causes of intra-renal failure
Prolonged ischemia
Post-renal failure
Damage after the kidneys
Causes of post-renal failure
Obstruction/blockage in the urinary tract
When can a synthetic AV graft start being used after placement?
1-4 weeks
When can a central venous catheter be used after placement?
Immediately
When can an AV fistula be used after placement?
2-3 months
Dialysis disequilibrium syndrome (DDS)
BUN reduced more quickly in body than in the brain causing cerebral edema and electrolyte shifts
S/S of DDS (9)
- Headache
- Restlessness
- Nausea with/without vomiting
- Agitation
- Altered LOC
- Confusion
- Seizures
- Cardiac dysrhythmias
- Cardiac arrest
3 phases of peritoneal dialysis
- Inflow
- Dwell time
- Drain
Inflow phase of PD
Administered over 10 minutes
Dwell time phase of PD
30 minutes - 8 hours
Drain phase of PD
15-30 minutes
Continuous ambulatory peritoneal dialysis (CAPD)
Patient does the exchange usually 4 times/day while awake
Continuous cycling peritoneal dialysis (CCPD)
Automated peritoneal dialysis uses a machine to perform exchanges at night while the patient is sleeping
Renal function
- Maintain fluids/electrolytes
- Secrete renin, aldosterone, angiotensin, erythropoietin
- Convert vitamin D to active form (calcitrol)
- Excrete metabolic wastes
Characteristics of AKI
- Sudden reduction in kidney function
- Decreased GFR
- Increased BUN, creatinine
- Decreased urine output
Pre-renal AKI management
- Fluid replacement
- Vasopressors
- MAP >70
Intra-renal AKI management
- Address underlying cause
Post-renal AKI management
- Remove blockage
S/S of AKI
- Edema
- Crackles in lungs
- HTN
- Azotemia
- Low SpO2
- Dyspnea
- Confusion
- Distended neck veins, bounding pulse
- MAP <65
- Tachycardia
- Weight gain
- Decreased urine output
Nephrotoxic NSAIDS
- Meloxicam
- Aspirin
- Indomethacin
- Ketorolac
- Ibuprofen
- Diclofenac
CKD parameters
- Kidney damage with resulting dysfunction
- GFR <60 lasting for 3 months or longer
- Urine albumin/proteinuria
S/S of hyperkalemia
- Tall, peaked T waves
- Weakness
- Tingling, numbness
- Irregular heartbeat
- Heart attack
- Shortened QT interval
- Flattened P waves
- Prolonged PR interval
- Widened QRS complexes
- Fib, asystole
S/S of stage 5 CKD
- Anorexia
- N/V
- Itching
- Fatigue, lack of energy
- Muscle cramps
- Very little urine output
- Change in mental status
S/S of peritonitis
- Fever
- Abdominal pain
- Rigid, board-like abdomen
- N/V/D
- Rebound tenderness
- Cloudy effluent
- Decreased bowel sounds
How long are dialysis sessions and how many times a week are they done?
4 hours 3 times/week
What patients are at risk for DDS
Patients with BUN levels >200 during their first few sessions of dialysis
S/S of organ rejection
- Fever >100.5
- Weight gain
- Decreased urine output
- Persistent/unusual weakness or fatigue
- SOB
- Aches, pains
Foods high in potassium
- Oranges
- Bananas
- Beans
- Milk
- Carrots
- Potatoes
- Deep green leafy veggies
- Tomatoes
- Fish
- Nuts
Food high in phosphorus
- Meats
- Poultry
- Fish
- Nuts
- Beans
- Dairy products
