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Med Surg IV > Kidney Crap > Flashcards

Kidney Crap Flashcards

1
Q

What do the kidneys do?

What is their normal function?

A 
Removal of sodium
Removal of water // Retaining water
Removal of waste
- Urea and Creatinine
Hormone production
- Erythropoietin and Vitamin D
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2
Q

What is urea?

A

Bi-product of protein breakdown

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3
Q

What is creatinine?

A

Bi-product of muscle breakdown

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4
Q

What does RAAS stand for?

A

Renin
Angiotensin
Aldosterone
System

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5
Q

What is the purpose of renin in RAAS?

A

Converts angiotensin 1 into angiotensin 2

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6
Q

What is the purpose of aldosterone in RAAS?

A

Allows for reabsorption of sodium and water

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7
Q

What diet should kidney patients avoid?

A

Ketogenic

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8
Q

What does GFR stand for?

A

Glomerular
Filtration
Rate

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9
Q

What is the normal value for GFR?

A

125 mL/min

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10
Q

The kidneys remove “waste”. What is included in the “waste”?

A

Creatinine, urea, potassium and other electrolytes

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11
Q

Too much potassium can cause what major problem?

A

Stop the heart

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12
Q

Too little potassium can do what?

A

Cause dysrythmias

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13
Q

What is epogen?

A

A medication given to increase RBC production

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14
Q

What do “normal” kidneys do with bicarb that kidneys that are failing cannot do?

A

Normal kidneys are able to reabsorb bicarb and excrete it. Failing kidneys cannot.

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15
Q

What is normal creatinine?

A

1 (Best for kidney function)

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16
Q

What is normal BUN?

A

20

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17
Q

Does a patient with a HIGH BUN but a normal creatinine indicate kidney failure?

A 
No. It could mean the patient is dehydrated. 
Both values (BUN and creatinine ) should be affected to indicate kidney damage.
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18
Q

What causes prerenal failure?

A

A sudden decreased blood flow to the kidneys or decrease in B/P

Examples:
Excessive blood loss (hemorrhage), shock

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19
Q

What causes intrarenal failure?

A

Cause affects ACTUAL kidney

Examples:
Inflammation, toxins, drugs, infection, nephrotoxic meds

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20
Q

What causes postrenal failure?

A

Obstructions

Examples:
Tumor, clot, BPH, stones

21
Q

How much output would a pt in oliguria be putting out?

A

< 400 mL/day

22
Q

How does a pt present (s/s) in the oliguria phase?

A 
Edema in extremities
- Excess fluid moves to lungs, then to heart
Increased B/P
Trouble breathing
- Crackles (due to fluid build up)
Metabolic Acidosis
23
Q

How much output would a pt in nonoliguric be putting out?

A

> 400 mL/day

NOTE:
Even though they are still putting out a lot, they aren’t ridding the body of waste

24
Q

How much does a pt put out in the diuretic phase?

A

Up to 5 L/day

What must we check?
- B/P

25
Q

How long does kidney recovery take?

A

Up to a year

Sometimes pt’s don’t get better

26
Q

Which classification of kidney failure is reversible?

A

Acute

27
Q

Clinical manifestations of ACUTE renal failure

A 
N/V/D
Lethargy
Dehydration
Dark, concentrated urine
- "Casts" in urine (tubules slothing off)
Headache
28
Q

What leads to chronic renal failure?

A

Unresolved ACUTE renal failure

29
Q

Clinical manifestations of CHRONIC renal failure

A

Increased B/P
Dysrhythmias
Anemia - decrease in RBC, increase in HR
Confusion

Major complication: heart failure

30
Q

How quickly do kidneys lose function in ARF?

A

A matter of hours or days

31
Q

Chronic Kidney Disease:

Stage 1 of 5

A

Kidney damage (protein in urine) and normal GFR

GFR - More than 90

Kidney function deterioration - 50-60%

32
Q

CKD:

Stage 2 of 5

A

Kidney damage and mild decrease in GFR

GFR - 60-88

Kidney function deterioration - 60-70%

33
Q

CKD:

Stage 3 of 5

A

Moderate decrease in GFR

GFR - 30-59

Kidney function deterioration - 70-77.5%

34
Q

CKD:

Stage 4 of 5

A

Severe decrease in GFR

GFR - 15-29

Kidney function deterioration - 77.5-85%

35
Q

CKD:

Stage 5 of 5

A

Kidney failure

  • End stage
  • Dialysis or kidney transplant is needed

GFR - < 15

Kidney function deterioration - 85% and above

36
Q

Hemodialysis

A

Traditional form of dialysis

PC’s:

  • Hypovolemia
  • Loss of blood, leading to anemia
37
Q

Peritoneal Dialysis

A

Dialysis through the stomach

PC’s:
Loss of more protein than traditional dialysis

38
Q

Where doe ACE inhibitors work?

A

In the kidneys, not the heart

39
Q

What do ACE inhibitors do?

A

Stop the conversion of angiotensin 1 from converting into angiotensin 2 - causing vasodilation - helping to lower the blood pressure

40
Q

What medications should a dialysis patient avoid before dialysis and why?

A

Blood pressure and related medications

Why? The patient will be at a higher risk for hypovolemia. Hypovolemia causes hypotension due to fluid loss. If the patient were to take their b/p med and become hypovolemic during dialysis, it could be highly dangerous for them.

41
Q

How is a patient’s blood pressure if they suffer from kidney failure?

A

HIGH

Why? Due to a buildup of fluid that the kidneys are unable to rid the body of, thus causing heart problems

42
Q

Say a patient with kidney failure has trauma causing them to bleed out… Will the RAAS system kick in to increase the B/P to help compensate for the blood loss?

A

NO!

The RAAS system is unavailable when a patient is in kidney failure

43
Q

How does osmosis work in dialysis?

A

Glucose (dextrose) is added to the dialysate solution and is causes an osmotic gradient across the membrane, pulling the excess fluids from the blood.

44
Q

How does diffusion work in dialysis?

A

The movement of solutes (creatinine, uric acid, electrolytes) from the blood to the dialysate. Purpose is to lower blood concentration.

45
Q

What is the recovery phase?

A

GFR begins to increase allowing BUN and creatinine to decrease. Usually happens for 1-2 weeks. Urine will be concentrated.

46
Q

What is the diuretic phase?

A

In this phase, kidneys have recovered their ability to excrete waste, however they still cannot concentrate the urine. Usually lasts 1-3 weeks

47
Q

What is azotemia?

A

The accumulation of nitrogenous waste products in the blood

48
Q

Normal ranges for potassium

A

3.5 - 5

Med Surg IV (12 decks)

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