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4th Semester > Kidney Exam 3 > Flashcards

Kidney Exam 3 Flashcards

1
Q

Where do the kidneys begin

A

T12-L3

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2
Q

What do kidneys do?

A

Regulate Na and water
Regulate electrolytes
Regulate BP through angiotensin system
Regulates peripheral vascular resistance
Regulates RBC production thru production of erythropoietin

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3
Q

What do kidneys stimulate

A

The production of RBC’s from bone marrow ( homeostasis mechanism)

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4
Q

When blood flow to the kidneys decreases, what ABG decreases accordingly?

A

PaO2

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5
Q

What do kidneys excrete

A

Metabolic waste products
Toxins
Hormones

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6
Q

What is the smallest part of the kidneys

A

The nephrons which secretes urine through the glomerular filtration system

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7
Q

What’s the normal GFR rate for men

A

90 - 140 men

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8
Q

What’s the normal GFR rate for woman

A

80-125

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9
Q

What is GFR

A

It is a time sensitive test

It is slightly different based on gender need to be maintained at a constant rate

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10
Q

What’s the most reliable indicator for progressively damaged kidneys

A

GFR

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11
Q

What is the creatinine clearance test

A

A measurement of the rate of removal of creatine from plasma
It is a time sensitive test

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12
Q

What is creatinine

A

It is the protein that is produced by muscle tissue and removed by the blood

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13
Q

What creatinine lab value is indicative of renal damage

A

If below 29 mm/min that is a indicator of renal damage. By this time the patient will be symptomatic.

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14
Q

How often should critical care patients urine output be monitored

A

Monitor it Q 1 hour

Rather than output be based on 30 ml/ HR urine output is based on the patients weight.

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15
Q

Is everyone who is diagnosed with AKI, in renal failure

A

Everyone who is in AKI is NOT in renal failure

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16
Q

What is Normal output

A

1500 ml/ day

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17
Q

What is considered polyuria

A

Urinating more than 2500 ml/ day

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18
Q

What is considered oliguria

A

100-400 ml/ day

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19
Q

What is considered Anuria

A

Less than 100ml of urine output per day

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20
Q

What does BUN reflect

A

BUN reflects the breakdown of protein into amino acids and nitrogen waste products. It is not a good indicator as GFR and Cr bc it reflects the persons protein intake and nutritional status.

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21
Q

What are some things BUN is affected by

A

TPN

MALNUTRITION

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22
Q

What is essential for kidney function

A

Adequate perfusion is essential for kidney function

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23
Q

Approx how much CO goes to the kidneys

A

About 25% of CO goes to the kidneys

Anything that decreases CO will affect renal perfusion

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24
Q

MAP

A

A good indicator of renal perfusion

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25
Q

What is the target MAP for adequate renal perfusion

A

80

When the kidneys sense low BP, arterioles will constrict as a way to self regulate

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26
Q

What are normal creatine levels

A

0.6-1.2

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27
Q

What can creatinine levels be affected by

A

Trauma

Malnutrition

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28
Q

How long can the kidneys compensate

A

The kidneys can compensate and continue to function with the pt. asymptomatic until 50-50% of functioning nephrons are destroyed

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29
Q

What’s the BUN creatinine ratio

A

Helpful to identify different stages of renal disease

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30
Q

What tests diagnose renal status

A
  1. GFR
  2. Cr
  3. BUN
  4. H&H
  5. Urinalysis to check for protein and glucose in urine
  6. Biopsy of kidney can tell if kidney is damaged or malignant
  7. KUB ( X-ray of kidneys, ureter, bladder)
  8. Pyelogram IVP ( inject contrast into vein and look at kidney)
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31
Q

What is AKI

A

Sudden
Acute
Abrupt loss of renal function

32
Q

What are the 2 criteria for AKI for 6 consecutive hours

A
  1. Cr…if creatinine increases 1.5x’s the baseline

2. Urine output….if UO decreases .5 ml/kg/hr for

33
Q

What do older ppl have in relation to the kidneys

A

Older adults have diminished kidney reserve
With age you loose nephron function
By age 70, 40-50% of nephrons are damaged

34
Q

What ppl are at risk for AKI

A

Diabetics
Pre existing renal disease ( poly cystic kidney disease)
HF, LIVER FAILURE
nephrotoxic drugs such as NSAIDS, DIURETICS, AMINOGLYCOSIDES
chemo therapy patients
Prolonged HTN
trauma which leads to hypovolemia,

35
Q

What are the 3 levels of kidney injury

A
  1. Pre renal renal injury
  2. Intra renal renal injury
  3. Post renal renal injury
36
Q

How many ppl develop pre renal renal injuries

A

50-60% of AKIs

37
Q

What is pre renal renal injury a result of

A

It is due to temporary periods of hypovolemia and hypotension
It is due to a lack of perfusion

38
Q

Is pre renal injury treatable

A

It is easily reversible and treatable

39
Q

What is intra renal renal injury

A

Actual damage to kidney tissue

40
Q

What is treatment for intra renal renal injury

A

The pt. may need dialysis for life or temporary dialysis

41
Q

What are causes of intra renal renal injury

A

Prolonged hypotension
Hypovolemia
Nephrotoxic drugs
SLE

42
Q

What is post renal renal injury

A

Obstruction of outflow of urine causing urine to back up,in the kidney
IT IS A URGENT SITUATION

43
Q

What are causes of post renal renal failure

A

Renal calculate

BPH

44
Q

How long can the kidneys go without perfusion

A

The kidneys can’t go longer than 25 min without perfusion before permanent damage takes place

45
Q

What does a protein calorie deficit result in

A

Kidney injury

46
Q

What are signs and symptoms of pre renal and intra renal renal injury

A

Oliguria

47
Q

When would a person need permanent dialysis

A

If kidney injury doesn’t improve in a year

some patients may need to go on a ventilator

48
Q

In what ways would hyperkalemia reflect on a EKG

A
  1. Peaked T waves
  2. Wide QRS
  3. Prolonged PR interval
49
Q

What is the albumin test

A

Tests 3 month nutritional status

50
Q

What is the pre albumin test

A

A current reflection of s patients protein stores

51
Q

What fluids are given for kidney injury

A

0.9% NS

Based on intake and output

52
Q

What can colloids interfere with

A

Heart function

53
Q

Before you give colloids, what should the nurse do first

A

Make sure the heart is functioning adequately

54
Q

What are drugs to increase UO

A

Norepinephrine

NEVER GIVE DOPAMINE TO IMPROVE CO

55
Q

What is hyperkalemic treatment

A 
Insulin IV with dextrose ( bc insulin will draw K+ into the cells 
Na bicarbonate 
Ca IV 
ALBUTEROL NEBULIZER 
dialysis RRT
56
Q

What is IHD

A

Intermittent hemodialysis

57
Q

What does IHD run the risk of

A

Hypotensive events

58
Q

What is RRT

A

Renal replacement therapy

59
Q

What are advantages of RRT

A

Reduces risk of hypotensive events bc it runs so long 12-15 hrs
Drug doses don’t need to be reduced
Patients dietary intake is not limited or adjusted
Not as much electrolyte shifting during and after treatment
Preserves hemodynamic stability
Doesn’t require a fistula ( double lumen vascular access)

60
Q

What are disadvantages of RRT

A

It is not available on a out patient basis

61
Q

What is CRRT and RRT not indicated for

A

Post renal renal injuries

62
Q

Who r ppl that need RRT

A

Critical K+ values
Burns with K+ loss
Drug overdoses

63
Q

What is RRT vascular access

A

Veno venous

Arterio venous

64
Q

Which kind of base produces more burns

A

Alkali produces more burns than acid base

65
Q

What is veno venous

A

The most common type of RRT vascular access
It involves 2 veins
There is 1 puncture site in which a dual lumen into a central vein, blood is removed from one lumen cleaned through the machine and put back into the other lumen.

66
Q

Can RRT vascular access be used for anything else

A

No MEDS
NO FLUIDS
NO LAB WORK
NOTHING

67
Q

What is dialysis classified as

A

Crystalloids
The solution is very similar to plasma
It contains glucose, electrolytes, buffering solutions like bicarbonate

68
Q

What type of access is needed for a IHD

A

A fistula or a graft

It takes a week to 10 days to heal

69
Q

Peritoneal dialysis

A

Not as common
Not as effective as other methods
Requires a catheter into the abdomen
TAKES HOURS

70
Q

What does refractory mean

A

Doesn’t respond to treatment

71
Q

Where are the 2 burn centers

A

West penn

Mercy

72
Q

What is true of burn patients

A

They are extremely hypovolemic with edema, and fluid shifts

73
Q

What does TBSA mean

A

Total body surface area

74
Q

What does insensate mean

A

Not sensitive to touch

75
Q

How do you get tar off

A

Dawn dishsoap

Oil

4th Semester (18 decks)

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