Kidney Exam 3 Flashcards
Where do the kidneys begin
T12-L3
What do kidneys do?
Regulate Na and water
Regulate electrolytes
Regulate BP through angiotensin system
Regulates peripheral vascular resistance
Regulates RBC production thru production of erythropoietin
What do kidneys stimulate
The production of RBC’s from bone marrow ( homeostasis mechanism)
When blood flow to the kidneys decreases, what ABG decreases accordingly?
PaO2
What do kidneys excrete
Metabolic waste products
Toxins
Hormones
What is the smallest part of the kidneys
The nephrons which secretes urine through the glomerular filtration system
What’s the normal GFR rate for men
90 - 140 men
What’s the normal GFR rate for woman
80-125
What is GFR
It is a time sensitive test
It is slightly different based on gender need to be maintained at a constant rate
What’s the most reliable indicator for progressively damaged kidneys
GFR
What is the creatinine clearance test
A measurement of the rate of removal of creatine from plasma
It is a time sensitive test
What is creatinine
It is the protein that is produced by muscle tissue and removed by the blood
What creatinine lab value is indicative of renal damage
If below 29 mm/min that is a indicator of renal damage. By this time the patient will be symptomatic.
How often should critical care patients urine output be monitored
Monitor it Q 1 hour
Rather than output be based on 30 ml/ HR urine output is based on the patients weight.
Is everyone who is diagnosed with AKI, in renal failure
Everyone who is in AKI is NOT in renal failure
What is Normal output
1500 ml/ day
What is considered polyuria
Urinating more than 2500 ml/ day
What is considered oliguria
100-400 ml/ day
What is considered Anuria
Less than 100ml of urine output per day
What does BUN reflect
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.
What are some things BUN is affected by
TPN
MALNUTRITION
What is essential for kidney function
Adequate perfusion is essential for kidney function
Approx how much CO goes to the kidneys
About 25% of CO goes to the kidneys
Anything that decreases CO will affect renal perfusion
MAP
A good indicator of renal perfusion
What is the target MAP for adequate renal perfusion
80
When the kidneys sense low BP, arterioles will constrict as a way to self regulate
What are normal creatine levels
0.6-1.2
What can creatinine levels be affected by
Trauma
Malnutrition
How long can the kidneys compensate
The kidneys can compensate and continue to function with the pt. asymptomatic until 50-50% of functioning nephrons are destroyed
What’s the BUN creatinine ratio
Helpful to identify different stages of renal disease
What tests diagnose renal status
- GFR
- Cr
- BUN
- H&H
- Urinalysis to check for protein and glucose in urine
- Biopsy of kidney can tell if kidney is damaged or malignant
- KUB ( X-ray of kidneys, ureter, bladder)
- Pyelogram IVP ( inject contrast into vein and look at kidney)
What is AKI
Sudden
Acute
Abrupt loss of renal function
What are the 2 criteria for AKI for 6 consecutive hours
- Cr…if creatinine increases 1.5x’s the baseline
2. Urine output….if UO decreases .5 ml/kg/hr for
What do older ppl have in relation to the kidneys
Older adults have diminished kidney reserve
With age you loose nephron function
By age 70, 40-50% of nephrons are damaged
What ppl are at risk for AKI
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,
What are the 3 levels of kidney injury
- Pre renal renal injury
- Intra renal renal injury
- Post renal renal injury
How many ppl develop pre renal renal injuries
50-60% of AKIs
What is pre renal renal injury a result of
It is due to temporary periods of hypovolemia and hypotension
It is due to a lack of perfusion
Is pre renal injury treatable
It is easily reversible and treatable
What is intra renal renal injury
Actual damage to kidney tissue
What is treatment for intra renal renal injury
The pt. may need dialysis for life or temporary dialysis
What are causes of intra renal renal injury
Prolonged hypotension
Hypovolemia
Nephrotoxic drugs
SLE
What is post renal renal injury
Obstruction of outflow of urine causing urine to back up,in the kidney
IT IS A URGENT SITUATION
What are causes of post renal renal failure
Renal calculate
BPH
How long can the kidneys go without perfusion
The kidneys can’t go longer than 25 min without perfusion before permanent damage takes place
What does a protein calorie deficit result in
Kidney injury
What are signs and symptoms of pre renal and intra renal renal injury
Oliguria
When would a person need permanent dialysis
If kidney injury doesn’t improve in a year
some patients may need to go on a ventilator
In what ways would hyperkalemia reflect on a EKG
- Peaked T waves
- Wide QRS
- Prolonged PR interval
What is the albumin test
Tests 3 month nutritional status
What is the pre albumin test
A current reflection of s patients protein stores
What fluids are given for kidney injury
0.9% NS
Based on intake and output
What can colloids interfere with
Heart function
Before you give colloids, what should the nurse do first
Make sure the heart is functioning adequately
What are drugs to increase UO
Norepinephrine
NEVER GIVE DOPAMINE TO IMPROVE CO
What is hyperkalemic treatment
Insulin IV with dextrose ( bc insulin will draw K+ into the cells Na bicarbonate Ca IV ALBUTEROL NEBULIZER dialysis RRT
What is IHD
Intermittent hemodialysis
What does IHD run the risk of
Hypotensive events
What is RRT
Renal replacement therapy
What are advantages of RRT
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)
What are disadvantages of RRT
It is not available on a out patient basis
What is CRRT and RRT not indicated for
Post renal renal injuries
Who r ppl that need RRT
Critical K+ values
Burns with K+ loss
Drug overdoses
What is RRT vascular access
Veno venous
Arterio venous
Which kind of base produces more burns
Alkali produces more burns than acid base
What is veno venous
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.
Can RRT vascular access be used for anything else
No MEDS
NO FLUIDS
NO LAB WORK
NOTHING
What is dialysis classified as
Crystalloids
The solution is very similar to plasma
It contains glucose, electrolytes, buffering solutions like bicarbonate
What type of access is needed for a IHD
A fistula or a graft
It takes a week to 10 days to heal
Peritoneal dialysis
Not as common
Not as effective as other methods
Requires a catheter into the abdomen
TAKES HOURS
What does refractory mean
Doesn’t respond to treatment
Where are the 2 burn centers
West penn
Mercy
What is true of burn patients
They are extremely hypovolemic with edema, and fluid shifts
What does TBSA mean
Total body surface area
What does insensate mean
Not sensitive to touch
How do you get tar off
Dawn dishsoap
Oil
