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Nursing and Complex Care > Kidney Failure > Flashcards

Kidney Failure Flashcards

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1
Q

How is urine formulated?

A

Includes 3 complex processes:

  1. Glomerus filtration
  2. Tubular reabsorption
  3. Tubular Secretion
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2
Q

What happens in the glomerus filtration process?

A
  1. Blood flows @ 1200mls/min
  2. 20% enters the nephrons
  3. Dependant on the flow & pressure
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3
Q

What happens in tubular reabsorption process?

A
  1. Majority happens within the proximal tubules.

2. Reabsorption of filtrate back to the capillaries

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4
Q

What happens in tubular secretion process?

A
  1. Movement from capillaries to the tubular filtrate.

2. Results in 1000ml-1500mls of urine

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5
Q

What are the roles of the kidneys?

A
  1. Regulation of water excretion
  2. Regulation of electrolytes
  3. Regulation of acids/bases
  4. Auto-regulation of Blood pressure
  5. Vit. D synthesis
  6. RBC production
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6
Q

What does ADH do?

A

Anti- diuretic hormone regulates water excretion and urine concentration, varying amount of water reabsorption.

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7
Q

What are the 3 types of ARF?

A
  1. Pre-renal: 60-70% of cases (decreased perfusion of kidneys -damage)
  2. Intra-renal: Drainage to nephrons
  3. Post- renal: Blockage of urethra
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8
Q

What is ARF?

A
  1. Rapid loss of renal function
  2. Causes imbalance fluid and electrolytes
  3. Can be life threatening
  4. Elevated creatinine 50% above baseline
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9
Q

What are the phases of ARF?

A
  1. Initiation
  2. Oliguria
  3. Diuresis
  4. Recovery
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10
Q

What is the initiation phase of ARF?

A

Initiation:

- Injury causing event

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11
Q

What is Oliguria in ARF?

A

Oliguria is the production of small amounts of urine

1 ) F&E imbalance

2) Decreased urine output
3) Increase Ur & Cr, K,
4) Lack of Oliguria in pt taking nephrontoxic antibiotics

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12
Q

What is Diuresis phase in ARF?

A

Return of urine

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13
Q

How long does it take in the recovery phase of ARF?

A

3-12 months

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14
Q

What are the signs/symptoms of ARF?

A
  1. Critically ill
  2. Lethargic
  3. Nausea, vomiting, diarrhoea
  4. Uraemic fetor
  5. Dehydration of the skin
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15
Q

How dose ARF affect CNS?

A
  1. Drowsiness
  2. Headaches
  3. Seizures
  4. Muscle twitching
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16
Q

Your Nursing considerations of ARF?

A
  1. Prevent/Minimise causative factor
  2. Care with nephrontoxic drugs
  3. Care with NSAIDs -> nephritis
  4. Age
  5. Co- morbidities
  6. Contrast
17
Q

Medication Management of ARF?

A
  1. Kidneys are robust if limited damage to the organ
  2. Monitor for complications of overload: APO
  3. Dialysis
  4. Pharmacological treatments:
    - Resonium: PO/PR
    - Diuretics
    - Glucose/insulin
    - Ca
18
Q

Nursing Management of ARF

A
  1. Early identification of ARF & implement preventative measures
  2. Treat the underlying cause
  3. Monitor F&E
  4. Conduct a holistic assessment of the patient
  5. Decrease metabolic rate
  6. Promotion respiratory function
  7. Prevent infections
  8. Provide skin care
  9. Psychological support
19
Q

What is Chronic Renal Failure?

A
  1. 3 or more of kidney damage or decreased glomerus filtration rate (GFR)
  2. Results in decrease QOL & frequent health care
  3. Results in pre-mature death
  4. Lead to end-stage renal disease (ESRD)
  5. Associated with CVD, HT, diabetes, obesity
20
Q

Name the 5 stages of CRF

A 
Stage 1: Kidney damage with chronic inflammation 
Stage 2: Mild decrease GFR
Stage 3: Moderate decrease GFR
Stage 4: Severe decrease GFR
Stage 5: End-stage renal failure
21
Q

Acute on Chronic:

A
  1. When patients with CRF develop ARF
  2. Tends to increase severity
  3. Escalation of CKD -> require treatment of ARF
22
Q

What is ESRD?

A
  1. 5th stage of CKD
  2. Build up of by-products; increase waste products: increase symptoms
  3. Symptoms:
  4. Fluid retention
  5. Anaemia/Acidosis
  6. Hyperkalaemia/ pericarditis/ pericardial tamponade
  7. HT, Bone disease
  8. CVD is predominately cause of death
  9. Require RRT on permanent basis (renal replacement therapy)
23
Q

What is the predominant cause of death in ESRD

A
  1. Cardiovascular disease
  2. Retention of fluid (oedema, HF, HT)
  3. Acidosis, anaemia
  4. Hyperkalaemia
  5. Pericarditis
  6. Pericardial
  7. Tamponade
  8. Bone disease
24
Q

What pharmacological interventions for ESRF?

A
  1. Anti-hypertensive: volume control
  2. Cardiac glycosides
  3. Beta-blockers
  4. Erythropoietin
  5. Fe
  6. Ca
  7. Phosphate
25
Q

What are your nursing care for ESRF?

A
  1. Fluid intake limit of 1-1.5L
  2. Nutrition
  3. Education
  4. Optimise ADL
  5. Self esteem & independence
  6. Monitor:
    - Hyperkalaemia
    - Pericarditis
    - Percardial effusion/ tamponade
    - HT
    - Anaemia
    - Bone Disease
    - Metastatic calcification
26
Q

What are modes of dialysis?

A

There are 3:

  1. Peritoneal
  2. Intermittent Haemodialysis
  3. Continuous Renal replacementherapy (RRT)
27
Q

What are the 3 different access of dialysis?

A
  1. Trochar into the peritoneal space
  2. Fistula
  3. Vascath
28
Q

What are the risk with dialysis

A
  1. Infection
  2. Haemodynamic instability
  3. Respiratory compromise

Nursing and Complex Care (8 decks)

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