RENAL Flashcards
What are some functions of the kidney that aren’t just related to fluid balance
adjusts fluid and electrolyte balance
Secretes bicarb to maintain acid-base balance
makes erythropoietin (makes RBCs)
Breaks down excess insulin
Regulate calcium and phosphorous
metabolizes vitamin d, which helps absorb calcium
What MAP do you need to perfuse the kidneys
MAP of 65 or greater
What is BUN and how does it indicate renal function?
Blood Urea Nitrogen: A waste product from the metabolism of protein. Kidney get rid of it. Whenever value is up, it indicates the inability for kidneys to remove
What is Creatine and how does it indicate renal function?
Basal creatine level reflects an individuals muscle mass. Some baselines will be higher than others. If there is an increase from baseline that indicates renal decline.
What is GFR and how does it indicate renal function?
Glomerular Filtration Rate
creatinine results are plugged into a formula with factors like age, sex, race
Lower number means less filtration and less kidney function, higher is better/more function
What should you do to ensure your renal patient is staying healthy
give them vitamins and minerals, daily weights, strict I/O, assess for hypo/hypervolemia
what kind of diet should a renal patient be on
low protein
kidney damage leads to…
metabolic acidosis because it can’t make its own bicarb
why do you treat renal patients with phosphorous binders
Calcium levels are decreased so there’s a decrease in activation of Vit D which helps body absorb Ca. Ca and Phosphorous have a reciprocal relationship. When Calcium levels go down, phosphorous increases. This drug will bind to the phosphorus and help excrete the excess amount.
What is an RRT
RENAL REPLACEMENT THERAPY
Movement of fluid and molecules (urea, creatinine and electrolytes) across a semipermeable membrane to do the job of the kidneys.
Two ways: Venous and Peritoneal
What are the long-term and short-term options available for venous type RRT
Short-term: Quinton Catheter
Central line in the jugular/subclavian vein removes blood, cleans it in machine, and puts it back in at right atrium. Faster procedure than a fistula
Long term: AV Fistula:
Graft and artery and vein together. After 6 months the site is ‘mature’ and can be used.
T/F: Peritoneal dialysis is the best treatment for patients with acute kidney disease.
False, Peritoneal dialysis is the best treatment for patients with chronic kidney disease.
Why would you do peritoneal dialysis instead of hemodialysis?
Hemodialysis requires anticoagulation and medical stability. If you’re at risk for bleeding r/t anticoagulation therapy or unstable, you woud do peritoneal dialysis.
T/F: More fluid should be coming out of the patient after peritoneal dialysis than what went in.
True
How does hemodialysis work
USED MOSTLY FOR CHRONIC ISSUES
3-5 TIMES A WEEK, 2-4HRS LONG
WAIT TO GIVE MEDS UNTIL AFTER DIALYIS TX COMPLETE
ALWAYS CHECK FOR A DISTAL PULSE/LOCAL THRILL BEFORE ACCESSING FISTULA
Clinton CATH ITSELF IS INNOC W/ HEPARIN
LOW DIALYSATE TEMP CAN CAUSE HYPOTENSION SO CHECK IF PT BECOMES HYPOTENSIVE
What type of dialysis do you use for an AKI
CRRT (continuous renal replacement therapy)
short term and it’s done typically at the bedside in the intensive care environment
What is the difference between CRRT and Hemodialysis
Hemodialysis, they’ll take off two days worth of fluid and 4 h.
RRT is designed to filter more like your kidney. So you’re taking off like 30 ml an hour, running continuously.
What is an indication the pt might be rejecting their kidney
HTN, fever, there’s going to be pain at the site and they’re going to start to have trailing off of their urine output
