Renal Flashcards
Acute renal failure is potentially reversible in which phase?
Initiation phase
A patient’s creatinine clearance is 5 mL/min. What does this value signify?
Renal Dysfunction
Hyponatremia in renal dysfunction is the result of what?
Water overload
Signs and symptoms of acute renal failure include what?
Tachypnea, low pH, and low serum bicarbonate
What is a common complication of hemodialysis?
Hypotension
Name a medication that has the dual effect of creating a solute diuresis and augmenting renal blood flow
Furosemide
In general, maintenance of cardiovascular function and what are the two key goals in the prevention of acute tubular necrosis?
Adequate intravascular volume
One of the most useful noninvasive diagnostic tools available for clinicians to monitor fluid volume status is what?
Monitoring daily weights
A study that delineates the size, shape, and position of the kidneys and also demonstrates abnormalities, such as calculi, hydronephrosis, cysts, or tumors is what?
KUB x-ray
While undergoing his first ever hemodialysis treatment, the patient suddenly becomes confused, complains of a headache, begins to twitch, and proceeds to have a seizure. The nurse realizes that this is most likely due to what?
Cerebral edema
Name the indications for hemodialysis.
Acid-base imbalances, electrolyte imbalances, and fluid overload
Name the principles that are the basis for dialysis.
Diffusion and ultrafiltration
After a patient has an arteriovenous fistula placed, what differences will occur in that arm?
The vein will dilate and the pulse distal to the fistula will need to be evaluated
Name the common complications of hemodialysis.
Dysrhythmias, hypotension, infection, and muscle cramps
In a patient undergoing peritoneal dialysis, what signs and symptoms should a nurse be looking for?
Abdominal pain and fever, cloudy return fluid, and poor drainage from the abdominal cavity
What might exposure to aminoglycoside antibiotics result in?
Acute tubular necrosis
What medications should be withheld for 4-6 hours before hemodialysis?
Antihypertensives
What is the most common intrarenal condition resulting from prolonged ischemia?
Acute tubular necrosis
How long after an aminoglycoside is administered is a peak level taken?
1-2 hours
What contributes to prerenal failure?
Hypovolemia and cardiogenic shock
Urine output of less than 400 mL in 24 hours
Oliguria
The sudden deterioration of renal function, resulting in retention of nitrogenous waste products
Acute renal failure
Conditions that produce acute renal failure by interfering with renal perfusion
Prerenal
Acute renal failure resulting from obstruction of the flow of urine
Postrenal
Conditions that produce produce acute renal by directly acting on functioning kidney tissues
Intrarenal
Particularly useful for patients in the critical care unit whose cardiovascular status is too unstable to tolerate rapid fluid removal
Continuous renal replacement therapy
Manifested by abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting, and difficulty in draining fluid from the peritoneal cavity
Peritonitis
Commonly used to treat the anemia of chronic renal failure
Epogen
Controversial treatment of acute renal failure
Dopamine
Primarily used for controlling fluid volume
Ultrafiltration
Separation of solute by differential diffusion
Dialysis
The normal BUN/Creatinine ratio
10:1 to 20:1
What should normal urine production be?
1 mL/kg/hr
What is the absolute minimum amount of urine production to sustain life?
30 mL/hr
Normal specific gravity or urine values
1.005-1.030
What does a urine specific gravity of greater than 1.030 indicate?
Dehydration
What do RBCs in the urine indicate?
Infection, damage, or a break in a membrane
What do WBCs in urine indicate?
Infection
Lack of control of voiding
Incotinence
Voiding at frequent intervals
Frequency
Difficulty in initiating voiding
Hesitancy
Need to void immediately
Urgency
Urine output <100 mL/day
Anuria
Urine remaining in the bladder post voiding
Residual urine
What is the normal residual volume of urine?
50 mL or less
Awakening at night to void
Nocturia
Painful urination
Dysuria
Presence of blood in the urine
Hematuria
Urine output of more that 2500 mL/day
Polyuria
What disease is polyuria indicative of?
Diabetes
What is the normal creatinine level?
0.5-1.2 mg/dL
Specifically indicates renal function, this value increases when glomerular filtration is impaired
Creatinine
How man nephrons must be lost before there is a change in creatinine levels?
25%
What is a normal BUN level?
5-25 mg/dL
Increases with excessive protein intake or trauma, but may be falsely elevated in many cases
BUN
What can falsely elevate BUN levels?
Lots of protein, blood, diet, and poor liver function
Direct visualization of the inner lining of the bladder
Cystoscopy
Abdominal x-ray of the kidney, ureters,and bladder
KUB x-ray
Visualizes the urinary tract
Intravenous pyelogram
What is important to evaluate before administering an IVP?
Normal creatinine levels in order to clear dye
What is the most common nosocomial infection?
UTI
What is done to diagnose a UTI?
Symptoms, urinalysis, urine culture and sensitivity, IVP, and an abdominal ultrasound
Why is a urine culture and sensitivity done on suspected UTIs?
It is necessary for definitive identification of the infecting organism and the most effective antibiotic
Which drug is prescribe for palliative reasons in a UTI patient?
Pyridium
Why is an anticholinergic prescribed to a UTI patient?
To decrease the spasms of the bladder
If a patient has a UTI, how much fluid should the take in?
An extra 2000-3000 mL/day
How can urine be acidified?
Intake of cranberry juice
Presence of stones in the urinary tract
Urolithiasis
Stones formed in renal parenchyma
Nephrolithiasis
Formation of stones in the ureter
Ureterolithiasis
What are predisposing factors for renal calculi?
Heredity, UTI, foley, IMMOBILITY, dehydration, pH of urine, hyperparathyroidism, GOUT, excess vitamin D
Who is most susceptible for renal calculi?
Young males
What are the types of renal calculi?
Calcium oxalate, calcium phosphate, uric acid, struvite, and cystine
Which type of renal calculi is the biggest and has sharp edges?
Struvite
Which type of renal calculi is influenced by heredity?
Cystine
What are the emergency treatments for renal calculi?
IV Dilaudid or Morphine, IV Fluid, Torodol, and Ditropan
Why is Torodol given to renal calculi patients?
To decrease inflammation
Why is Ditropan given to renal calculi patients?
To depress the smooth muscle of the ureter
What are the signs and symptoms of renal calculi?
Pain, hematuria, changes in urine output, urgency and frequency, and pyuria
How are renal calculi diagnosed?
Lab findings, x-rays, KUB, IVP, renal ultrasounds, spiral CT scan
What nursing interventions can be taken for a patient with renal calculi?
Strain all urine, force fluids, walk, narcotics, spasmolytic agents, check vitals, back rubs, PIV dye
Rapid deterioration of renal function associated with an accumulation of nitrogenous wastes of the body that is not due to extrarenal factors
Acute Renal Failure
Accumulation of nitrogenous wastes of the body
Azotemia
Renal failure caused by poor blood flow to the kidneys
Prerenal azotemia
Trauma causes what kind of renal failure?
Prerenal
What is the most common and most curable type of renal failure?
Prerenal
Acute renal failure resulting from damage to the kidney itself
Intrarenal failure
What are the causes of intrarenal failure?
Inflammation, Immunologic, and ATN
What can cause ATN?
Damage to the nephrons, antibiotics, and rhybdomylosis
Obstruction of the urinary collecting system
Postrenal Acute Renal Failure
What are the phases of ARF?
Onset, Oliguric, Diuretic, and Recovery
What signs and symptoms will a patient in ARF exhibit?
SOB, lots of backed up fluid, and increased BUN and Creatinine
What nursing interventions should be done for a patient in ARF?
Decrease fluid intake, give Lasix, assess for pulmonary edema, and daily weights
Why should patients in ARF be on a low protein, high CHO and calorie diet?
Because they can’t break proteins down and they are in a high metabolic state
What happens to the urine of a patient in ARF?
The specific gravity decreases because they lose the ability to concentrate it
What are the signs of Dig Toxicity?
Halo vision and bradycardia
Why is low does dopamine used in ARF patients?
To restore renal perfusion and help increase blood pressure
What does Vitamin K combat in ARF patients?
Increased BUN that interferes with platelet aggregation
What should the diet of a patient in ARF look like?
High CHO, high calorie, low protein, low sodium, low fluid, low magnesium, low phosphorous, and low potassium
How is fluid replaced in a ARF patient?
With output from previous 24 hours + 400 mL for insensible loss
A standard treatment with dialysate solution that uses vascular access for continuous arteriovenous and venovenous hemofiltrations
Continuous Renal Replacement Therapy
Remove plasma water and dissolved contents from the clients’ blood across a membrane
Dialysis
What is the pH problem of all patients in ARF?
Metabolic Acidosis
How does dialysis decrease the BUN and Creatinine levels?
By removing water and waste
Progressive, irreversible kidney injury where kidney function does not recover
Chronic Kidney Disease
How do patients with CRF survive?
By using artificial means of replacing kidney function
Inflammatory process involving both kidneys’ immune response of glomerular membrane to the protein beta hemolytic streptococcus
Chronic Glomerulonephritis
Inherited disorder in which nephrons form cysts and are non-functional
Polycystic Kidney Disease
Which antibiotics are nephrotoxic?
Mycins
What is the leading cause of CRF?
Diabetes Mellitus
What is the second leading cause of CRF?
Hypertension
Why does hypertension cause CRF?
Shrinks and scars the kidneys
What are the stages of CRF?
Reduced renal reserve, renal insufficiency, renal failure, end-stage renal disease
In which stage does the healthier kidney compensate for the more diseased kidney?
Reduced Renal Reserve
In which phase of CRF does metabolic waste being to accumulate?
Renal Insufficiency
In which stage of CRF does anemia occur?
Renal Insufficiency
Condition in which nephrons cannot reabsorb Bicarb and are unable to excrete hydrogen ions
Acidosis
How does the body attempt to compensate for acidosis?
Increased respirations to blow off CO2
Why are patients in CRF anemic?
Because of decrease in Erythropoietin
In which phase of CRF do patients become acidotic?
Renal Failure
In which phase of CRF are there excessive amounts of nitrogenous wastes accumulating in the blood to an extent that the patient is unable to maintain homeostasis?
End Stage Renal Disease
Why are patients in End Stage Renal Disease hard to resuscitate after a cardiac event?
Because they are acidotic
What symptom to only patients in ENRD exhibit?
Paroxysmal Nocturnal Dyspnea
What is the classic indicator of renal failure?
Azotemia
What are the signs and symptoms of CRF?
Nausea, vomiting, anorexia, diarrhea, constipation, increased nitrogenous wastes, restlessness, muscle spasms, peaked T waves, arrhythmias, AMS, halitosis, pale, uremic frost, RLS
Rate at which the kidneys remove creatinine from plasm
Creatinine Clearance
Why does sodium-hyponatremia occur in early renal failure?
Increase in urine output and less nephrons to reabsorb the sodium
What symptoms of CRF are caused by a increase in potassium levels?
Peaked T waves, arrhythmias, bradycardia, and cardiac arrest
What will be increased in the urine of a CRF patient?
Protein
Why is the calcium of a patient with CRF decreased?
Because the kidneys cannot excrete phosphorus and when phosphorous increase, calcium decreases
Besides the kidneys, what other organ hypertrophies in a patient with CRF?
The parathyroid
What is the end result of the kidneys’ inability to excrete phosphorous?
Brittle bones
What is the sign of severe CRF?
Anemia
What are the side effects of Epogen?
Pain and hypertension
Why do patients with CRF also have hypertension?
The renin-angiotensin aldosterone system fails to recognize the increased renal blood flow so it increases renin production, which increases blood pressure
Why do CRF patients have pericarditis?
From the uremic toxins
How much does 1 liter of excess fluid weigh?
2.2 lb
What cardiac conditions will a CRF patient exhibit?
Hypertension, hyperlipidemia, heart failure, and pericarditis
What will the urine of a patient in ESRF look like?
Dilute and clear
What laboratory assessments should be done to diagnose CRF?
BUN, Creatinine, Electrolyte, CBC, ABG
What is the test of choice to diagnosis CRF?
MRI
When should the nurse administer vitamin and mineral supplements to a patient in CRF?
After dialysis
What drugs are used to treat CRF?
Digoxin, Antacids, Amphojel, Stool Softeners, Narcotics, Antihypertensives, Diuretics, Insulin, and Erythropoietin
What tests are used to diagnose CRF?
KUB, IVP, Aortorenal angiography, Ultrasounds, MRI, Renal Biopsy
How can a CRF patient decrease their risk for infections?
Meticulous skin care, preventive skin care, inspection of vascular access site for dialysis, and monitoring of vital signs
How can a nurse prevent a patient with CRF from feeling fatigued?
Give vitamin and mineral supplements, give epogen, and give iron
What types of vascular access devices are used to administer hemodialysis?
Arteriovenous fistula or graft long term or catheter or shunt for short term
What complications can arise from the vascular access devices used for hemodialysis?
Thrombosis or stenosis, infection, aneurysm formation, ischemia, heart failure
What causes post dialysis disequilibrium syndrome?
Lots of fluid taken up quickly
Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate
Peritoneal dialysis
Why is the peritoneum used for dialysis?
Because it is a semipermeable membrane
What is the nurse’s responsibility when administering peritoneal dialysis?
Observe the outflow amount and pattern of the fluid
If a kidney is going to be transplanted, what needs to be matched between the donor and recipient?
Blood type and HLA
How is a kidney transplanted?
The old kidney is left in and the new kidney is placed in front of it
What does the nurse look for after a kidney transplant?
Golden Nectar
What is the nurse’s responsibility in a patient that just had a kidney transplant?
Keep the kidney very hydrated
Inflammation of the bladder caused by irritation or, more commonly, by infectioin
Cystitis
An inflammation of the urethra that causes symptoms similar to UTIs
Urethritis
For a patient with renal calculi, what do nursing interventions focus on?
Pain management and prevention of infection and urinary obstruction
The use of sound, laser or dry shock waves to break the renal calculi into small fragments
Lithotripsy
How much fluid should a normal person drink?
1.5-2.5 L/day
What exercises can women with incontinence do to reverse the condition?
Pelvic floor strengthening exercises
What is the kidney’s role in the human body?
Filtering wastes and balancing fluids, electrolytes, acids and bases
Involves an active bacterial infection and tissue inflammation, tubular cell necrosis, and possible abscess formation anywhere in the kidney
Acute pyelonephritis
Occurs with a lower urinary tract defect, obstruction, kidney stones, or, most commonly, when urine reflexes from the bladder back into the ureters
Chronic pyelonephritis
Why do ARF patients need a high calorie diet?
Because there is a high rate of catabolism
What types of dialysis are used in emergency situations?
Continuous renal replacement therapy, continuous arteriovenous hemofiltration, continuous arteriovenous hemodialysis and filtration
Which systemic diseases put patients at higher risk for CRF?
Diabetes Mellitus, hypertension, lupus, and sickle cell disease
What is urea the end product of?
Protein metabolism
What type of dialysis is the least disruptive to a normal lifestyle?
Continuous Ambulatory Peritoneal Dialysis
What does protein in a urinalysis indicate?
Kidney injury and muscle wasting
What would cause a BUN to be elevated?
Excessive protein intake or trauma
What is the most common cause of renal calculi?
Dehydration
Why does Diabetes Mellitus cause CRF?
The fluctuations between high and low sugars does constant damage
