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High Acuity Exam 2 > Renal > Flashcards

Renal Flashcards

1
Q

normal GFR

A

above 90

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2
Q

which lab is the key indicator of renal function

A

GFR

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3
Q

what is uremia

A

BUN over 80

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4
Q

what is GFR measuring?

A

amt of blood filtered through kidneys per minute

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5
Q

what is BUN measuring?

A

amount of urea in blood; indicates filtration efficiency

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6
Q

purposes of bladder scanning

A

troubleshooting UO, determine post void residual, need for catheterization

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7
Q

post-biopsy monitoring

A

bleeding, hematoma, pain, hematuria

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8
Q

AKI hallmark symptoms

A

increased BUN & Cr, decreased UO

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9
Q

AKI symptoms

A

metabolic alkalosis, hyperkalemia, hyponatremia, FVO, hypocalcemia

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10
Q

metabolic alkalosis in AKI

A

can cause arrhythmias, hyperK, confusion, seizure, increased RR; give bicarb or dialyze

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11
Q

hyperkalemia symptoms - 5-6

A

muscle weakness, nausea

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12
Q

hyperK symptoms - 6-6.5

A

peaked T waves

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13
Q

hyperK symptoms - 6.5-7.5

A

bundle branch block, dampened Ps and Ts

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14
Q

hyperK symptoms - 7.5+

A

no P waves, wide QRS

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15
Q

hyperkalemia treatment - under 6.5

A

limit K, diuretic, get a 12-lead & put on monitor

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16
Q

hyperK treatment - over 6.5

A

12-lead, put on monitor, hyperkalemia protocol

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17
Q

hyperkalemia protocol

A

insulin + dextrose, bicarb IVP, albuterol, calcium IVP

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18
Q

hyperK treatment - above 7

A

emergent dialysis

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19
Q

hypocalcemia symptoms

A

numbness + tingling, Chvostek’s, Trousseau’s, tetany, seizure, clotting dysfx

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20
Q

hypocalcemia treatment

A

phosphate binder, PO or IV supplementation

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21
Q

FVO treatment

A

fluid restriction, diuretics, supplement Na, I+Os, daily weights

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22
Q

hyponatremia s/s

A

headache, lethargy, confusion, coma, seizure, irreg breathing

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23
Q

hyponatremia treatment

A

fluid restriction, diuretic, NS infusion, dialysis or hypertonic saline if severe

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24
Q

what are the stages of AKI?

A

onset, oliguric, diuretic, recovery

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25
onset stage of AKI
subtle s/s - HTN, mildly decreased UO & lab changes
26
oliguric stage of AKI
less than 400mL/day, increased BUN & Cr; hypoNa, hyperK, metabolic acidosis occur
27
diuretic stage of AKI
UO over 4L/day, hypoNa; can't concentrate urine - F&E replacement
28
recovery stage of AKI
gradual improvement & labs slowly return to normal - but some damage can be permanent
29
causes of pre-renal AKI
hypovolemia, shock, HF, low CO, vasopressor use, burns, renal artery stenosis
30
risk of pre-renal AKI
can cause intrarenal damage - causing intrinsic AKI
31
causes of intrinsic AKI
nephrotoxins, TLS, contrast, untreated prerenal AKI, ATN
32
what is ATN
acute tubular necrosis - ischemic kidney injury
33
IV contrast considerations
check allergies, BUN, & Cr before; bolus before & after; no metformin; monitor UO
34
what procedure puts u at highest risk for contrast-associated AKI?
cardiac catheterization
35
how often should IV contrast be given
ideally only once every 24h
36
causes of postrenal AKI
kidney stone, tumor, BPH, neurogenic bladder
37
intrinsic AKI treatment
supportive care - monitor F&E, I+Os, BP, etc.
38
postrenal AKI treatment
relieve obstruction, nephrostomy, stent, etc.
39
urolithiasis
kidney stones
40
s/s of urolithiasis
severe, colicky flank pain
41
urolithiasis tx
IVF, removal
42
pyelonephritis
kidney infection, sepsis risk
43
pyelonephritis s/s
fever, chills, flank pain, dysuria
44
pyelonephritis tx
IVF, abx
45
nephrotic syndrome s/s
severe edema, significant proteinuria
46
nephrotic syndrome tx
diuretics
47
glomerulonephritis
inflammation of glomerulus
48
glomerulonephritis s/s
proteinuria, hematuria, edema, HTN
49
glomerulonephritis tx
control HTN & FVO, steroids
50
polycystic kidney disease s/s
HTN, hematuria, pain, high infection risk
51
polycystic kidney disease treatment
symptom mgmt/supportive care - no cure
52
CKD diagnostic criteria
GFR <60 for 3+ months
53
CV s/s of CKD
HTN, FVO, HF, increased stroke risk
54
GI s/s of CKD
n/v/d, anorexia, bleeding, dyspepsia
55
hematologic s/s of CKD
anemia, thrombocytopenia
56
resp s/s of CKD
pulmonary edema, Kussmaul respirations from met. alkalosis
57
skin s/s of CKD
ulcers, calciphylaxis, pruritis, uremic frost
58
main goal of CKD
prevent progression to ESRD
59
how can u prevent CKD from getting worse?
aggressive BP control - goal 140/90
60
ideal antihypertensives in CKD
ACE inhibitors, ARBs
61
ACE inhibitors
lisinopril, captopril
62
ACE inhibitors side effects
cough, angioedema
63
ARBs
losartan, valsartan
64
CCBs
verapamil, nicardipine, diltiazem
65
tunneled catheter indications
needs dialyzed while waiting for fistula to mature
66
when can the access catheters be used for dialysis?
as soon as placement is verified by xray
67
nontunneled catheter indications
emergent/short term need for dialysis
68
AV graft
heals in 2-4 weeks, but only lasts 2-3 years
69
what is the preferred access for dialysis? why?
AV fistula - lasts a lifetime, low infection risk, easier for pt
70
assessment of AV dialysis access
thrill & bruit; limb alert, monitor for steal syndrome
71
steal syndrome
fistula "steals" distal blood flow - do neurovascular checks
72
before dialysis interventions
weigh, hold antihypertensives, hold abx until after
73
during dialysis assessments
hypotension, arrhythmias, hypothermia, cramping, disequilibrium syndrome
74
what is disequilibrium syndrome
cerebral edema from rapid fluid shifts during dialysis
75
disequilibrium syndrome s/s
headache, n/v, confusion, seizure, coma
76
disequilibrium syndrome prevention
shorter more frequent sessions, decrease rate
77
CRRT indications
hemodynamically unstable patients - cannot handle big fluid shifts
78
CRRT mgmt
trend pressures - clotting risk; hypothermia, monitor lytes, strict I&Os to adjust removal rate
79
peritoneal dialysis contraindications
AKI, DM, abd infections, adhesions, surgeries, or hernias
80
complications from peritoneal dialysis
infection, poor drainage, pain, hyperglycemia, SOB, weight gain
81
pt education for peritoneal dialysis
aseptic technique, s/s of infection, warm dialysate, reposition if flow is poor

High Acuity Exam 2 (2 decks)

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