Renal 2 Flashcards
the increased fluid in renal failure causes
risk for heart failure
describe the electrolyte imbalance of renal failure
- potassium levels increase in the blood (hyperkalemia and acidosis- Kussmol breathing)
- phosphorus increases
this is caused by renal deficiency (inadequate calcium and phosphorus levels)
renal osteodystrophy
what electrolytes are inversely related
calcium and phosphorus
what is a healthy glomerulous filter rate (GFR)
> 90 mL/min
broadly describe acute kidney disease
- oliguric phase, diuretic phase, recovery phase
- expect pt to recover
- kidneys injured by prerenal, intrarenal, or postrenal
describe oliguric phase of AKD
- <400 mL/day
- occurs within 1-7 days of kidney injury
- metabolic acidosis
- hyperkalemia and hyponatremia
- increased BUN and creatinine
- fatigue
describe diuretic phase of AKD
- 1-3 L/day
- manage fluid volume deficit (loss)
- hypovolemia, dehydration
- hypotension
- BUN and creatinine normalize
describe recovery phase of AKD
- begins with GFR increase
- BUN and creatinine levels plateau then decrease
- can occur up to a year after injury
broadly describe chronic kidney disease
- progressive, irreversible kidney disease
- glomerular function excessively decreases in BOTH kidneys
what is azotemia
increased nitrogen wastes (common in CKD)
GFR in ESRD
GFR<15 mL/min
- *kidney is NOT functioning in end stage
- NEED to implement dialysis or transplant
what is important to remember about GFR
parameters differ by race and gender
if pt at stage 1 of kidney failure what is goal
lengthen amount of time until getting to stage 5 (lifestyle changes)
metabolic changes of CKD
- increase in BUN and Cr
- increase in hydrogen
- elevated potassium (7 or 8)- leads to cardiac arrest
- elevated sodium in later stages
- decreased Ca, increased phosphorus (inversely related)
describe peritoneal dialysis
- easy access
- fewer hemodynamic complications
- infections and adhesions can occur
- less effective
- protein loss and peritonitis
- uses intra abdominal cath (often done at night)
describe hemodialysis
- specific facility (3-4 day a week)
- short time treatment
- better clearance
- disequilibrium
- muscle cramps
- hemorrhage
- restricted diet
- moves a lot of blood, FAST
describe AV graft
- can use it in 2 wks
- for chronic dialysis pt who does not have adequate blood vessels for the creation of a fistula
describe AV fistula
- natural way
- surgical connection of artery and vein
- fistula matures high pressure system
important to remember for AV fistula
- do NOT take BP or blood draws from arm with fistula
- don’t compromise access site
describe continuous ambulatory peritoneal dialysis (CAPD)
- 20 min process, every night
- catheter is in cavity, not any organ
- take dialysate(made specifically for individual)
how do you do a CAPD
inflow, clamp, dwell, unclamp, flow out with toxins and fluids
automated peritoneal dialysis
- preferred by most pts on peritoneal dialysis
- can perform exchange while sleeping
complications of peritoneal dialysis
- peritonitis (contaminated catheter will cause cloudy outflow)
- pain esp in back (d/t fluid)
- poor outflow and leakage
important to remember for peritoneal dialysis
whatever goes in should be coming out
ex/ if 200 mL in, 200 mL needs to come out
turn pt side to side to get out
interventions for peritoneal dialysis
- Sterile procedure
- warm temp of dialysate (prevent cramping and constriction)
