Renal

Question 1

Renal questions

Answer 1

any kidney problems
infx- how often/frequent 
kidney stones
bladder infection 
CRF-due to what
Dialysis: last, frequency, wt before and after, ant take off, how do you tolerate it
nephrologist?
change in diet- avoidance of protein
b&b changes

Question 2

Acute renal failure

Answer 2

don’t take to OR unless emergent

Question 3

Chronic renal failure

Answer 3

when dx, dialysis, AV fistula?

Question 4

Dialysis required and does what

Answer 4

GFR>10, oliguria, fluid overload, hyperK, sever acidosis, encephalopathy
remove metabolic waste, urea
restore buffers to blood

Question 5

pre op: dialysis should

Answer 5

be done with in 24hrs
note pre and post wt
amt taken off
***K >5.5
don't give Succ

Question 6

AV fistula

Answer 6

between cephalic vein and radial art

*no BP IV

Question 7

peritoneal dialysis

Answer 7

implanted catheter

can’t tolerate big fluid changes

Question 8

Dialysis and meds

Answer 8

give after,

LMWH, water soluble, and protein bound redly cleared by dialysis

Question 9

Question to ask in RF

Answer 9

acute/chronic
what was cause: DM, HTN, drug?
dialysis-how often, when was last
where is fistula

Question 10

Renal assessment

Answer 10

Neuro: encephalopathy 
Heme: anemia
CV: CHF, HTN, arrhythmias, 
Fluid balance: 
Pulm: pulm edema 
endocrine: poor flu tol, inc hormones
GI/liver: inc risk of GI hemorrhage, delayed gastric emptying

Question 11

Renal neuro

post dialysis

Answer 11

uremic encephalopathy
asterixis (jerky mvmt) sz, lethargic, confusion, autonomic/ peripheral neuropathy
**post dialysis: disequilibrium syndrome-CNS disturbance after rapid dec in ECF osmolality
ASK: orientation, dizziness, weak…baseline!

Question 12

renal Heme

Answer 12

anemia typical: 6-8 chronic
dec EPO, RBC production, BM suppression
*most tolerate anemia except CAD 
Shift to the Right
m acidosis 
dec O2 carrying capacity 
try not to transfuse- risk of transplant rejection
impaires plts- prolonged bleeding time 
dec adhesiveness and aggression 
impaired WBC function-- infx
release of defective vWF

Question 13

pre op: dialysis should

Answer 13

be done with in 24hrs
note pre and post wt
amt taken off
***K >5.5
don't give Succ
*ask about bruising, bleeding, take EPO, GIB
residual anticoag--cause hypercoag

Question 14

Aseptic technique

Answer 14

infx common

ETT, IV

Question 15

CV assessment Renal 8

Answer 15

• Inc CO bc of anemia -compensation fo dec O2 carrying capacity
• HTN
• LVH- with HTN
• CHF and pulm edema–fluid overload
• Deposits of Ca on conduction system and valves
• Arrhythmias- hyperK
• Uremic pericarditis- tamponde 2nd to inadequate dialysis
• CAD/PVD- HTN, DM

Question 16

fluid balance asmt Renal

Answer 16

fluid overload vs. IV depletion after dialysis

Assess: skin turgor, mucous membrane, body at and VS–HTON

Question 17

Pulm asmt Renal

Answer 17

inc MV to compensate for m acidosis
widening A-a gradient bc of leaky pulm cap
Butterfly wings on CXR bc of inc Permeability of alveolar cap membrane
SOB, pulm edema ASK: hospitalizations fo pulm edema?

Question 18

endocrine asmt Renal

Answer 18

peripheral resistance to insulin = poor glu tolerance
hypERparathyroidism—fx
abn lipid metab— inc Atherosclerosis
inc circulation hormones–vasodilatory properties

Question 19

GI/Liver asmt Renal

Answer 19

GI hemorrhage, anorexia, delayed gastric emptying

Question 20

RF impacts on drugs

Answer 20

Me Ape
anemia- impaired O2 demand (epic, Ketamine)
dec serum potein: inc free drug
elyte imbalance: no Succ
abn cell membrane activity: inc access to cell
Contraindicated eliminated UNCHANGED by kidney

Question 21

Renal physical

Answer 21

VS , mucus membrane, orthostatics Heart Lungs, airway