Renal Flashcards
decribe how a fistula works
bridges arterial and venous segment
def renal failure
when the kidneys cannot remove the metab waste or perform the regulatory functions
renal failure results in what
accumulation of body fluids and electrolyte disturbances
what is the avg amt of fluid removed per hour on the CVVD?
50-100 mL/ hr
how much fluid is removed during hemodialysis
2-3L
1 kilo=
1 liter
how long does hemodialysis last
on avg 3 hours
when would we have to stop dialysis
when the pressure drops too low
what do we give if the patients pressure drops too low during dialysis
vasopressors
what is a shiley
a central line access that has a double lumen and is only used for dialysis
what should we think when we hear the term “shiley”
dialysis
def chronic kidney disease
kidney damage or a decrease in GFR for 3 months or more
CKD leads to what if untreated
end stage renal disease or need for renal replacement therapy
what kinds of ppl ignore the needs/importance of dialysis
low income
uneducated
denial
geriatric
what are the clinical manifestations of CKD
elevated serum creatinine levels anemia metab acidosis fluid retention HTN electrolyte disorders
fluid retention in CKD can lead to
edema
HF
what are the primary electrolyte disturbances seen in CKD
calcium
phosphorous
def GFR
the amt of plasma filtered through the glomeruli per unit of time
what is the avg gfr
min/1.73 m2
def creatinine clearance
amt of creatinine the kidneys clear in a 24 hr period
what labs will be drawn
bun
creatinine
calcium
phosphorius
what is the significance of drawing labs in these pts?
assessing the trends
at what bp should we be worried?
below 130/80
who runs CVVD?
ICU nurses
who runs hemo?
dialysis nurses
def acute renal failure
rapid loss of kidney fx due to damage to the kidneys
what are the categories of ARF
pre
intra
post
what is pre ARF
caused by the conditions or subs that interfere with blood flow to the kidneys
what is intra ARF
caused by conditions that affect structure and function of the kidneys
what is Post ARF
caused by problems witht he flow of urine as it leaves the body
what is Post ARF
caused by problems witht he flow of urine as it leaves the body
what conditions can lead to pre- ARF
shock heart failure insufficient pumping/blood flow decreased blood flow resp failure- no perfusion with o2 low bp
what conditions lead to intra ARF
tumors infection nephrotoxic abxs trauma kidney stones- obstructions
what conditions lead to post ARF
lacerations
cancers
obstructions
infections
what structures are affected in post ARF
bladder
ureters
urethra
what causes acute tubular necrosis
lack of oxygen to the tubes
what is the most common type of intrinsic ARF
acute tubular necrosis
what else causes acute tubular necrosis
intratubular obstructions
tubular back leak
vasoconstriction
changes in glomerular permeability (decr GFR)
what is usually the most common type of intratubular obstruction?
vascular obstruction
what is the minimal amt of urine production
30 ml/hr
do we flush catheters?
NOOOOOO!!!!!!
what are the phases of ARF
Initiation
Oliguric
Diuretic
Recovery
Initiation phase of ARF
initial injury occurs
ends when oliguria develops
what will you see in the oliguric phase?
hyperkalemia
elevated blood levels
what will you see in the diuretic phase of ARF?
gradual increase in output (GRF recovery)- temporary
blood levels stabilize/ decrease
renal fx still abnormal
ARF Clinical Manifestations
all systems affected critically ill/lethargic patient dry/ dehydrated cns symptoms- dprwsiness, h/a, muscle twitching, seizures oliguria/anuria elevated bun/creatinine hyperkalemia
what systems are affected in ARF?
GI
neuro
resp
cardiac
list the cns symptoms you may see in ARF
drowsiness
h/a
muscle twitching
seizures
BUN increase depends on
degree of catabolism (breakdown of protein)
renal perfusion
protein intake
what does creatinine reflect?
kidney fx and disease progression
hyperkalemia causes…
dysrhythmias
cardiac arrest
how can you prevent ARF
hydration treat shock promptly treat hypotension (whether from shock or not) monitor cvp and arterial pressure assess renal function
normal range of BUN
7-18
normal range of creatinine
0.6-1.2
pharmacology interventions for ARF
reduce dosages of meds- more dilute
diuretics
sodium bicarb
what contributes to nutritional imbalances in these patients
NV
how is nutrition and digestion affected in ARF?
impaired glucose use
impaired protein synthesis
what kind of diet is needed for these patients
high carb, low protein
what electrolytes are restricted in these pts
K and Ph
def ESRD
sustained kidney damage
final stage of CKD
ESRD requires what kinf of therapy
renal replacement ther
kidney transplant
name the 3 kinds of dialysis
hemo
continuous Renal Replacement Therapy (CRRT)
peritoneal
what is the avg time span needed for CRRT?
5 days
how much fluid is totally removed from the pt during CRRT
50-100 mL PLUS whatever we gave them
how do we maintain bp during CRRT
pulling fluids slowly and in small increments per hour
what will the patient be on at this point if CRRT is needed
vasopressors
how does peritoneal dialysis work
fluid is placed in the abdominal/peritoneal cavity, sits for a while, and is pulled back along with waste
below the peritoneal cavity- dirty or clean
dirty
above the peritoneal cavity- dirty or clean
should be clean
what part of the abdominal cavity is very vascular
mesenteric lining
by what processes is peritoneal done?
osmosis and diffusion
how long is the fluid in the abdominal cavity for in peritoneal?
approx 4 hrs
hemodialysis extracts _______- substances
nitrogoneous
hemodialys also removes what from the body
excess fluid
what are the main principals of the dialyizer for hemo?
diffusion
osmosis
ultrafiltration
how does diffusion on the dialyzer work
toxins and watses from the blood are removed
molecules move from high concentration to low conc
how does osmosis in the dialyzer work?
excess water removed
low conc to high conc
what is ultrafiltration
water moves under high pressure to a lower pressure
which is more efficient ultrafiltration or osmosis?
ultrafiltration
blood flows in this direction through the dialyzer
downward
water flows in this direction through the dialyzer
upward
what is produced from the process of dialysis and what does it look like?
effluent drainage- yellow
what are the 3 types of vascular accesses used for dialysis?
hemo cath
AV fistula
AV graft
hemo cath is _____ lumen
double
when is a hemo cath used?
for acute/immediate access
what is the problem with AV fistulas
take time to plan, do, and mature
what is an AV graft?
synthetic tubing btw artery and vein
when/ why is CRRT used/necessary?
when pts are clinically unstable for traditional hemodialysis due to fluid overload or unstable bp
does CRRT produce rapid fluid shifts?
no
name the 2 types of CRRT?
Continuous venous hemofiltration (CVVH)
Continuous Venous Hemodialysis (CVVHD)
what are the dynamics of CVVH
continuous slow FLUID removal
hemodynamic effcets are mild
arterial access not required
** all u move is fluid molecules- K and glucose remain the same **
is arterial access required for CVVH?
no
what is the most common type of CRRT used
CVVHD
what process is used during CVVH
ultrafiltration
what process is used during CVVHD and why?
ultrafiltration PLUS concentration gradient
- to facilitate the removal of toxins AND fluid
is arterial access required for CVVHD?
no
which patients are candidates for peritoneal dialysis
unwilling/unable to undergo hemo
younger
working
motivated to learn how to do it on their own
which dialysis has a slower fluid shift- hemo or peritoneal?
peritoneal
what are the steps in peritoneal dialysis
infusion (fill)
dwell
drainage
how long does infusion normally take during peritoneal
5-10 mins for 2-3 L
what is the dwell stage of peritoneal
the prescribed time allowed for diffusion and osmosis
drainage stage of peritoneal
end of dwell time
tubing is unclamped and solution drains
10-20 mins
peritoneal is a _____- system
closed
what is absolutely necessary for a closed system process/ procedure
sterile technique
what other force aids in peritoneal?
gravity
what other force aids in peritoneal?
gravity
name complications of peritoneal dialysis
peritonitis
leakage
bleeding
what will you see if leakage occurs
bloody drainage
what may you see before bleding occurs
pain, change in drainage
name the different types of peritoneal dialysis that can be implemented
acute intermittent PD
continuous ambulatory PD
continuous cyclic PD
what is the goal of kidney transplant
to come off dialysis
benefits of renal transplant
avoid dialysis
improve qual of life
decr health costs
complications of kidney transplant
rejection
infection
