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409 > Renal > Flashcards

Renal Flashcards

1
Q

decribe how a fistula works

A

bridges arterial and venous segment

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2
Q

def renal failure

A

when the kidneys cannot remove the metab waste or perform the regulatory functions

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3
Q

renal failure results in what

A

accumulation of body fluids and electrolyte disturbances

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4
Q

what is the avg amt of fluid removed per hour on the CVVD?

A

50-100 mL/ hr

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5
Q

how much fluid is removed during hemodialysis

A

2-3L

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6
Q

1 kilo=

A

1 liter

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7
Q

how long does hemodialysis last

A

on avg 3 hours

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8
Q

when would we have to stop dialysis

A

when the pressure drops too low

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9
Q

what do we give if the patients pressure drops too low during dialysis

A

vasopressors

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10
Q

what is a shiley

A

a central line access that has a double lumen and is only used for dialysis

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11
Q

what should we think when we hear the term “shiley”

A

dialysis

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12
Q

def chronic kidney disease

A

kidney damage or a decrease in GFR for 3 months or more

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13
Q

CKD leads to what if untreated

A

end stage renal disease or need for renal replacement therapy

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14
Q

what kinds of ppl ignore the needs/importance of dialysis

A

low income
uneducated
denial
geriatric

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15
Q

what are the clinical manifestations of CKD

A 
elevated serum creatinine levels
anemia
metab acidosis
fluid retention
HTN
electrolyte disorders
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16
Q

fluid retention in CKD can lead to

A

edema

HF

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17
Q

what are the primary electrolyte disturbances seen in CKD

A

calcium

phosphorous

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18
Q

def GFR

A

the amt of plasma filtered through the glomeruli per unit of time

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19
Q

what is the avg gfr

A

min/1.73 m2

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20
Q

def creatinine clearance

A

amt of creatinine the kidneys clear in a 24 hr period

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21
Q

what labs will be drawn

A

bun
creatinine
calcium
phosphorius

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22
Q

what is the significance of drawing labs in these pts?

A

assessing the trends

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23
Q

at what bp should we be worried?

A

below 130/80

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24
Q

who runs CVVD?

A

ICU nurses

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25
Q

who runs hemo?

A

dialysis nurses

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26
Q

def acute renal failure

A

rapid loss of kidney fx due to damage to the kidneys

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27
Q

what are the categories of ARF

A

pre
intra
post

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28
Q

what is pre ARF

A

caused by the conditions or subs that interfere with blood flow to the kidneys

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29
Q

what is intra ARF

A

caused by conditions that affect structure and function of the kidneys

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30
Q

what is Post ARF

A

caused by problems witht he flow of urine as it leaves the body

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31
Q

what is Post ARF

A

caused by problems witht he flow of urine as it leaves the body

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32
Q

what conditions can lead to pre- ARF

A 
shock
heart failure
insufficient pumping/blood flow 
decreased blood flow
resp failure- no perfusion with o2
low bp
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33
Q

what conditions lead to intra ARF

A 
tumors
infection
nephrotoxic abxs
trauma
kidney stones- obstructions
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34
Q

what conditions lead to post ARF

A

lacerations
cancers
obstructions
infections

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35
Q

what structures are affected in post ARF

A

bladder
ureters
urethra

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36
Q

what causes acute tubular necrosis

A

lack of oxygen to the tubes

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37
Q

what is the most common type of intrinsic ARF

A

acute tubular necrosis

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38
Q

what else causes acute tubular necrosis

A

intratubular obstructions
tubular back leak
vasoconstriction
changes in glomerular permeability (decr GFR)

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39
Q

what is usually the most common type of intratubular obstruction?

A

vascular obstruction

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40
Q

what is the minimal amt of urine production

A

30 ml/hr

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41
Q

do we flush catheters?

A

NOOOOOO!!!!!!

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42
Q

what are the phases of ARF

A

Initiation
Oliguric
Diuretic
Recovery

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43
Q

Initiation phase of ARF

A

initial injury occurs

ends when oliguria develops

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44
Q

what will you see in the oliguric phase?

A

hyperkalemia

elevated blood levels

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45
Q

what will you see in the diuretic phase of ARF?

A

gradual increase in output (GRF recovery)- temporary
blood levels stabilize/ decrease
renal fx still abnormal

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46
Q

ARF Clinical Manifestations

A 
all systems affected
critically ill/lethargic patient
dry/ dehydrated
cns symptoms- dprwsiness, h/a, muscle twitching, seizures
oliguria/anuria
elevated bun/creatinine
hyperkalemia
47
Q

what systems are affected in ARF?

A

GI
neuro
resp
cardiac

48
Q

list the cns symptoms you may see in ARF

A

drowsiness
h/a
muscle twitching
seizures

49
Q

BUN increase depends on

A

degree of catabolism (breakdown of protein)
renal perfusion
protein intake

50
Q

what does creatinine reflect?

A

kidney fx and disease progression

51
Q

hyperkalemia causes…

A

dysrhythmias

cardiac arrest

52
Q

how can you prevent ARF

A 
hydration
treat shock promptly
treat hypotension (whether from shock or not)
monitor cvp and arterial pressure
assess renal function
53
Q

normal range of BUN

A

7-18

54
Q

normal range of creatinine

A

0.6-1.2

55
Q

pharmacology interventions for ARF

A

reduce dosages of meds- more dilute
diuretics
sodium bicarb

56
Q

what contributes to nutritional imbalances in these patients

A

NV

57
Q

how is nutrition and digestion affected in ARF?

A

impaired glucose use

impaired protein synthesis

58
Q

what kind of diet is needed for these patients

A

high carb, low protein

59
Q

what electrolytes are restricted in these pts

A

K and Ph

60
Q

def ESRD

A

sustained kidney damage

final stage of CKD

61
Q

ESRD requires what kinf of therapy

A

renal replacement ther

kidney transplant

62
Q

name the 3 kinds of dialysis

A

hemo
continuous Renal Replacement Therapy (CRRT)
peritoneal

63
Q

what is the avg time span needed for CRRT?

A

5 days

64
Q

how much fluid is totally removed from the pt during CRRT

A

50-100 mL PLUS whatever we gave them

65
Q

how do we maintain bp during CRRT

A

pulling fluids slowly and in small increments per hour

66
Q

what will the patient be on at this point if CRRT is needed

A

vasopressors

67
Q

how does peritoneal dialysis work

A

fluid is placed in the abdominal/peritoneal cavity, sits for a while, and is pulled back along with waste

68
Q

below the peritoneal cavity- dirty or clean

A

dirty

69
Q

above the peritoneal cavity- dirty or clean

A

should be clean

70
Q

what part of the abdominal cavity is very vascular

A

mesenteric lining

71
Q

by what processes is peritoneal done?

A

osmosis and diffusion

72
Q

how long is the fluid in the abdominal cavity for in peritoneal?

A

approx 4 hrs

73
Q

hemodialysis extracts _______- substances

A

nitrogoneous

74
Q

hemodialys also removes what from the body

A

excess fluid

75
Q

what are the main principals of the dialyizer for hemo?

A

diffusion
osmosis
ultrafiltration

76
Q

how does diffusion on the dialyzer work

A

toxins and watses from the blood are removed

molecules move from high concentration to low conc

77
Q

how does osmosis in the dialyzer work?

A

excess water removed

low conc to high conc

78
Q

what is ultrafiltration

A

water moves under high pressure to a lower pressure

79
Q

which is more efficient ultrafiltration or osmosis?

A

ultrafiltration

80
Q

blood flows in this direction through the dialyzer

A

downward

81
Q

water flows in this direction through the dialyzer

A

upward

82
Q

what is produced from the process of dialysis and what does it look like?

A

effluent drainage- yellow

83
Q

what are the 3 types of vascular accesses used for dialysis?

A

hemo cath
AV fistula
AV graft

84
Q

hemo cath is _____ lumen

A

double

85
Q

when is a hemo cath used?

A

for acute/immediate access

86
Q

what is the problem with AV fistulas

A

take time to plan, do, and mature

87
Q

what is an AV graft?

A

synthetic tubing btw artery and vein

88
Q

when/ why is CRRT used/necessary?

A

when pts are clinically unstable for traditional hemodialysis due to fluid overload or unstable bp

89
Q

does CRRT produce rapid fluid shifts?

A

no

90
Q

name the 2 types of CRRT?

A

Continuous venous hemofiltration (CVVH)

Continuous Venous Hemodialysis (CVVHD)

91
Q

what are the dynamics of CVVH

A

continuous slow FLUID removal
hemodynamic effcets are mild
arterial access not required
** all u move is fluid molecules- K and glucose remain the same **

92
Q

is arterial access required for CVVH?

A

no

93
Q

what is the most common type of CRRT used

A

CVVHD

94
Q

what process is used during CVVH

A

ultrafiltration

95
Q

what process is used during CVVHD and why?

A

ultrafiltration PLUS concentration gradient

- to facilitate the removal of toxins AND fluid

96
Q

is arterial access required for CVVHD?

A

no

97
Q

which patients are candidates for peritoneal dialysis

A

unwilling/unable to undergo hemo
younger
working
motivated to learn how to do it on their own

98
Q

which dialysis has a slower fluid shift- hemo or peritoneal?

A

peritoneal

99
Q

what are the steps in peritoneal dialysis

A

infusion (fill)
dwell
drainage

100
Q

how long does infusion normally take during peritoneal

A

5-10 mins for 2-3 L

101
Q

what is the dwell stage of peritoneal

A

the prescribed time allowed for diffusion and osmosis

102
Q

drainage stage of peritoneal

A

end of dwell time
tubing is unclamped and solution drains
10-20 mins

103
Q

peritoneal is a _____- system

A

closed

104
Q

what is absolutely necessary for a closed system process/ procedure

A

sterile technique

105
Q

what other force aids in peritoneal?

A

gravity

106
Q

what other force aids in peritoneal?

A

gravity

107
Q

name complications of peritoneal dialysis

A

peritonitis
leakage
bleeding

108
Q

what will you see if leakage occurs

A

bloody drainage

109
Q

what may you see before bleding occurs

A

pain, change in drainage

110
Q

name the different types of peritoneal dialysis that can be implemented

A

acute intermittent PD
continuous ambulatory PD
continuous cyclic PD

111
Q

what is the goal of kidney transplant

A

to come off dialysis

112
Q

benefits of renal transplant

A

avoid dialysis
improve qual of life
decr health costs

113
Q

complications of kidney transplant

A

rejection

infection

409 (11 decks)

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