Renal Flashcards
1
Q
decribe how a fistula works
A
bridges arterial and venous segment
2
Q
def renal failure
A
when the kidneys cannot remove the metab waste or perform the regulatory functions
3
Q
renal failure results in what
A
accumulation of body fluids and electrolyte disturbances
4
Q
what is the avg amt of fluid removed per hour on the CVVD?
A
50-100 mL/ hr
5
Q
how much fluid is removed during hemodialysis
A
2-3L
6
Q
1 kilo=
A
1 liter
7
Q
how long does hemodialysis last
A
on avg 3 hours
8
Q
when would we have to stop dialysis
A
when the pressure drops too low
9
Q
what do we give if the patients pressure drops too low during dialysis
A
vasopressors
10
Q
what is a shiley
A
a central line access that has a double lumen and is only used for dialysis
11
Q
what should we think when we hear the term “shiley”
A
dialysis
12
Q
def chronic kidney disease
A
kidney damage or a decrease in GFR for 3 months or more
13
Q
CKD leads to what if untreated
A
end stage renal disease or need for renal replacement therapy
14
Q
what kinds of ppl ignore the needs/importance of dialysis
A
low income
uneducated
denial
geriatric
15
Q
what are the clinical manifestations of CKD
A
elevated serum creatinine levels anemia metab acidosis fluid retention HTN electrolyte disorders
16
Q
fluid retention in CKD can lead to
A
edema
HF
17
Q
what are the primary electrolyte disturbances seen in CKD
A
calcium
phosphorous
18
Q
def GFR
A
the amt of plasma filtered through the glomeruli per unit of time
19
Q
what is the avg gfr
A
min/1.73 m2
20
Q
def creatinine clearance
A
amt of creatinine the kidneys clear in a 24 hr period
21
Q
what labs will be drawn
A
bun
creatinine
calcium
phosphorius
22
Q
what is the significance of drawing labs in these pts?
A
assessing the trends
23
Q
at what bp should we be worried?
A
below 130/80
24
Q
who runs CVVD?
A
ICU nurses
25
who runs hemo?
dialysis nurses
26
def acute renal failure
rapid loss of kidney fx due to damage to the kidneys
27
what are the categories of ARF
pre
intra
post
28
what is pre ARF
caused by the conditions or subs that interfere with blood flow to the kidneys
29
what is intra ARF
caused by conditions that affect structure and function of the kidneys
30
what is Post ARF
caused by problems witht he flow of urine as it leaves the body
31
what is Post ARF
caused by problems witht he flow of urine as it leaves the body
32
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
```
33
what conditions lead to intra ARF
```
tumors
infection
nephrotoxic abxs
trauma
kidney stones- obstructions
```
34
what conditions lead to post ARF
lacerations
cancers
obstructions
infections
35
what structures are affected in post ARF
bladder
ureters
urethra
36
what causes acute tubular necrosis
lack of oxygen to the tubes
37
what is the most common type of intrinsic ARF
acute tubular necrosis
38
what else causes acute tubular necrosis
intratubular obstructions
tubular back leak
vasoconstriction
changes in glomerular permeability (decr GFR)
39
what is usually the most common type of intratubular obstruction?
vascular obstruction
40
what is the minimal amt of urine production
30 ml/hr
41
do we flush catheters?
NOOOOOO!!!!!!
42
what are the phases of ARF
Initiation
Oliguric
Diuretic
Recovery
43
Initiation phase of ARF
initial injury occurs
| ends when oliguria develops
44
what will you see in the oliguric phase?
hyperkalemia
| elevated blood levels
45
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
46
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
```
47
what systems are affected in ARF?
GI
neuro
resp
cardiac
48
list the cns symptoms you may see in ARF
drowsiness
h/a
muscle twitching
seizures
49
BUN increase depends on
degree of catabolism (breakdown of protein)
renal perfusion
protein intake
50
what does creatinine reflect?
kidney fx and disease progression
51
hyperkalemia causes...
dysrhythmias
| cardiac arrest
52
how can you prevent ARF
```
hydration
treat shock promptly
treat hypotension (whether from shock or not)
monitor cvp and arterial pressure
assess renal function
```
53
normal range of BUN
7-18
54
normal range of creatinine
0.6-1.2
55
pharmacology interventions for ARF
reduce dosages of meds- more dilute
diuretics
sodium bicarb
56
what contributes to nutritional imbalances in these patients
NV
57
how is nutrition and digestion affected in ARF?
impaired glucose use
| impaired protein synthesis
58
what kind of diet is needed for these patients
high carb, low protein
59
what electrolytes are restricted in these pts
K and Ph
60
def ESRD
sustained kidney damage
| final stage of CKD
61
ESRD requires what kinf of therapy
renal replacement ther
| kidney transplant
62
name the 3 kinds of dialysis
hemo
continuous Renal Replacement Therapy (CRRT)
peritoneal
63
what is the avg time span needed for CRRT?
5 days
64
how much fluid is totally removed from the pt during CRRT
50-100 mL PLUS whatever we gave them
65
how do we maintain bp during CRRT
pulling fluids slowly and in small increments per hour
66
what will the patient be on at this point if CRRT is needed
vasopressors
67
how does peritoneal dialysis work
fluid is placed in the abdominal/peritoneal cavity, sits for a while, and is pulled back along with waste
68
below the peritoneal cavity- dirty or clean
dirty
69
above the peritoneal cavity- dirty or clean
should be clean
70
what part of the abdominal cavity is very vascular
mesenteric lining
71
by what processes is peritoneal done?
osmosis and diffusion
72
how long is the fluid in the abdominal cavity for in peritoneal?
approx 4 hrs
73
hemodialysis extracts _______- substances
nitrogoneous
74
hemodialys also removes what from the body
excess fluid
75
what are the main principals of the dialyizer for hemo?
diffusion
osmosis
ultrafiltration
76
how does diffusion on the dialyzer work
toxins and watses from the blood are removed
| molecules move from high concentration to low conc
77
how does osmosis in the dialyzer work?
excess water removed
| low conc to high conc
78
what is ultrafiltration
water moves under high pressure to a lower pressure
79
which is more efficient ultrafiltration or osmosis?
ultrafiltration
80
blood flows in this direction through the dialyzer
downward
81
water flows in this direction through the dialyzer
upward
82
what is produced from the process of dialysis and what does it look like?
effluent drainage- yellow
83
what are the 3 types of vascular accesses used for dialysis?
hemo cath
AV fistula
AV graft
84
hemo cath is _____ lumen
double
85
when is a hemo cath used?
for acute/immediate access
86
what is the problem with AV fistulas
take time to plan, do, and mature
87
what is an AV graft?
synthetic tubing btw artery and vein
88
when/ why is CRRT used/necessary?
when pts are clinically unstable for traditional hemodialysis due to fluid overload or unstable bp
89
does CRRT produce rapid fluid shifts?
no
90
name the 2 types of CRRT?
Continuous venous hemofiltration (CVVH)
| Continuous Venous Hemodialysis (CVVHD)
91
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 ***
92
is arterial access required for CVVH?
no
93
what is the most common type of CRRT used
CVVHD
94
what process is used during CVVH
ultrafiltration
95
what process is used during CVVHD and why?
ultrafiltration PLUS concentration gradient
| - to facilitate the removal of toxins AND fluid
96
is arterial access required for CVVHD?
no
97
which patients are candidates for peritoneal dialysis
unwilling/unable to undergo hemo
younger
working
motivated to learn how to do it on their own
98
which dialysis has a slower fluid shift- hemo or peritoneal?
peritoneal
99
what are the steps in peritoneal dialysis
infusion (fill)
dwell
drainage
100
how long does infusion normally take during peritoneal
5-10 mins for 2-3 L
101
what is the dwell stage of peritoneal
the prescribed time allowed for diffusion and osmosis
102
drainage stage of peritoneal
end of dwell time
tubing is unclamped and solution drains
10-20 mins
103
peritoneal is a _____- system
closed
104
what is absolutely necessary for a closed system process/ procedure
sterile technique
105
what other force aids in peritoneal?
gravity
106
what other force aids in peritoneal?
gravity
107
name complications of peritoneal dialysis
peritonitis
leakage
bleeding
108
what will you see if leakage occurs
bloody drainage
109
what may you see before bleding occurs
pain, change in drainage
110
name the different types of peritoneal dialysis that can be implemented
acute intermittent PD
continuous ambulatory PD
continuous cyclic PD
111
what is the goal of kidney transplant
to come off dialysis
112
benefits of renal transplant
avoid dialysis
improve qual of life
decr health costs
113
complications of kidney transplant
rejection
| infection
