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Unit #3 > Renal > Flashcards

Renal Flashcards

1
Q

Glomerular filtration definition

A

Passive, non-selective process- hydrostatic pressure forces fluid and dilutes through membrane.

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2
Q

GFR definition

A

Amount of fluid filtered from blood into capsule per minute

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3
Q

Urine formation

A
  1. By Kidneys: processes 180 L of blood-derived fluid a day. 1% is excreted as urine, rest is returned to circulation.
  2. By nephrons via 3 processes.
    - glomerular filtration
    - tubular reabsorption
    - tubular secretion
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4
Q

Serum creatinine

A
  1. 6-1.2 mg/dL (male)

0. 5-1.1 mg/dL (female)

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5
Q

Creatinine clearance

A

90-139 mL/min/m2 (male)

80-125 mL/min/m2 (female)

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6
Q

Serum albumin

A

3.2-5 g/dL

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7
Q

K+

A

3.5-5 mEq/L

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8
Q

Sodium

A

135-145 mEq/L

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9
Q

Calcium

A

4.5-5.5 mEq/L

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10
Q

Phosphorus

A

3-4.5 mg/dL

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11
Q

RBCs

A

4.0-6.2 million/mm3

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12
Q

GFR

A

125 mL/min

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13
Q

Polyuria

A

Urine volume >2L/day

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14
Q

Oliguria

A

Urine output

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15
Q

Hematuria

A

Most characteristic of glomerulonephritis. May also be due to trauma or tumor

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16
Q

Osmolality

A

1200 normal

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17
Q

RIFLE

Acute kidney injury progression CKD

A 
R- risk
I- injury
F- failure
L- loss
E- end stage kidney disease
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18
Q

Types of AKI: pre renal azotemia

S/S

A

AKI: pre renal azotemia

  • hypotension
  • tachycardia
  • decrease UO
  • decreased CVP
  • decreased cardiac output
  • lethargy
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19
Q

Types of AKI: intrarenal; post renal key features

A

Renal:

  • oliguria, anuria
  • ^urine specific gravity

Cardiac:

  • HTN
  • tachycardia
  • JVD
  • increased CVP
  • ECG changes; tall T waves

Respiratory:

  • SOB
  • Orthopnea
  • crackles
  • pulmonary edema
  • friction rub

GI:
-anorexia, N/V, flank pain

Neuro:
Lethargy, HA, tremors, confusion

General:
-generalized edema, weight gain

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20
Q

BUN

A

10-20 mg/dL

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21
Q

Bicarbonate level

A

21-28 mEq/L

Decreases in kidney disease

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22
Q

Causes of Prerenal AKI

A

Any condition decreasing blood flow to the kidneys leading to ischemia in nephrons;

  • shock (hypovolemia, hemorrhage)
  • heart failure
  • pulmonary embolism
  • anaphylaxis
  • sepsis
  • pericardial tamponade
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23
Q

Causes of intrarenal AKI

A

Actual physical, chemical, hypoxic, or immunologic damage directly to kidney tissue;

  • acute interstitial nephritis
  • exposure to nephrotoxins
  • acute glomerular nephritis
  • vasculitis
  • acute tubular necrosis
  • renal artery/vein stenosis
  • renal artery/vein thrombosis
  • formation of crystals/precipitates in nephron tubes
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24
Q

Causes postrenal AKI

A

Obstruction of urine collecting system anywhere from calyces to the urethral meatus;

  • ureter, bladder, urethral cancer
  • kidney, ureter, bladder stones
  • bladder atony
  • prostatic hyperplasia, or cancer
  • cervical cancer
25
Q

Amount of fluid permitted

A

Equal to urine volume plus 500 mL

26
Q

Indications for dialysis

A 
Presence of uremia
Persistent high K+
Metabolic acidosis
Continues fluid overload
Uremic pericarditis
Encephalopathy
27
Q

Peritoneal dialysis

A

Uses peritoneum as dialysing membrane.
Abdominal cath care needed.
Can be done at home

Fill, dwell, drain

Fluid should be clear, yellow

28
Q

Hemodialysis

A
  • HDC Have 2 or 3 lumens: inflow/outflow & blood draw.
  • IJ or subclavian vein
  • AV fistula or AV graft
  • have to have dialysate
  • complex, more efficient clearance
29
Q

Chronic kidney disease

A

Progressive, irreversible disorder; kidney function does not recover.

30
Q

Uremia S/S

A
  • metallic taste in mouth
  • anorexia
  • N/V
  • muscle cramps
  • uremic “frost” on skin
  • itching
  • fatigue & lethargy
  • hiccups
  • edema
  • dyspnea
  • muscle cramps
  • parasthesias
31
Q

End-stage kidney disease

ESKD

A

When kidney function is too poor to sustain life

32
Q

4 different types of CRRT

A
  1. SCUF
    - slow continuous ultrafiltration
  2. CVVH
    - continuous vevo venous hemofiltration
  3. CVVHD
    - continuous vevo venous hemodiafiltration
  4. CVVHDF
    - continuous vevo venous haemodiafiltration
33
Q

Never give hemodialysis pts these type of drinks

A

Citrus drinks.
Orange, grapefruit, prune, or tomato.

Cranberry is okay

34
Q

Foods high in potassium avoided in hemodialysis pts

A

Oranges, bananas, prunes, extra milk. Not to be given.

Mandarin oranges are fine.

35
Q

Check patency of fistula daily by:

A

Feeling for thrill over anastomosis along fistula.

And by listening for bruit with a stethoscope.

36
Q

Hemodialysis

A

Used with patients in L & E levels of AKI.
Indications for dialysis include:
-presence of uremia, persistent high K+,
metabolic acidosis, cont. fluid overload, uremic pericarditis, & encephalopathy.

37
Q

Hemodialysis catheter (HDC)

A

Usually in internal jugular or subclavian vein.
Femoral site may be used but only for a couple of days (high risk infection)

Subclavian HDC Inserted at bedside by physician or NP.

Monitor for manifestations of complications:
Pneumothorax (reduced breath sounds, tracheal deviation, poor movement one side of chest), subcutaneous emphysema.

Cath is checked by xray before use.

38
Q

Nursing care for pt returning from dialysis

A

Monitor for side effects:

  • hypotension
  • N/V
  • headache
  • malaise
  • dizziness
  • muscle cramps
  • assess vascular access site
  • observe for bleeding
  • monitor LOC

Obtain VS & weight to compare.
All invasive procedures must be avoided for 4-6 hrs after dialysis.

39
Q

Digoxin

A 
Pts with kidney failure at high risk for toxicity.
S/S: 
-N/V
-anorexia
-visual changes
-restlessness
-headache
-fatigue
-confusion
-bradycardia & tachycardia

Therapeutic range: (0.8-2 ng/mL)

40
Q

Hypophosphatemia

A

Complication of phosphate binding, especially in pts who are not eating adequately but are continuing to take phosphate-binding drugs.

41
Q

Aluminum based phosphate binders

Aluminum hydroxide

A 
If taken for prolonged periods, aluminum deposits may cause none disease or permanent neuro problems. 
Monitor:
-muscle weakness
-anorexia
-malaise
-tremors
-bone pain
42
Q

Calcium acetate & calcium carbonate, aluminum hydroxide

A

Used as phosphate binding agents and help prevent renal osteodystrophy.

43
Q

Phases of oliguric AKI

A
  1. Onset
    Begins with precipitating event & cont. until oliguria develops
  2. Oliguric phase
    Urine output of 100-400 mL/24hr
    Does not respond to fluid challenges or diuretics
  3. Diuretic phase
    Sudden onset wishing 2-6 wk post oliguric phase. Urine flow increases rapidly & can result in UO of up to 10L/day
  4. Recovery phase (convalescent)
    Pt begins to return to normal levels of activity. Complete recovery may take up to 12 mths.
44
Q

Bumetanide

A

Loop diuretic
May cause muscle cramps, dizziness, hypotension, HA, nausea

Obtain baseline VS before admin, assess for edema.
Teach pt to eat foods high in K+ such as; whole grains (cereals), legumes, meats, bananas, apricots, OJ, potatoes, raisins.

45
Q

Triamterene

A

K+ sparing diuretic
Anti edema, anti hypertensive

Side effects: fatigue, nausea, diarrhea, abdominal pain, leg cramps, HA

Watch for hyperkalemia (muscle changes, tremors, cramps, AMS, cardiac arrhythmias)

46
Q

Calcium carbonate

Calcium acetate

A

Administer with meals, thoroughly chew tabs
Give plenty of water.

Teach: do not take within 1-2h of oral medications, fiber containing food

47
Q

Sodium polystyrene sulfate

Kayexalate

A

Antihyperkalemic
Do not mix with OJ if giving PO.

Side effects: anorexia, N/V, constipation.
Can cause fecal impaction in elderly.

Monitor K+ levels, assess EKG, mag, calcium levels, daily bowel pattern.

48
Q

Epoetin Alfa

Epogen

A

Glycoprotein, erythropoietin

Used in tx of anemia to lessen need for RBC transfusion in chronically ill pts.

Side effects: fever, diarrhea, N/V, edema

49
Q

Potassium chloride

A

Potassium replenisher

Side effects: N/V, diarrhea, flatulence, abdominal discomfort w/distention, phlebitis with IV admin (particularly when concentration >40m q/L)

Assess for hyperkalemia; skin pallor/coldness, paresthesia, feeling of “heaviness” in lower extremities.

50
Q

Caring for a pt with PD catheter

A

-mask yourself/patient. Wash hands
-put on sterile gloves, remove old dressing, remove dirty gloves
-assess for s/s of infection; swelling, redness, or discharge around site
-use aseptic (sterile) technique
***To clean use cotton swabs soaked in iodine
Cover with sterile two 4x4, tape only edges of gauze.

51
Q

Dry weight

A

Weight after all the extra fluid is taken off

52
Q

Major complication of PD

A

Peritonitis
*cloudy dialysate outflow (effluent), fever, abdominal tenderness, pain, general malaise, N/V

  • Warm dialysate bags to promote comfort
  • constipation may occur which leads to poor dialysate flow. (Stool softeners & high fiber diet)
  • bowel perforation can occur
  • when first placed dialysate outflow may be bloody or blood-tinged last 2 wks
53
Q

Diffusion

A

Spontaneous free movement of particles (solute) across a permeable membrane down a concentration gradient.
From higher concentration to lower

54
Q

Osmosis

A

Movement of solvent across semipermeable membrane.
(Membrane that allows a solvent, but not the solute to pass through)

From lesser to greater concentration.

55
Q

Ultrafiltration

A

Using a medium fine enough to retain colloidal particles, or large molecules

56
Q

Uremic syndrome S/S

A

Neuro: fatigue, sleep disturbances, HA, seizures, COMA

Psych: depression, anxiety, denial, psychosis

Ocular: red eye syndrome, band keratopathy, hypertensive retinopathy

Cardio: HTN, CHF, ASHD, pericarditis, myocardiopathy, uremic lung

Skin: pallor, pigmentation, pruritis, ecchymosis, calcium deposits, uremic frost

Metabolic: carb intolerance, hyperlipemia, gout

Endocrine: hyperparathyroidism, thyroid abnormalities, amenorrhea, infertility, sexual dysfunction

Peripheral neuropathy: restless legs, parasthesia, motor weakness, paralysis

Anemia, bleeding

GI: anorexia, N/V, uremic factor on breath, gastroenteritis, peptic ulcer

57
Q

Hemodialysis diet

A

Restricted: fluids, phosphorous, sodium, potassium

Protein to maintain nitrogen balance

  • too high = waste products
  • too low = decrease albumin, ⬆️ mortality

Enough calories to maintain or reach ideal weight

58
Q

PD diet

A

Protein is lost during PD so usually 1.2-1.5g/kg per day recommended.

High-cal supplements (ensure, boost)

Sodium restrictions vary
K+ rarely restricted

Unit #3 (5 decks)

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