Renal Flashcards
Avoid all invasive procedures within ___ to ____ hours after hemodialysis.
4 -6
What does Kayexelate do to decrease K+ ?
It causes exchange of Na+ & K+ in the bowel.
Complications of Dialysis
- Hypovolemia
- Shock
- Disequilibrium syndrome
Hematological Changes of Chronic Kidney Failure
- Anemia because…
- Decreased erythropoetin
- Iron and folate deficiencies
- Uremic toxins interfere with platelet adhesion.
- Less survival time of RBC
condition that results when kidneys unable to remove body’s metabolic waste or perform regulatory functions and return of these functions are not expected
Chronic Renal Failure
What is the #1 way to manage kidney failure?
eliminating the underlying cause
occurs when the body is dumping fluid but still retaining electrolytes
High Output Kidney Failure
cause of acute renal failure that stems from problems that interfere with renal perfusion, causing renal hypoperfusion
Pre-Renal Causes
Causes of Chronic Kidney Failure
- Diabetes - leading cause
- Chronic glomerulonephritis
- Pyelonephritis
- Uncontrolled HTN
- Hereditary lesions (polycystic kidney dx)
- Vascular lesions
- Urinary tract obstructions•Infections
- Drugs
- Toxic agents
- Environmental agents
Pre-Renal Causes of Acute Renal Failure are:
- Decreased cardiac output
- Vascular obstruction
- Hypovolemia
- Hemorrhage (Trauma)
- Hypotension (Severe dehydration)
- Septicemia
type of transplant rejection that occurs slowly over months to years with symptoms of renal failure including fever, graft tenderness, anemia, and malaise
Chronic Rejection
After dialysis, take the BP every ___ minutes X4 then every ____ minutes.
15; 30
GI Changes in Chronic Kidney Failure
- Anorexia
- Nausea/ Vomiting
- Bitter, metallic taste
- Breath smells like urine
- Ulcers (gastrin accumulation)
- Constipation (due to meds like phosphate binders)
Sudden decline in kidney function that causes disturbance in fluid, electrolyte, & acid-base balance because of loss in clearance of small solutes & decreased GFR
Acute Renal Failure or Acute Kidney Injury
Assess all patients at risk for ____________ or ____________ for adequacy of kidney perfusion.
dehydration or hypovolemia
Acute Renal Failure is an abrupt loss of kidney function over a period of ______ to _______.
a few hours to a few days
The main indications for beginning dialysis are:
- high/rising K+
- fluid volume overload
- increased acidosis
- pericarditis
- severe confusion
What interventions are performed to decrease K+ ?
- IV Insulin and Glucose
- Kayexelate
- Dialysis
- K+ restriction
Complications of Peritoneal Dialysis
- Peritonitis
- Low back pain
- Leakage
- Glucose absorption
- Bleeding
- Disturbed Body image
- Hernias
Phase of Renal Failure in which the event causes injury
Onset Phase
In Severe Kidney Disease, GFR = ______ mL/min
15-29 mL/min
type of dialysis in which a machine is programmed to run the fluid bags in and out (usually during the night while patient is sleeping)
Cycler Peritoneal Dialysis (CPD)
Factors influencing increasing mortality rates for Acute Renal Failure
- increasing age
- co-morbidities
Treatment for Chronic Transplant Rejection
- Continuing immunosuppressive therapy
- Measures to support renal function until dialysis is necessary
Metabolic Changes in Chronic Kidney Failure
- Increased BUN and Creatinine
- Increased uric acid
- Changes in insulin requirement
- Elevated serum triglycerides
- Metabolic acidosis
What does IV Insulin & Glucose do to decrease K+ ?
–Insulin increases activity of Na+ / K+ pump
–Moves K+ into the cell long enough for us to perform other definitive treatment
Treatment for Acute Transplant Rejection
- High dose steroids
- Monoclonal antibody (OKT3)
- Polyclonal antibody (ALG(
- Antilymphocyte (ALS)
Post-Operative Interventions for Kidney Transplant
- Assess for threatened rejection
- Assess for infection/ septicemia
- Assess BP for hypotension
- Monitor urinary function
- Provide psychological support
- Educate regarding follow-up
What should the nurse do immediately if Disequilibrium syndrome is suspected after dialysis?
Raise HOB and call the physician
Integumentary Changes in Chronic Kidney Failure
- Severe intractible pruritis
- Dry skin (atrophy of sweat glands)
- Increased bruising (bleeding tendency)
- Pallor (gray) of anemia
- Skin orange-green or gray
- Brittle hair and nails
Pre-Operative Interventions for Kidney Transplant
- Bring metabolic state as close to normal as possible
- Antibody screen – ensure good match
- Immunosuppressive drugs started
- AHD (dialysis) day before transplant
- Reassess for infection
Intrarenal (Intrinsic) Causes of Acute Renal Failure are:
- Acute tubular necrosis
- Prolonged ischemia
- Transfusion reaction
- Myglobinuria
- Nephrotoxic agents
- Glomerulonephritis
Kidney transplant patients must have a normally functioning ____________.
lower urinary tract
What kind of management can …
- Preserve renal function
- Delay need for dialysis/transplant
- Improve body chemistry values
- Alleviate extra-renal manifestations
- Provide optimal quality of life
medical management
Immunological Changes in Chronic Kidney Failure
- Immunosuppression
- Depression humoral antibody formation
- Decreased chemotactic function of leukocytes
When kidney function is less than ____%, the body cannot maintain homeostasis.
25%
complication of dialysis that usually only happens after the first treatment in which electrolyte levels are so high that when they are pulled of, they are pulled out of cerebral fluid leading to headache or seizures
Disequilibrium Syndrome
In End-Stage Kidney Disease, GFR = ______ mL/min
< 15 mL/min
phase of renal failure in which renal function improves during a 3 - 12 month period and the onset is when lab values return to normal
Period of Recovery
Systemic disease in which the kidneys are unable to remove body’s metabolic wastes or perform regulatory function which interferes with meeting human need for urinary elimination and maintaining homeostasis
Renal Failure
How is Kidney Failure diagnosed?
- History and physical
- Electrolytes, including BUN/Creatinine
- CBC; ABG
- Urinalysis
- Renal ultrasound
- CT scan
- Renal biopsy
- Renal markers
Why does metabolic acidosis occur in kidney failure?
kidneys cannot excrete hydrogen or conserve bicarb
What is onset of the recovery period of kidney failure?
when labs are normal
In Renal Replacement Therapy, the artificial kidney only holds _______ mL and runs for ____ hours.
250; 24
access to circulation for dialysis in which the radial artery is surgically connected to the cephalic vein so that arterial blood shunts into the vein to makethe walls stronger to support dialysis
Fistula
Kayexelate is given in a __________.
retention enema
type of dialysis that combines pressure gradients with true dialysis requiring exchanges of 2 L of dialysate at 30 - 60 minute intervals
Intermittent Peritoneal Dialysis (IPD)
Electrolyte Imbalances in Chronic Kidney Failure
- Hyperkalemia
- Hypocalcemia
- Hyperphosphatemia
- Hypermagnesemia
Advantages of Renal Transplant
- Eliminates dialysis
- Less restricted diet
- More normal life
- Cost-effective after first year
In period of oliguria, lab work will show…
- Increase in BUN & creatinine
- Increase in Uric acid
- Urine electrolytes
- Hyperkalemia
- Hyperphosphatemia & Hypocalcemia
- Hypo- or Hyper-naterima
- Acidosis
Teach patients on immunosuppressive therapy to assess themselves daily for ________, _________, ________, or __________.
fever, malaise, nausea or vomiting
In Moderate Kidney Disease, GFR = ______ mL/min
30-59 mL/min
Synthetic vessel placed between an artery and vein in order to access circulation for patient whose vessels are not strong enough for fistula
Graft
Musculoskeletal Changes in Chronic Kidney Failure
- Bone re-absorption (renal osteodystrophy)
- Muscle cramps
Cardiovascular Changes in Chronic Kidney Failure
- Hypertension (renin-angiotensin cycle)
- Volume Overload
- Chest pain (due to anemia)
- Arrhythmias (due to electrolytes)
- Atherosclerosis
- Pericarditis
therapy used for acutely ill renal patients that does not produce rapid fluid shifts and does not require a hemodialysis nurse
Renal Replacement Therapy
Use a higher dose of _______ in a dialysis catheter.
heparin
What medications are given to kidney failure patients?
- Fluids
- Diuretics
- Dopamine (to perfuse kidneys)
- Steroids (inflammatory)
phase of renal failure in which urinary volume less than 400 mL/24 hours and there is an increase in urea, creatinine, uric acid, organic acids, intracellular cations
Period of Oliguria
the body can adapt to renal failure until __/__ of the nephrons are destroyed
3/4
Respiratory Changes in Chronic Kidney Failure
- Pulmonary edema (due to fluid overload)
- CHF
- Pleuritis
- Pneumonitis
- Respiratory Rate Increase (compensate for metabolic acidosis)
The nurse should assess a fistula by palpating a _______ and auscultating a _______ over the site.
thrill; bruit
type of transplant rejection that occurs at the point of revascularization up to 48 hrs post-op caused by circulating antibodies destructingthe new kidney and must result in immediate removal of the kidney (very rare)
Hyperacute Rejection
phase of renal failure in which there is a gradual increase in UOP, the glomerular filtration rate is recovering, fluid volume may be normal, function may be abnormal, and renal tubules begin to heal
Period of Diuresis
Cause of renal dysfunction caused by obstruction to outflow of urine from kidney
Post-renal Causes
The longer a patient is in the period of oliguria, the higher the risk for _________.
irreversibility
The best indicator of fluid volume in a renal patient is _________.
daily weights
Post-renal Causes of Acute Renal Failure
- Any Urinary tract obstruction
- calculi
- tumors
- BPH (benign prostatic hypertrophy)
- strictures
Renal Diet consists of…
- Low protein (only high biologic value protein)
- Limited Na+, K+
- High calorie
The most common route for access to circulation is the _______ vein.
jugular
type of transplant rejection that occurs usually within 6 weeks after transplant (3 months most common but also up to 2 years) with symptoms of fever, malaise, elevated WBC, acute hypertension, graft tenderness, and decreased renal function
Acute Rejection
type of dialysis that uses surface of peritoneum as diffusing surface so that there are not high swings of electrolytes like hemodialysis
Continuous Ambulatory Peritoneal Dialysis (CAPD)
MAP Formula
SYSTOLIC BP + (DIASTOLIC BP x 2)
3
Cause of Acute Renal Failure involving renal parenchyma (changes in renal tissue)
Intrarenal (Intrinsic) Causes
Neurological Changes in Chronic Kidney Failure
- Peripheral neuropathy
- Burning feet
- Restless leg syndrome
- Gait changes
- Footdrop
- Forgetfulness
- Inability to concentrate
- Short attention span
- Impaired reasoning
- Twitching
- Seizures
- Coma
Non-functioning kidney may not be removed during transplant if it not producing ______/_______.
renin/angiotensin
In Mild Kidney Disease, GFR = ______ mL/min
60-89 mL/min
Fluids for a Renal patient should be ____ to _____ mL more than 24 hour UOP.
500 - 600 mL
The most common test to measure GFR
creatinine clearance / 24 hour urine
Manifestations of Chronic Kidney Failure
All systems affected!
Reproductive Changes in Chronic Kidney Failure
- Menstrual irregularities
- Amenorrhea
- Infertility
- Impotence
- Decreased libido
After initial kidney injury, labs won’t change for ____ hours.
24
Psychosocial Changes in Chronic Kidney Failure
- Physiologic alterations
- Extreme stress
- Life style alterations
- Role reversal
- Curtailed employment
- Depression
The concerns during period of diuresis
- Fluid Volume Deficit
- Hypokalemia
- Hyponatremia
Contraindications for Peritoneal Dialysis
- Adhesions
- Chronic backache
- Ostomies
- Immunosuppressive therapy
- Arthritis
- Advanced respiratory disease
The concerns during Period of Oliguria
- Hypo- or Hypernatremia
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
- Acidosis
- Fluid Volume Excess
