Renal Flashcards by Amee KrissyLee Salazar

What are causes of pre renal?

Happens outside the kidney.
Impaired blood flow. (Hypofunction, decreased GRF).
Renal/GI loses.
Heart issues(MI,shock)
Vasodilation (sepsis,anaphylaxis, antihypertensives)
Burns

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What are the causes of intra renal?

Parenchymal damage to glomeruli/nephrons.
Ischemia(burns,trauma, transfusion reaction, hemolytic anemia).
Infection(pylo/glomeruloneohritis).
Toxins(ABX, contrast, NSAIDS,ACE, heavy metals).

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What are the causes of post renal?

Obstruction (distal to kidney. Pressure rises in tubules. GFR decreases). 
Stones
Tumor
BPH
Clot
Stricture

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What are the phases of acute renal failure?

Initiation-initial insult
Oliguria-rise in serum concentration of things kidney usually excretes.
Diuresis- gradual increase in UO(glom started to heal)
Recovery-improved renal function, 1-3% perminant loss of GFR.

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What are some clinical manifestations of ARF?

NVD
Dehydration
Urine breath
CNS-lethargic,HA, drowsy
Twitch, seizure.

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What are some clinical manifestation of ARF in regards to electrolytes?

Increased BUN and CRE. 
Hyper K
Hypo Ca
Hyper phos
Metabolic acidosis
Anemia

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What medication do we give if the pt is hyperK? And what route?

Kayexalate.
Orally or retention enema
Give cleansing enema after.

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If the cause of ARF is due to low protein than what do we give? Hypovolemia?

Albumin

IVF

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What is limited during the oliguric phase of ARF?

Protein.

To limit the toxic end product that need to be eliminated.

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What foods are restricted during the diuresis phase of ARF?

High K and NA and fluids.

They will be governed by lab work.

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What foods will the pt be placed on during the recovery phase of ARF?

High protein and calories.

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What are the main things nursing care will be in charge of?

Monitor F and E. 
Reduce metabolic rate
Promote pulmonary function
Prevent infection
Skin
Support
Educate

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CKD is?

Progressive and irreversible

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If in CKD, can pt maintain metabolic and F and E balance?

No.

Will retain urea and other nitrogenous wastes.

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Does CKD affect all systems?

Yes.

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What are some things that cause CKD?

Systemic disease, environmental/occupational agents.

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What are the stages of CKD based on?

GFR.
Reduced renal reserve
Renal insufficiency
ESRD

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Stage 1

Kidney damage
Proteinurea.
Normal or increased GFR.( more than 90)

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Stage 2

Kidney damage and mild decrease in GFR. 60-88

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Stage 3

Moderate decrease in GFR. 30-59

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Stage 4

Severe decrease in GFR

15-29

Stage 5

Failure.
Dialysis or transplant needed.
GFR less than 15

What is the normal GFR?

125 mL/hour

How do we manage CKD?

Diet, exercise, BP

With CKD what are the CV effects?

Increased BP due to edema and fluid overload. Withdrawn/depression, behavior changes. Late- pitting edema, periorbital edema. Increased CVP. Pericarditis.

With CKD what are the Neuro effects?

HA,Weakness, fatigue , confusion

With CKD what are some pulmonary affects?

SOB, depressed cough | Thick sputum.

With CKD what are some hematologic affects?

Anemia,

With CKD what are some musculoskeletal effects?

Cramps, renal osteodystrophy (Ca/phos) | Bone pain

With CKD what are some GI effects?

Pee breath (ammonia), metallic taste, mouth/gum ulcerations, anorexia, NV

With CKD what are some skin effects?

Dry, flaky, pruritus, ecchymosis, purpura.

What types of meds will we give for CKD

Antacids Antihypertensives/CV Anti-seizure EPO

Regarding dialysis, what is osmosis?

Dextrose added to the dialysate and causes an osmotic gradient to pull excess fluid from the blood.

In regards to dialysis what is diffusion?

Movement of solutes (care, uric acid, lytes) from the blood to the dialysate. To lower blood concentrations.

In CKD stages 1-4 what food is restricted?

Protein

Is protein limited in stage 5 CKD?

No because they’re losing it through dialysis

What are some commonalities in HD and PD?

Osmosis- fluid removal (dextrose) Diffusion-waste removal (uric acid, Cre, lytes) Use of dialysate

Some issues with HD

``` Increased blood loss- anemia It’s faster than PD. Through fistula or graft Increased hypotension Decreased protein loss. ```

Some issues with PD

``` Increased hyperglycemia Increased protein loss More possible at home Fewer diet restrictions Contra if had bowel surgeries Possibility for infection due to cath. ```

What is the fistula? | How long does it take to mature and heal?

Anastomose of vein and artery. 6weeks to 3 months Less risk for infection

What is a graft?

Loop connecting vein and artery. More likely to get infected due to it being a foreign substance. Can use a graft sooner than a fistula due to healing time.

When doing PD, how much fluid should come out?

More than what was put in. The longer the fluid dwells the more it will pull out.

What color should dialysate be?

Clear. | Cloudy could be sign of infection.

Can a family member overturn a pts decision to donate organs?

Yes. Due to pt being unable to speak.

Does the nurse discuss organ donation with family?

No, call organ donor services.

What is our goal with CKD?

Slow down progression.

ARF phases- oliguric

Rise in serum concentration of lytes, bun, cre. Can’t reabsorbe HCO3. Metabolic acidosis

ARF phases-diuresis

Gradual increase in UO. Glom starting to heal. Losing lytes. Watch BP, dont give IVF if BP okay.

ARF phases- non oliguria

Peeing but not pushing out lytes.

Aldosterone does what?

Allows for reabsorption of NA and H2O. | Increases BP