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Med Surg III Final > Renal > Flashcards

Renal Flashcards

1
Q

What are causes of pre renal?

A

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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2
Q

What are the causes of intra renal?

A

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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3
Q

What are the causes of post renal?

A 
Obstruction (distal to kidney. Pressure rises in tubules. GFR decreases). 
Stones
Tumor
BPH
Clot
Stricture
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4
Q

What are the phases of acute renal failure?

A

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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5
Q

What are some clinical manifestations of ARF?

A 
NVD
Dehydration
Urine breath
CNS-lethargic,HA, drowsy
Twitch, seizure.
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6
Q

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

A 
Increased BUN and CRE. 
Hyper K
Hypo Ca
Hyper phos
Metabolic acidosis
Anemia
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7
Q

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

A

Kayexalate.
Orally or retention enema
Give cleansing enema after.

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8
Q

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

A

Albumin

IVF

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9
Q

What is limited during the oliguric phase of ARF?

A

Protein.

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

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10
Q

What foods are restricted during the diuresis phase of ARF?

A

High K and NA and fluids.

They will be governed by lab work.

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11
Q

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

A

High protein and calories.

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12
Q

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

A 
Monitor F and E. 
Reduce metabolic rate
Promote pulmonary function
Prevent infection
Skin
Support
Educate
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13
Q

CKD is?

A

Progressive and irreversible

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14
Q

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

A

No.

Will retain urea and other nitrogenous wastes.

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15
Q

Does CKD affect all systems?

A

Yes.

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16
Q

What are some things that cause CKD?

A

Systemic disease, environmental/occupational agents.

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17
Q

What are the stages of CKD based on?

A

GFR.
Reduced renal reserve
Renal insufficiency
ESRD

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18
Q

Stage 1

A

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

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19
Q

Stage 2

A

Kidney damage and mild decrease in GFR. 60-88

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20
Q

Stage 3

A

Moderate decrease in GFR. 30-59

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21
Q

Stage 4

A

Severe decrease in GFR

15-29

22
Q

Stage 5

A

Failure.
Dialysis or transplant needed.
GFR less than 15

23
Q

What is the normal GFR?

A

125 mL/hour

24
Q

How do we manage CKD?

A

Diet, exercise, BP

25
Q

With CKD what are the CV effects?

A

Increased BP due to edema and fluid overload.
Withdrawn/depression, behavior changes.

Late- pitting edema, periorbital edema.
Increased CVP.
Pericarditis.

26
Q

With CKD what are the Neuro effects?

A

HA,Weakness, fatigue , confusion

27
Q

With CKD what are some pulmonary affects?

A

SOB, depressed cough

Thick sputum.

28
Q

With CKD what are some hematologic affects?

A

Anemia,

29
Q

With CKD what are some musculoskeletal effects?

A

Cramps, renal osteodystrophy (Ca/phos)

Bone pain

30
Q

With CKD what are some GI effects?

A

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

31
Q

With CKD what are some skin effects?

A

Dry, flaky, pruritus, ecchymosis, purpura.

32
Q

What types of meds will we give for CKD

A

Antacids
Antihypertensives/CV
Anti-seizure
EPO

33
Q

Regarding dialysis, what is osmosis?

A

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

34
Q

In regards to dialysis what is diffusion?

A

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

35
Q

In CKD stages 1-4 what food is restricted?

A

Protein

36
Q

Is protein limited in stage 5 CKD?

A

No because they’re losing it through dialysis

37
Q

What are some commonalities in HD and PD?

A

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

38
Q

Some issues with HD

A 
Increased blood loss- anemia
It’s faster than PD.
Through fistula or graft
Increased hypotension
Decreased protein loss.
39
Q

Some issues with PD

A 
Increased hyperglycemia
Increased protein loss
More possible at home
Fewer diet restrictions
Contra if had bowel surgeries
Possibility for infection due to cath.
40
Q

What is the fistula?

How long does it take to mature and heal?

A

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

41
Q

What is a graft?

A

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.

42
Q

When doing PD, how much fluid should come out?

A

More than what was put in.

The longer the fluid dwells the more it will pull out.

43
Q

What color should dialysate be?

A

Clear.

Cloudy could be sign of infection.

44
Q

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

A

Yes. Due to pt being unable to speak.

45
Q

Does the nurse discuss organ donation with family?

A

No, call organ donor services.

46
Q

What is our goal with CKD?

A

Slow down progression.

47
Q

ARF phases- oliguric

A

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

48
Q

ARF phases-diuresis

A

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

49
Q

ARF phases- non oliguria

A

Peeing but not pushing out lytes.

50
Q

Aldosterone does what?

A

Allows for reabsorption of NA and H2O.

Increases BP

Med Surg III Final (13 decks)

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