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assessment > renal > Flashcards

renal Flashcards

1
Q

disequilibrium syndrome

A

transient CNS disturbance after rapid decrease in ECF osmolality compared to ICF osmolality - post dialysis

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2
Q

Typical Hgb of ESRD:

A

6-8 g/dL

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3
Q

Less RBCs in ESRD because

A
  1. decreased EPO
  2. PTH replaces marrow with fibrous tissue
  3. shorter RBC life span
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4
Q

ESRD RBC will have increased

A

2-3 DPG

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5
Q

Oxygen-hgb dissociation curve in ESRD

A

shifted to the right, r/t 2-3 DPG that means oxygen is unloaded more quickly -> helps with chronic anemia.

Also chronically acidosis so also favors this.

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6
Q

prolonged bleeding in ESRD r/t to

A

decreased platelet factor III activity
defective von Willebrand factor
decreased adhesiveness and aggregation of platelets

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7
Q

anemia is almost present with CKD when

A

GFR <30 mL/min

unless they are on aggressive EPO therapy

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8
Q

Goal of EPO therapy

A

to keep HCT between 36 and 40%, avoid possibility of transfusion

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9
Q

increase CO in renal disease is to

A

compensate for decrease oxygen carrying capacity

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10
Q

Left ventricular hypertrophy

A

is common

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11
Q

uremic pericarditis can progress to

A

pericardial effusion and tamponade

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12
Q

chronic renal disease is a significant risk for

A

CV morbidity and mortality.

50% of deaths of patients with ESRD are CV in nature.

  • HTN
  • Anemia
  • Hyperlipidemia
  • atherosclerosis
  • Calcification of valves - stenosis, regurgitation, or both
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13
Q

MV of patients with kidney disease

A

may be increased to compensate for chronic metabolic acidosis

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14
Q

pulmonary affects of renal disease

A

increased pulmonary extravascular water

  • interstitial edema
  • widened alveolar/arterial O2 gradient
  • Butterfly wings on CXR
  • hyperventilation, interstitial edema, alveolar edema, pleural effusion
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15
Q

abnormal lipid metabolism associated with renal disease

A

leads to accelerated atherosclerosis

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16
Q

percentage of patients with renal disease who develop GI hemorrhage

A

10-30%

17
Q

renal disease is associated with hyper secretion of

A

gastric acid + delayed gastric emptying (from autonomic neuropathy) this leads to high risk for aspiration (RSI?)

18
Q

drugs eliminated by kidneys unchanged are contraindicated:

A

phenobarbital, gallamine, LMWH

19
Q

before lab tests are changed or impacted

A

> 50% of nephrons must be destroyed

20
Q

BUN can be abnormal despite a normal GFR due to

A

hIgh protein diet
GI bleed
febrile illness

21
Q

lag time r/t plasma creatinine

A

8-17 hrs lag time between change in GFR and related increase in serum creatinine

22
Q

Creatinine Clearance Approximates GFR

Normal:
Decreased Renal Reserve:
Mild Renal Impairment
Moderate Insufficiency 
Renal Failure:
ESRD:
A

Creatinine Clearance Approximates GFR

Normal: 100 - 120 mL/min
Decreased Renal Reserve: 60 - 100 mL/min
Mild Renal Impairment: 40-60 mL/min
Moderate Insufficiency: 25-40 mL/min
Renal Failure: <25 mL/min
ESRD: <10 mL/min
23
Q

electrolyte abnormalities common with renal failure

A 
Hyponatremia - usually dilution 
Hyperkalemia 
Metabolic Acidosis with high anion gap 
Hypermagnesemia - usually not an issue
Hypocalcemia - increase PTH, calcification deposits 
Hypoalbuminemia - esp with dialysis 
Hyperglycemia - if insulin resistant
24
Q

If renal patient remains hypotensive

A

check free calcium level, supplement as appropriate

25
Q

first choice for symptomatic hyperkalemia >6.4

A

Calcium gluconate 10%
10-20 mL.
Avoid with dioxin therapy

26
Q

desmopressin dose

A

DDAVP 0.3- 0.4 mg/kg over 30 min

27
Q

The most common cause of increased BUN is

A

increased BUN secondary to reabsorption of bUN

28
Q

normal creatinine clearance:

A

110 to 150 mL/min

29
Q

If patient is on dialysis, assume GFR is

A

about 10-25 mL/min

30
Q

phenobarbital is excreted 30-60% unchanged

A

and is therefore contraindicated in renal failure

31
Q

anion gap formula

A

Na+ - HCO3 - Chloride

32
Q

metabolic acidosis is protective against

A

tetany with hypocalcemia

assessment (5 decks)

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