Renal and Hematology Flashcards
What is the main consideration when caring for a patient with a pre-existing AV fistula??
don’t place a BP cuff or IV on the same side
When will dialysis be required?
severe metabolic acidosis hyperkalemia drug toxicity fluid overload metabolic encephalopathy coagulopathy refractory GI symptoms pericarditis *when GFR falls 10-15% below normal
Why should dialysis occur the day before or day of surgery?
to correct potassium and to dry the patient out for the OR
What is the ideal potassium for the OR in a renal patient?
potassium
What kind of drugs are cleared out by dialysis?
low molecular weight, water soluble, and non-protein bound drugs
What are the cardiac effects that are evident in a renal patient?
increased cardiac output - to compensate for low O2 carrying capacity
HTN - r/t RAA actvation
LV hypertrophy
CHF with pulm edema - after compensation has failed
calcium deposits - on heart valves and in conduction system
arrhythmias - r/t electrolyte imbalances
uremic pericarditis - secondary to inadequate dialysis
accelerated CAD and PVD
What are some important pre-op considerations regarding fluid balance in a renal patient?
check a body weight
get VS with orthostatics
check atrial filling pressures if necessary
choose drugs that won’t aggravate hypotension
LR isn’t advised because it contains K+
hydrate with small volumes of fluid (NS)
How is the respiratory system affected in a renal patient?
increased minute ventilation to compensate for metabolic acidosis
increased pulmonary water leading to interstitial edema
widened alveolar/arterial gradient
“butterfly wings” on CXR r/t to increased membrane permeability
Why wouldn’t you want to use nitric oxide on a renal patient with pulmonary compromise?
increases their chances of pleural effusions, despite normal pulmonary capillary pressures.
*so you would want to use 100% O2
How is the endocrine system affected in a renal patient?
peripheral resistance to insulin = poor glucose tolerance
hyperparathyroid = prone to fractures
abnormal lipid metabolism = prone to atherosclerosis
high circulating hormones = increased GH, PTH, insulin, glucagon, etc.
What are some GI complications of a renal patient?
GI hemorrhage
anorexia
N/V
delayed gastric emptying and hypersecretion of gastric acid
high incidence of transfusion related hepatitis
ascites possible with dialysis
Why do you want to minimize blood transfusions in a renal patient?
multiple transfusions create antibodies to the blood that can make them a difficult candidate for a kidney transplant
Why might an RSI be considered in a renal patient?
if there is a high degree of suspicion that the patient has delayed gastric emptying and oversecretion of gastric acid
When are some pre-op considerations when administering drugs to a renal patient?
altered effects of most drugs due to anemia, decreased serum proteins, electrolyte abnormalities, fluid retention, abnormal cell membrane permeability
So… reduce doses of drugs that are bound to protein!
What are some drugs that are contraindicated in renal failure? Why?
gallamine, phenobarbitol, and LMWH
*because they are eliminated by the renal system unchanged!
Why wouldn’t you want to give succinylcholine to a renal patient?
because it can precipitate hyperkalemia?
What are some ways that you can assess fluid status in a renal patient?
VS, mucous membranes, orthostatics, edema, rales
How are electrolytes altered in renal failure?
low bicarb, sodium, chloride, albumin, calcium
high potassium, magnesium, glucose
metabolic acidosis with high anion gap
What are the symptoms of uremic encephalopathy?
asterixis myoclonus lethargy confusion seizures coma
What are the neurologic consequences of renal disease?
uremic encephalopathy
autonomic neuropathy (hypotension and tachycardia)
peripheral neuropathy
disequilbrium syndrome s/p dialysis
What is disequilibrium syndrome?
transient CNS disturbance following dialysis where there is a rapid increase in ECF osmolality as compared to ICF osmolality
presents as dementia
Why are patients anemic when they patient have renal disease?
anemia with normal HGb of 6-8: decreased EPO decreased RBC life span hemodilution r/t fluid overload excess PTH replaces bone marrow with fibrous tissue
Why can renal patients generally tolerate persistent anemia?
because they have increased 2,3 DPG and metabolic acidosis favor a shift to the R on the oxy-Hgb dissociation curve, which allows for better oxygen delivery to the tissues
How is clotting affected in a renal patient?
decreased # and function of platelets
abnormal vWF
Why is aseptic technique required in a renal patient?
they are at increased risk of infections r/t WBC dysfunction.
*infection is a common cause of death in renal patients
What are the cardiovascular effects that occur in renal patients?
increased CO to compensate for anemia HTN r/t salt and water retention LV hypertrophy CHF with pulm edema r/t fluid overload calcium deposits on the heart valves arrhythmias r/t electrolyte imbalances uremic pericarditis r/t inadequate dialysis accelerated CAD and PAD
How would you assess fluid and electrolyte balance altered in a renal patient?
vital signs
body weight
atrial filling pressures
*did they have dialysis?!?
What are important considerations when deciding on fluid replacement for a renal patient?
want them dry when they’re coming to the OR (dialyze 1st)
would want to choose normal saline and hang on a micro drip to avoid hyperglycemia and hyperkalemia that would be associated with LR and D5.
also choose drugs that wouldn’t aggravate hypotension during induction
How is the pulmonary system effected in a renal patient?
MV increases to compensate for metabolic acidosis
increased risk of pulmonary edema r/t fluid overload
butterfly wings on CXR r/t increased capillary permeability –> high risk for pleural effusions
What are the three main components of any physical assessment?
airway
cardiac
pulmonary
