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Tests various > 👩🏾‍🎓- Renal & Crisis Test > Flashcards

👩🏾‍🎓- Renal & Crisis Test Flashcards

1
Q

Two functions of the kidney

A

Regulatory- controls fluid/electrolyte & acid/base balance

Hormonal- RBC formation, BP regulation, vitamin D activation

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2
Q

Normal renal function values

BUN, creatinine, Uric acid, GFR, urine output

A

BUN- 8 to 25 mg/dL

Creatinine- 0.6 to 1.3 mg/dL

Uric Acid- 2.5 to 8.0 mg/dL

GFR- 125 ml/min

Urine output- 1 to 3 L/day

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3
Q

Hormones in kidney function

A

ADH- antidiuretic hormone regulates osmolarity

RAAS- renin angiotensin aldosterone System regulates BP and volume

ANF- atrial natriuretic factor regulates BP and volume

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4
Q

Decreased GFR will cause which hormone to be secreted

A

Renin

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5
Q

3 most common causes of kidney disease

A

Diabetes
Hypertension
Glomerulonephritis

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6
Q

Types of drugs that are nephrotoxic

Example of each

A

NSAIDS - ibuprofen, naproxen, ketorolac

Chemo- cisplatin, methotrexate, cyclophosphamide

Antibiotics- vancomycin, gentamicin, amphotericin B, methicillin

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7
Q

Acute kidney injury vs chronic kidney disease

A

AKI- sudden onset, about 50% kidney function, usually last a few weeks but no more than 3 months, with treatment function resolved to original state

CKD- gradual onset, permanent, less than 10% function is present, fatal with renal replacement therapy

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8
Q

Three causes/subcategories of AKI

A

Prerenal- outside the kidney, caused by decreased intravascular volume, sepsis, dehydration and obstruction

Intrarenal- actual damage to renal parenchyma, causes by tubular necrosis, prolonged prerenal ischemia, infection and nephrotoxicity

Postrenal- obstruction of urinary outflow from the collecting ducts in the kidney to the external urethral orifice, causes renal stones, bladder tumors, prostate cancer, blood clots

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9
Q

4 phases of acute kidney injury

A

Onset phase- begins with precipitating event

Oliguric phase- urine output below 400mL/day. HIGH electrolyte levels. Requires supportive measures (no nephrotoxic drugs, decrease BP and possible dialysis). ⬇️ gfr, hyperkalemia, hypocalcemia

Diuretic phase- occurs when cause of AKI has been corrected. Urine output from 3-5L/day. LOW electrolyte levels.

Recovery phase- NORMAL electrolyte levels. ⬆️ gfr, complete recovery may take 1-2yrs. Memory improves

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10
Q

How is AKI diagnosed

A

X-ray (kub)

Renal ultrasound

Serum labs (CBC, bun/creatinine, electrolytes)

Urine labs (24hr collection, u/a, specific gravity)

CT scans/MRI

Nuclear imaging

Cystoscopy

Renal biopsy

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11
Q

Clinical manifestations of hypovolemia or reduced CO

Prerenal azotemia

A

Hypotension

Tachycardia

Decreased Central Venous Pressure

Decreased urine output

Weakness/fatigue

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12
Q

S&S of volume overload

Intrarenal or postrenal azotemia

A

Hypertension

Tachycardia

Increased central venous pressure

Increased jugular vein distention

SOB, crackles, pulmonary edema

Weight gain/ edema

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13
Q

Azotemia

S&S

A

Inability to secrete waste, elevated BUN

S&S- n/v, anorexia, headache, confusion, weakness/fatigue

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14
Q

Lab changes during an AKI

A

⬆️ BUN

⬆️ creatinine

⬆️ K, Ph, Mg, PaCO2

⬇️ Ca, HCO3

↕️ Na is variable

↕️ H&H are usually stable unless patient is hemorrhaging

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15
Q

Normal lab values

Bun, creatinine, k, ph, Mg, Ca, Na, hemoglobin, hematocrit, HCO3, PaCO2

A

Bun: 10-20 mg/dL

Creatinine: 0.5-1.1 mg/dL

K: 3.5-5 mEq/L

Phosphorus: 3-4.5 mg/dL

Mg: 1.3-2.1 mEq/L

Ca: 9-10.5 mg/dL

Na: 135-145 mEq/L

Hemoglobin: 12-17 mmol/L

Hematocrit: 38-50%

HCO3: 22-26 mEq/L

PaCO2: 35-45 mmHg

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16
Q

What is the most serious electrolyte disorder in kidney injury

A

Hyperkalemia

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17
Q

How is hyperkalemia treated

A

IV insulin

IV glucose (push k back in cell. Glucose to prevent hypoglycemia)

IV Ca gluconate (⬇️ threshold ❤️ arrhythmia)

Sodium polystyrene sulfonate (kayexelate)

Lasix, sodium bicarb, albuterol nebs

Emergent hemodialysis

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18
Q

Under what conditions should kayexelate NOT be given

A

Hypoactive bowels

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19
Q

Common causes of chronic kidney disease

A

Diabetes

Hypertension

Glomerulonephritis (lupus, wegeners, hiv, amyloidosis)

Interstitial nephritis (allergic or pvelo)

Microangiopathic vascular disease (scleroderma)

Cogenital

Genetic disease (pkd)

Neoplasm or tumor

Transplant rejection

Hepatorenal syndrome

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20
Q

Hepatorenal syndrome

A

Life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or liver failure

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21
Q

List the 5 phases of chronic kidney disease

A

Stage I- gfr > 90ml/min. (Screen)

Stage II- gfr 60-89ml/min (Reduce risk factors)

Stage III- gfr 30-59ml/min (Slow progression)

Stage IV- gfr 15-29ml/min (Manage/rrt)

Stage V- gfr < 15ml/min (Rrt/transplant)

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22
Q

Ca has an adverse relationship with which other electrolyte

A

⬇️ Ca = ⬆️ phosphate

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23
Q

Lab changes in CKD

A

Bun & creatinine gradual increase to very high levels

Na initial decrease, later maybe increased or “normal”

K & Ph rise quickly

Ca decreased

Metabolic acidosis due hydrogen ions not being excreted and unable to bind to HCO3

⬇️ iron, folic acid. ⬆️ cholesterol

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24
Q

People with CKD are more prone to which 3 conditions

A

Metabolic acidosis , ❤️ problems and bleeding

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25
Q

Cardiovascular changes in CKD

At risk for ?

A

Hypertension

Fluid overload

Heart failure (results from htn, hypervolemia, anemia and ultimately causes LV enlargement)

Risk for- CAD, pericarditis, pericardial effusion

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26
Q

Pulmonary changes in CKD

A

Dyspnea/tachypnea (watch for kussmauls)

Crackles

Pulmonary effusions

Pulmonary edema

Pneumonitis

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27
Q

Kussmauls breathing indicates what

A

Severe acidosis

Associated with CKD

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28
Q

Neurological changes in CKD

Untreated?

A

Lethargy

Decreased alertness/cloudy mentation

Poor concentration

Neuropathy

If untreated can cause seizures, coma

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29
Q

Integument changes in CKD

A

Yellow or darkening of skin

Pruritus

Uremic frost (uremia seeping from pores)

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30
Q

Urinary changes in CKD

A

Initially May appear “normal”

Oliguric

Anuric (may occur once crrt is initiated)

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31
Q

Psychosocial concerns in CKD

A

Anxiety

Depression

Fear of death

Economic status changes

Loss of independence

Loss of control

Role change at home and/or work

32
Q

S&S of uremic syndrome

A

Anorexia, n/v

Weakness, fatigue

Itching

Uremic frost

Muscle cramps

Hiccups

Stomatitis

Ulcers

Bowel changes (diarrhea or constipation)

33
Q

Prescribed diet for some in CKD would consist of

A

Moderate protein (to decrease the workload on the kidneys)

High carb

Low potassium , low phosphorus

34
Q

Dietary changes for CKD

Fluid, protein, k, na, ph

A

Fluid- restricted to 1-1.5 L/day

Protein- restricted in early stages because it slows CKD

K- restricted to 70 mEq/day

Na- typical restriction is 2g/day

Ph- restricted to 700 mg/day

35
Q

Hemodialysis vs CRRT vs Peritoneal dialysis

A

Hemodialysis- fluid & waste removal with dialysate and ultrafiltration via machine, generally required 12 hours/week in divided treatments, may be used emergently

CRRT- fluid & waste removal by hemofiltration (and sometimes dialysate) via machine, continuous treatment, typically reserved for icu

Peritoneal dialysis- fluid & waste removal with dialysate and ultrafiltration in peritoneal cavity

36
Q

List the 5 types of crrt

A

Continuous veno-venous hemofiltration CVVH: filter only, no dialysate

Continuous veno-venous hemodiafiltration CVVHD: filter & dialysate

Continuous arterio-venous hemofiltration CAVH: filter only, no dialysate

Continuous arterio-venous hemodiafiltration CAVHD: filter & dialysate

SCUF: slow continuous ultrafiltration

37
Q

What 3 things must be prescribed by a doctor in hemodialysis treatment

A

Dialysate, Time (schedule) and ultrafiltration

38
Q

How does dialysate function

A

Regulates blood acidity and electrolytes

39
Q

Two primary types of hemodialysis access

A

Venous catheter (external access)

Fistula or graft (internal access)

40
Q

Venous catheters and hemodialysis access

Vascath, permcath

A

Inserted in jugular, subclavian or femoral vein

Vascath (non tunneled)- temporary

Permcath (tunneled)- lasts longer than vascath, but not intended to be permanent

41
Q

Internal access and hemodialysis access

Fistula, graft

A

AV fistula- surgical anastomosis of vein and artery

AV graft- surgical implantation of artificial graft to connect vein & artery (listen for bruit and thrill)

42
Q

Hemodialysis access: risks

Venous catheters vs internal access

A

Venous catheters- infection, embolism (air or thrombus), pneumothorax after insertion

AV fistula or graft- infection, clotting, loss of blood flow secondary to hypotension, steal syndrome, aneurysm in access

43
Q

Steal syndrome

A

Ischemia resulting from a vascular access device

Risk associated with fistula or graft hemodialysis access

44
Q

Disequilibrium syndrome

S&S, treatment

A

Occurrence of neurological s&s attributed to cerebral edema during or following shortly after hemodialysis

S&S- vomiting, confusion, headache, twitching, seizures

Treatment- slow or stop dialysis and give hypertonic saline and mannitol to pull off fluid from brain

45
Q

List 4 things to report immediately associated with issues in a fistula or graft

A

Loss of thrill

S&S of infection

Bulging

Pain

46
Q

Hemodialysis: special considerations

A
  • daily weights before and after treatment
  • know your patients dry weight
  • medication management around dialysis
  • protect and assess access continually
  • assesses the CKD patient appropriately (watch hemodynamics and monitor for complications)
47
Q

Dietary considerations for the HD patient

A

Fluid restriction

Less Na

Less proteins 8-10 oz/daily

Grains/cereal/bread 6-11 servings

Milk, cheese, yogurt 1 oz/day (⬆️ phosphorus)

Veggies & fruit 2-3 servings each (watch for K)

48
Q

When was peritoneal dialysis and hemodialysis first performed

A

Peritoneal dialysis- 1923

Hemodialysis- 1937 at the university of Lund, Sweden

49
Q

Continuous ambulatory peritoneal dialysis CAPD

A

Dialysate is constantly in peritoneal cavity

4-5 manual exchanges during day

Low concentration dialysate swells over night

50
Q

Continuous-cycle peritoneal dialysis (CCPD, cycler)

A

Dialysis dwells primarily overnight

4-5 machine/cycler exchanges overnight

Low concentration dialysate dwells during day

51
Q

What 3 things are prescribed by a doctor in peritoneal dialysis

A

Dialysate, dwell time and additives

52
Q

List the 3 dialysate options

Higher concentration ?

A
  1. 5% glucose
  2. 5% glucose
  3. 25% glucose
    * higher concentration of glucose, removes more fluid & solutes*
53
Q

What are the 3 steps to perform peritoneal dialysis treatment (exchange)

A
  1. Fill peritoneum with 1-2 L dialysate (takes about 20 mins)
  2. Dwell dialysate (3-5 hrs)
  3. Drain effluent (takes about 20mins)
54
Q

What’s in hemodialysis dialysate

A 
Sodium 
Bicarbonate 
Acetate 
Chloride
Calcium 
Potassium 
Magnesium 
(Treated) tap water
55
Q

What’s in peritoneal dialysis dialysate

A 
Glucose 
Lactate 
Sodium 
Potassium 
Chloride
Calcium 
Magnesium 
Hydrochloric acid (prevents caramelization)
56
Q

Complications of peritoneal dialysis

A
  • peritonitis
  • leakage
  • bleeding

Long term: hypertriglyceridemia, abdominal hernia or exacerbation of hemorrhoids and hiatal hernia

57
Q

S&S of peritonitis

associated with complications of PD

A

Cloudy drainage

Abdominal pain

Rebound tenderness

Hypotension

58
Q

Peritoneal dialysis dietary restrictions

A

Protein requirements increase (protein is pulled across the peritoneal membrane

Fruits and vegetables aren’t restricted b/c PD patients don’t have issues with K regulation

No fluid or sodium restriction

Restricted phosphorus and carbs

59
Q

List the 3 types of crisis

A

-maturational crisis
Predictable, transitional points
Ex: getting married in a few weeks

-situational crisis
Unexpected, unpredictable, common
Ex: going through a divorce

-adventitious crisis
Unexpected, unpredictable, uncommon
Ex: big and devastating

60
Q

Crisis vs disaster

A

Crisis- upset in a previously steady state = poor problem solving

Disaster- overwhelming event that leads to temporary disruption of function

61
Q

Mass casualty vs multi casualty

A

Mass casualty- 100 or more affected

Multi casualty- 2 but less than 100

62
Q

List the 8 types of disaster

A 
Internal 
External
Predictable 
Unpredictable 
Natural 
Frequent 
Rare
Manmade
63
Q

Acts of terrorism

Examples

A

Violence against persons or property in violation of the crimson laws of the U.S

Ex- assassinations, kidnapping, hijacking, bombings, imputed based attacks, chemical/biological/nuclear/radiological weapons

64
Q

Phases of a disaster

A

Mitigation- lessen the impact of a disaster before it strikes

Preparedness- activities undertaken to handle a disaster when it strikes

Response- search and rescues, clearing debris and feeding and sheltering victims

Recovery- getting a community back to its pre-disaster status

65
Q

Classic 5 response phases

A

Heroic- need to help

Honeymoon- survivors reminisce

Disillusionment- delay in receiving help

Reconstruction- sense of normalcy

PTSD- 1 to 3 months later

66
Q

Who declares a state of emergency

A

Governor has to declare a state of emergency

67
Q

S&S of transplant rejection

A 
Oliguria 
Edema
Fever
Increasing BP 
Weight gain 
Swelling or tenderness over transplant site
68
Q

S&S of kidney trauma

A 
Flank pain 
Renal colic 
Hematuria 
Flank mass/swelling
Ecchymosis 
Abdominal wounds
69
Q

Emergency severity index

A

Five level triage algorithm

1 (most urgent) to 5 (least urgent)

70
Q

Parkland formula

A

Calculates fluid requirements for burn patients in a 24hr period

4ml/kg x %TBSA

71
Q

Heat exhaustion vs heat stroke

Symptoms, treatment

A
  • Exhaustion
    symptoms: faint or dizzy, excessive sweating, cool, pale, clammy skin, n/v, rapid weak pulse, muscle cramps

Treatment: move to cooler location, drink water, take a cool shower or use cold compress

-stroke
Symptoms: throbbing headache, no sweating, body temp above 103, red, hot, dry skin, n/v, rapid strong pulse, may lose consciousness

Treatment: get emergency help, keep cool until treated

72
Q

Trauma triad of death

A

Coagulopathy, metabolic acidosis, hypothermia

73
Q

What is the antidote for benzodiazepines overdose

A

Flumazenil

74
Q

Convection, conduction, evaporation

A

Convection- heat is loss by being exposed to cool air or water

Conduction- loss of heat to cold object

Evaporation- loss of heat through sweating

75
Q

Clinical manifestations of hypothermia

A

Myocardial irritability (arrhythmias), bradycardia and altered mental status

76
Q

What is the functional unit of the kidney

A

Nephrons

Tests various (20 decks)

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