Renal Failure

Question 1

Acute renal failure caused from:

Answer 1

• Trauma
• Infection
• Decreased CO
• Dehydration
• Drugs

Question 2

Acute renal failure S&S

Answer 2

• Anorexia
• Lethargy
• Nausea
• HA

Question 3

2 types of antibiotics that can cause renal damage

Answer 3

• Aminoglycosides

- Cephalosporins

Question 4

Aminoglycosides:

Answer 4

Inhibits protein synthesis in Gram (-) bacteria

• Neomycin
• Streptomycin
• Tobrax
• Amican

Question 5

Cephalosporins

Answer 5

Inhibits synthesis of bacterial cell wall

• Keflex
• Ceclor
• Rocephin
• Maxipime

Question 6

NSAIDs can cause:

Answer 6

Vasoconstriction that then leads to pre-renal failure

That can lead to interstitial nephritis

Question 7

If your patient has severe renal disease with oliguria and azotemia, the doctor should order:

Answer 7

Lasix

Question 8

What is azotemia?

Answer 8

Abnormal high levels of nitrogen in the blood

Question 9

Avoid heavy metals such as (for renal failure):

Answer 9

• Mercury
• Lead
• Iron
• Industrial pollutants

Question 10

Always watch which lab result for a patient with renal failure?

Answer 10

-Potassium (K+)

Question 11

Pre-renal Failure

Answer 11

• Problems affecting the flow of blood before it reaches the kidneys
• Decrease in urinary output due to decreased blood supply to kidney

Question 12

Renal (Intrarenal) Failure

Answer 12

• Problems with the kidney itself that prevent proper filtration of blood or production of urine
• Decrease in urinary output due to kidney damage to tissues or nephrons

Question 13

Postrenal Failure

Answer 13

-Problems affecting the movement of urine out of the kidneys

Question 14

Pre-renal Failure Urinary Output

Answer 14

<400 mL/day

Question 15

Causes of pre-renal failure

Answer 15

• Dehydration - Hypovolemia (Low BP):
  
  • V/D
  • Diuretics
  • Blood loss or disruption to the kidneys
• CHF
• Hypoprofusion:
  
  • Low CO
  • Cardiac disorders
  • Renal artery disease
  • Hepatorenal syndrome

Question 16

Intrarenal Failure Urinary Output

Answer 16

<400 mL/day

Question 17

Intrarenal (Renal) Failure is also known as:

Answer 17

Acute Tubular Necrosis (ATN)

Question 18

Causes of Intrarenal (ATN) Failure

Answer 18

• Ischemia

- Nephrotoxic substances (drugs) `

Question 19

Intrarenal (ATN) Failure causes of ischemia:

Answer 19

• Hemorrhage
• Burns
• Sepsis
• HF
• Transfusion reactions

Question 20

Intrarenal (ATN) Failure causes of nephrotoxicity:

Answer 20

• Heavy metals
• Medications
• Street drugs
• Contrast dye - x-rays
• Tissue breakdown

Question 21

3 stages of Acute Tubular Necrosis

Answer 21

1. Oliguric
2. Polyuric
3. Recovery

Question 22

Oliguric Stage of ATN

Answer 22

• Lasts 10-17 days
• Increased: BUN, Creatinine, K+
• Fluid overload
• CHF
• Peritoneal dialysis

Question 23

Polyuric Stage of ATN

Answer 23

• Last 2 weeks - 3 months
• Increased: BUN & Creatinine
• Low K+
• Fluid depleted

Question 24

Recovery Stage of ATN

Answer 24

• Lasts 3 months - 1 year

- Pray the kidney regenerates

Question 25

Urinary Na+: Pre-Renal vs. ATN

Answer 25

Pre-Renal: 20 ATN: 40-100

Question 26

BUN:Creatinine - Pre-renal vs. ATN

Answer 26

Pre-renal: 20:1 ATN: 10:1

Question 27

Lasix/Fluid Challenge: Pre-renal vs. ATN

Answer 27

Pre-renal: + urine ATN: No urine

Question 28

Your MEDICAL client has a urine output of 20 mL for 2 hours. What do you think would be ordered to increase urine output?

Answer 28

-Lasix

Question 29

Your SURGICAL client has a urine output of 20 mL for 2 hours. What do you think would be ordered to increase urine output?

Answer 29

``` -Fluid challenge or -500 mL of NSS or -Both ```

Question 30

Post-Renal (Obstructive) Failure causes:

Answer 30

- Stones - Clots - Tumors -(Rare; 5-10%)

Question 31

Blood & Urine tests for renal failure patients

Answer 31

- 24 hour urine collection for creatinine clearance - K+ - Na+ - Glucose - Hct

Question 32

Medical Management of renal failure patients

Answer 32

- Fluids and osmotic preparations to prevent decreased renal perfusion - Managing fluid volume and electrolytes - Diet - Drug therapy

Question 33

The Renal Diet

Answer 33

LOW: - Phosphorus - K+ - Protein - Na+ - PO intake of fluids

Question 34

Foods a renal failure patient should avoid:

Answer 34

- Cola - Peanut butter - Sardines - Nuts - Beer - Meat - Milk products, ice cream, cheese - Eggs - Anything salty - Condiments - Canned soup, vegetables, prepared dinners - Anything that melts at room temperature

Question 35

Classic hyperkalemia sign:

Answer 35

Muscle weakness

Question 36

Your renal patient c/o dry mouth due to fluid restrictions. | Your suggestion?

Answer 36

- Ice chips - Sips of water - Hard candy

Question 37

Causes of chronic renal disease:

Answer 37

-Diabetic nephropathy (Intrarenal) 43%