Renal Failure and Dialysis

Question 1

Acute renal failure is (reversible/irreversible)

Answer 1

reversible

Question 2

Acute renal failure

Answer 2

Rapid reduction in urine output

Usually reversible

Tubular cell death and regeneration

Question 3

ARF s/s

Answer 3

Decreased urine output (70%)
Edema
Mental changes
Heart failure
N&V
Pruritus (itching)
Anemia
Tachypenia
Cool, pale, moist skin

Question 4

Pre-renal causes of ARF

Answer 4

Vomiting
Diarrhea
Poor fluid intake
Fever
Diuretic use
Heart Failure
Liver dysfunction
Septic Shock

Question 5

Intrinsic causes of ARF

Answer 5

Interstitial nephritis
Acute glomerulonephritis
Tubular necrosis
Ischemia
Toxins

Question 6

Post-renal causes of ARF

Answer 6

Prostatic hypertrophy
Retroperitoneal disorders
Neurogenic bladder
Bilateral renal calculi

Question 7

Causes of ARF

Answer 7

Pre-renal=55%
Renal parenchymal (intrinsic)= 40%
Post-renal= 5-15%

Question 8

Acute renal failure staging

Answer 8

Onset to time of oliguria

Question 9

Oliguric/Anuric phase of ARF

Answer 9

<400 ml/24 hrs

Question 10

Diuretic phase of ARF

Answer 10

Time from urine output <400 ml/24 hrs until BUN stops rising

Question 11

Late/recovery phase of ARF

Answer 11

Time of stabilization of BUN

Question 12

Convalescent phase of ARF

Answer 12

Urine and BUN WNL

Question 13

Life threatening complication of ARF

Answer 13

Hyperkalemia (can cause cardiac arrest)

Question 14

Hyperkalemia s/s

Answer 14

Weakness
Lethargy
Muscle cramps
Paresthesias
Hypoactive DTR
Dysrhythmias

Question 15

EKG of Hyperkalemia

Answer 15

at K> 5.5-6
Tall, peaked T's
Wide QRS
Prolonged PR
Diminished P
Prolonged QT
QRD-T merge-sine wave

Question 16

ARF management

Answer 16

Identify cause

Hydrate, remove drug thats causing, relieve obstruction.

Question 17

Chronic Renal Failure

Answer 17

Progressive
Not reversible
Nephron loss
75% of function can be lost before its noticeable

Question 18

Causes of CRF

Answer 18

Diabetes
HTN
Glomerulonephritis
HIV
Polycystic kidney disease
Kidney infections and obstructions

Question 19

CRF s/s

Answer 19

Malaise
Weakness
Fatigue
Neuropathy
CHF
Anorexia
N&V
Seizure
Constipation
Peptic Ulcer
Diverticulitis
Anemia
Pruritis
Jaundice 
Hemostasis

Question 20

ESRD problems

Answer 20

Metabolic: K/Ca/Na
Volume overload
Anemia, platelet disorder, GI bleed
HTN
Pericarditis
Peripheral neuorpathy
Dialysis Dementia
Immune dysfunction

Question 21

Dialysis

Answer 21

Diffuse harmful waste out of body

Control BP

Question 22

Hemodialysis

Answer 22

3-4x/wk
2-4 hrs
Machine filters blood back to body

Question 23

AV fistula

Answer 23

Surgeon combines artery and vein

3-6 mo to mature

Question 24

AV graft

Answer 24

Tube inserted by surgeon to connect artery and vein

2-6 wks to mature

Question 25

Dialysis PT implications

Answer 25

No BP on fistula arm
Protect arm

Control bleed if it occurs

Question 26

Peritoneal dialysis

Answer 26

Abdominal lining filters blood

Question 27

Continuous Renal Replacement Therapy

Answer 27

Slowly remove fluid, electrolytes, solutes

Used in ICU

Question 28

Continuous AV hemofiltration

Answer 28

uses arterial system to drive blood flow

Connects femoral artery and vein with oncotic pressures driving process

Question 29

Continuous venovenous hemofiltration

Answer 29

Requires mechanical pump

Question 30

Dialysis problems

Answer 30

Lightheadedness-give fluids
Hypotension
Dysrhythmias

Disequilibration syndrome: at end of session (confusion, tremor, seizure) due to cerebral edema

Question 31

Dialysis PT implications

Answer 31

Blood levels optimum after, but fatigue high

Best time to ex varies

May have low BP after dialysis