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Med Surg III Exam 3 > Renal Failure and Dialysis > Flashcards

Renal Failure and Dialysis Flashcards

1
Q

Is acute renal failure reversible?

A

Usually- involves tubular cell death and regeneration

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2
Q

What are symptoms of acute renal failure?

A 
Decreased urine output (70%)
Edema (usually LE)
Mental changes
Heart failure
Nausea/vomiting
Pruritus (severe itching)
Anemia
Tachypenia
Cool, pale, moist skin
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3
Q

What are causes of acute renal failure at the pre-renal level?

A 
Vomiting
Diarrhea
Poor fluid intake
Fever
Use of diuretics
Heart failure
Liver dysfunction
Septic shock
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4
Q

What are intrinsic causes of acute renal failure?

A 
Interstitial nephritis
Acute glomerulonephritis
Tubular necrosis
Ischemia
Toxins
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5
Q

What are some post-renal causes of acute renal failure?

A

Prostatic hypertrophy
Retroperitoneal disorders
neurogenic bladder
Bilateral renal calculi

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6
Q

At what level is acute renal failure most commonly caused?

A

Pre-renal = 55%
Intrinsic = 40%
Post renal = 5-15%

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7
Q

What are the stages of acute renal failure?

A

Onset to time of oliguria
Oliguric/anuric phase
Diuretic phase

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8
Q

Describe the oliguric phase.

A

Less than 400 ml of urine output in 24 hours

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9
Q

How long does the diuretic phase last?

A

From time of urine output at <400 ml/24 hours to the time the BUN levels stop rising

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10
Q

What are the sub phases of the diuretic phase?

A

Late/recovery phase (BUN levels stabilize)
and the
Convalescent phase (urine output and BUN are WNL

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11
Q

What is the life threatening condition and symptoms associated with acute renal failure?

A

Hyperkalemia: weakness, lethargy, muscle cramps, paresthesias, hypoactive DTRs, dysrhythmias
THIS CAN CAUSE CARDIAC ARREST

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12
Q

What would an EKG look like for a pt with hyperkalemia?

A 
K>5.5-6
• Tall,peakedT’s
• WideQRS
• Prolong PR
• DiminishedP
• ProlongedQT
• QRS-Tmerge–sine wave
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13
Q

What are the steps in managing acute renal failure?

A
  1. Treat life threatening conditions
  2. Identify cause (hypovolemia? drugs? obstruction?)
  3. Treat reversible elements (Hydrate, remove drug, relieve obstruction)
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14
Q

Which part of the kidney is lost in chronic renal failure?

A

The nephron –> 75% of function can be lost before it is noticed

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15
Q

What is the mortality of chronic renal failure?

A

20%

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16
Q

What are the causes of chronic renal failure?

A 
Diabetic nephropathy
Hypertension
glomerulonephritis
HIV nephropathy
Polycystic kidney disease
Kidney infections and obstructions
17
Q

What are symptoms of chronic renal failure? (hint: theres a ton)

A 
Malaise
Weakness
Fatigue
Neuropathy
CHF
Anorexia
Nausea/vomiting
Seizures
Consitpation
Peptic ulceration
Diverticulosis
Anemia
Pruritus
Jaundice
Abnormal hemostasis
18
Q

What are some other problems related to ESRD?

A 
Metabolic (K/Ca/Na)
Volume overload
Anemia, platelet disorders, GI bleeding
HTN, pericarditis
Peripheral neuropathy
Dialysis dementia
Abnormal immune function
19
Q

What is the purpose of dialysis?

A

Diffuse harmful waste out of the body
Control blood pressure
Keep safe level of chemicals in the body

20
Q

How does hemodialysis work?

A

Pts go 3-4 times a week for 2-4 hours, machine filters blood and returns it to the body

21
Q

What are the different kinds of access for hemodialysis?

A 
Temporary site
AV fistula (surgeon combines artery and vein, 3-6 months to mature)
AV graft (surgeon inserts tube to connect artery and vein, 2-6 weeks to mature)
22
Q

What are the PT implications for hemodialysis?

A

No BP on the same arm as port
Protect arm from injury
Control obvious hemorrhage (Will be arterial, maintain direct pressure)

23
Q

How does peritoneal dialysis work?

A

The abdominal lining filters the blood

24
Q

What is continuous renal replacement therapy? what are the two types?

A

It slowly removes fluid, electrolytes, and solutes, and is mainly used in ICU.

  1. Continuous arteriovenous hemofiltration
  2. Continuous venovenous hemofiltration
25
Q

What is Continuous arteriovenous hemofiltraiton?

A

It uses the arterial system to drive blood flow. Usually connects femoral after and vein with oncotic pressures driving the process

26
Q

What is continuous venovenous hemofiltration?

A

Uses a pump to filter blood because the arterial system isn’t driving blood flow.

27
Q

What are some dialysis related problems?

A

Lightheaded- give fluids
Hypotension
Dysrhythmias
Disequalibration syndrome (Occurs at end of early sessions… confusion, tremor, and seizure related to cerebral edema)

28
Q

PT implications for dialysis patients

A

Blood levels are optimum after dialysis but fatigue is high
Best time for exercise varies from pt to pt
Pt may have low BP after dialysis

Med Surg III Exam 3 (8 decks)

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