Renal - Part 2 Flashcards
(77 cards)
1
Q
Acute renal failure - ______ loss of kidney function caused by ____, ______, or a ______ that stresses the kidneys. What may happen afterwards? How long does this last?
A
- ARF
- Sudden loss
- Caused by illness, injury, toxin
- Kidney function may recover but can be fatal
- Less than 3 motnhs
2
Q
A long and usually slow process where the kidneys lose their ability to function. How long? Reversible? Fatal?
A
- Chronic kidney disease (CKD)
- Months to years
- Not reversible
- Can be fatal without lifelong medication therapy/dialysis
3
Q
Kidneys shut down completely and permanently
A
*End stage renal disease
4
Q
Azotemia is?
A
build up of nitrogenous wastes
5
Q
Uremia is?
A
azotemia (build up of nitrogenous wastes) with clinical symptoms of CKD
6
Q
3 primary causes of CRF?
A
- Diabetic nephropathy (Damage of vessels that filter wastes)
- Hypertension
- Obesity
7
Q
Primary cause of ARF?
A
*glomerulonephritis (inflammation and damage to the filtering part of the kidneys)
8
Q
4 effects of renal failure?
A
- Fluid-volume excess
- Electrolyte and acid-base disturbances
- Accumulated nitrogenous wastes
- Hormonal inadequacies
9
Q
3 types of ARF?
A
- Prerenal failure
- Intrarenal failure
- Postrenal failure
10
Q
Caused by anything that causes prolonged hypoperfusion to the kidneys. Another name for this? What does this lead to?
A
- Prerenal failure or prerenal azotemia
* Leads to ischemia in nephrons and tubular necrosis
11
Q
4 causes/examples of prerenal failure
A
- Severe volume depletion/drop in BP
- Shock
- Sepsis
- Heart failure
12
Q
Actual tissue damage to the kidney caused by inflammatory or immunologic processes. Another name for this?
A
*Intrarenal Failure or Acute Tubular Necrosis
13
Q
4 causes/examples of intrarenal failure?
A
- Drugs
- Infection
- Contrast dyes
- Glomerulonephritis
14
Q
Two types of drugs that can cause intrarenal failure?
A
- NSAIDS
* Antibiotics( e.g. vanco, genatmycin)
15
Q
All ______-based IV contrast dyes that are used in ______are extremely ______. Who is most at risk for contrast induced nephropathy? What can be done?
A
- Iodine-based
- Diagnostic testing
- NEPHROTOXIC
- Clients with impaired kidney function
- Given prophylactic hydration
16
Q
What can occur to clients taking metformin who need to be given contrast dyes? How can this be avoided?
A
- Acute lactic acidosis
* Hold med day of test and 48 hours after
17
Q
Glomerulonephritis is usually preceeded by what? How long for symptoms to begin occurring?
A
- Infection
* within 10 days of infection
18
Q
In glomerulonephritis, _____ reactions cause glomerular ______ resulting in what five things
A
- Antibody reactions cause glomerular inflammation
- PROTEINURIA
- HEMATURIA
- EDEMA
- DECREASED GFR
- HYPERTENSION
19
Q
Caused by anything that obstructs the urine collecting system from the calyces to the urethral meatus. Another name for this?
A
*Postrenal Failure or postrenal azotemia
20
Q
3 examples/causes of postrenal failure
A
- Urethral/Bladder cancer
- Urethral strictures
- Kidney stones
21
Q
1st phase of ARF? What will be seen?
A
- Onset/initiation phase
* BUN and CREAT begin to rise
22
Q
2nd phase of ARF? What will be seen? How long does this last?
A
- Oliguric phase
- Urine output of 100-400 ml/24 hours unresponsive to fluid challenges or diuretics
- typically lasts 8-15 days
23
Q
3rd phase of ARF? What will be seen? How long can this last?
A
- Diuretic phase
- May diurese up to 10 L of diluted urine per day as kidneys begin to recover
- Goes from 2-6 weeks after oliguric phase to when BUN reaches normal limits
24
Q
4th phase of ARF? What will be seen? How long can this last?
A
- Recovery phase
- Renal function continues to improve and client returns to normal level of activity
- Lasts up to a year
25
Physical appearance of a client with ARF? What will dehydration cause?
* Critically ill or lethargic
| * Dry skin and mucous membranes from dehydration
26
4 CNS s+s of ARF?
* Drowsiness
* Headache
* Muscle twitching
* Seizures
27
Physical/Laboratory assessments of ARF?:
Volume of urine? phase?
Specific gravity? Phase?
What happens to sodium in urine during prerenal azotemia
* Scant to normal volume (oliguric phase)
* Low specific gravity (Diuretic phase
* Low sodium in urine with prerenal azotemia
28
Decreased GFR, Oliguria, and Anuria increases patients risk of what electrolyte imbalance
*Hyperkalemia
29
Prevention of ARF?
* Fluids?
* Shock?
* 3 things to monitor in critically ill patients?
* Blood pressure?
* Assess what two things?
* Precautions with?
* Prevent and treat ______?
* Meticulous care of?
* Prevent toxic _____?
* Promote proper Hydration
* Prevent and treat shock
* CVP, arterial pressure, urine output
* Treat hypotension
* assess renal function and risk factors for sepsis
* Precautions with blood administration
* Prevent and treat infections
* Patients with indwelling catheters
* Prevent toxic drug effects.
30
3 causes of ARF in older adults? What 2 things should community nurses monitor?
* DEHYDRATION
* Use of nephrotoxic agents
* Complications of surgery
*Monitor all meds and clients that are undergoing procedures w/ fasting and bowel prep due to dehydration risk
31
Treatment for ARF is aimed at ____ and ____.
* Restoring chemical balance
| * preventing complications
32
```
Management ARF:
Eliminate what?
Maintain what?
Prevent what?
Reduce?
Promote what function?
Provide what when indicated?
What should be treated promptly if present?
```
* Eliminate underlying cause
* Maintain Fluid/electrolyte balance
* Prevent Fluid excess
* Reduce Metabolic rate
* Promote pulmonary function
* Renal replacement therapy
* Shock and Infection (meticulous skin care)
33
In ARF if signs and symptoms of fluid excess are present, what are two options to give and why?
* Mannitol or Furosemide
| * Initiate diuresis
34
In ARF, what two things can be given to restore renal blood flow?
* IVFs
| * Blood products
35
3 types of dialysis used in ARF?
* Hemodialysis
* Peritoneal dialysis
* CRRT - continuous renal replacement therapies
36
Pharmacologic Therapy for ARF should be aimed at treating? What other type of therapy can be initiated?
* Hyperkalemia
| * Nutritional therapy
37
Fifth final stage of chonic kidney disease - Progressive and irreversible decline in kidney function
Chronic renal failure or end stage renal disease
38
What develops in ESRD and what does it affect?
* Uremia (raised levels of urea and nitrogen in blood)
| * Adversely affects every system in body (Gastrointestinal and neurologic manifestations will be seen)
39
In CKD what diagnostic test will show a decrease?
GFR
40
In CKD, what happens to Na and Fluid and why?. What does this do to blood pressure? What does this do the heart? Lungs?
* NA and Fluid are retained due to decreased GFR
* Hypertension (too much fluid and Na)
* Heart failure ( pericardial effusion, cardiac tamponade) from too much fluid
* Pulmonary Edema
41
In CKD, what happens to potassium balance and why? What complication can this cause?
* Hyperkalemia
| * Lethal arrhytmias
42
What happens to RBC count in CKD? Why?
*Kidneys produce less erythropoietin, leading to low RBC production/anemia
43
Kidneys are responsible for activating what? In CKD, Without this what will decrease? What will increase? What endorcine condition will occur as a result? What other complications can occur?
* Vitamin D
* Hypocalcemia
* Hyperphosphatemia
* Hyperparathyroidism (Due to lack of calcium)
* Bone diseases/osteodystrophy
44
In CKD what 3 electrolytes are increased? What 2 are decreased? Which electrolyte may remain normal or decrease?
* Potassium, phosphate, magnesium
* Calcium, Bicarbonate
* Sodium
45
What acid/base imbalance occurs with CKD? What are the two reasons?
* Metabolic Acidosis
* Kidneys cannot excrete hydrogen ions (Acid)
* Kidneys cannot reabsorb bicarbonate (Base)
46
Two hematologic changes in CKD?
* Decreased H+H (Due to lack of EPO)
| * Abnormal bleeding due to altered platelet action
47
Why does preicarditis occur in CKD?
*Uremic toxins being retained or infection causes pericardial sac to become inflamed.
48
What 3 common GI changes caused by uremia? What disease may develop?
* Anorexia, N/V, HICCUPS
| * Peptic ulcer disease
49
manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin...what are 3 other skin changes that can be seen?
*Uremic Frost
* Yellowish pigmentation of skin
* severe pruritis
* Purpa or ecchymosis
50
Elevated phosphorus levels and decreased action of vitamin D causes what?
Osteodystrophy
51
In CKD creat may rise as high as? Bun may rise to?
* Creat may rise as high as 15-30 mg/dl
| * 10 to 20 times the value of creat
52
Urinalysis for CKD might show ___ with _____
*Increased urine specific gravity with oliguria
53
Five general pharmacologic therapies for CKD?
* Calcium replacement/phosphorus binders
* Antihypertensives/.cardiovascular agents
* Antiseizure agents
* erythropoietin
* Diuretics
54
what type of laxative drugs should CKD clients avoid?
*MAGNESIUM containing laxatives and antacids
55
Teaching with Phosphate binders? (2 things)
* Take with meals
| * Constipation is a side effect
56
What can be given to reduce excess potassium in CKD? How does it work? How can it be given? What may this cause?
* Sodium polystyrene (kayexalate)
* Pulls serum potassium into large intestine where its excreted in stool
* Given PO as suspension or rectally as retention enema
* May cause diiarrhea
57
Depending on the stage a diet given should be low in what? 3 restrictions? What 3 vitamins should be supplemented?
* LOW PROTEIN
* Restrict Sodium, potassium, phosphorus
* Supplement Vitamin D, calcium, Iron
58
What is used to perfrom filtering and excretion functions in hemodialysis? What does this remove and restore?
* Artificial semipermeable membrane
| * Removes excess fluids and waste and restores electrolyte balance.
59
What four things does an HD system consist of?
* Dialyzer (artifical kidney)
* Dialysate
* Vascular access routes
* Dialysis machine
60
In HD DIALYSATE CONTAINS A BALANCED
MIX OF _____AND______
THAT CLOSELY RESEMBLES _____.
* electrolytes and water
| * Human plasma
61
```
PROCESSES OF _______AND
_____ARE USED TO DRAW
EXCESS ______AND _____ OUT
OF THE _____, ACROSS THE
_______ AND INTO THE
______ TO BE
DISCARDED.
```
* Diffusion and Osmosis
* Fluid and waste out of blood
* Across the membrane and into diasylate to be discarded
62
Most clients require how much HD a week? What are they given prior and why?
* 3 treatments at 4 hours each
| * Heprain to prevent clotting in dialyzer
63
VASCULAR ACCESS IS REQUIRED FOR HD TO ALLOW FOR _______TO FLOW THROUGH THE MACHINE.•
300 TO 800 ML/MIN
64
LONG-TERM ACCESS for dialysis requires what? 2 options.
* AV fistula
| * AV graft
65
```
Complications for HD
•HYPER_____
•AN____/BL
•Respiration?
•Blood pressure?
•MUSCLES?
*Risk for?
•HEAD?
*Sleep?
```
* HYPERTRIGLYCERIDEMIA
* Anemia/BLeeding
* SOB
* Hypotension
* Muscle cramps
* Infection
* Headache
* Sleep problems/fatigue
66
What 3 drugs can be washed out during dialysis? What drugs should be held prior to HD?
* Antibiotics, digoxin, water soluble viatmins
| * Anti-hypertensives
67
What two things should be obtained prior to dialysis?
* Weight
| * Baseline blood pressure
68
In HD,_____ should be monitored post procedure to check for ______. Monitor for _____ post procedure for ____.
* Monitor blood pressure for hypotension (May need to rehydrate)
* Monitor for bleeding for 6 hours post procedure.
69
PD process
______ OF DIALYSATE IS INFUSED INTO THE
PERITONEAL CAVITY BY _____ OVER _____
•THE FLUID ______FOR THE SPECIFIED TIME PERIOD.
•THE FLUID IS DRAINED OUT OF THE PERITONEAL CAVITY AND
IT TAKES ______WITH IT.
•_______ and _____ARE THE PROCESSES THAT
REMOVE THE EXCESS WASTE AND FLUIDS.
* 1-2 Liters of dialysate infused by gravity over 10-20 minutes
* Fluid dwells for specified time
* Fluid is drained and takes wastes with it
* Diffusion (from higher to less concentration and osmosis (From less to greater concentration)
70
4 possible additives to diasylate?
* HIPA
* Heparin
* Insulin
* Potassium
* Antibiotics
71
How can peritonitis be avoided in PD?
Meticulous sterile technique when connecting and disconnecting bags
72
When can pain occur during PD? How long does it last?
* With inflow of dialysate
| * disappears after a week or two
73
In PD what two types of infection can occur? What kind of outflow can be seen and how long is this normal for? If poor flow occurs, what can be done?
* Tunnel and exit site
* Blood tinged outflow for 1st week or two
* Reposition client
74
Prior to administration Dialysate bag should be ___? What should not be used?
* Warmed
| * Don't use microwave
75
Normal outflow for PD should look like? What should be done after each exchange?
* Clear/pale yellow
| * Measure amount of outflow after each exchange (fill, dwell, drain = 1 exchange.
76
CRRT: Uses_______ to eliminate excess fluids
| and nitrogenous wastes when _____and ______ are ineffective. This is better tolerated by?
* Hemofiltration
* Diuretics and renal dopamine
* Critically ill patients
77
CRRT: ALL CARRY A RISK OF ______ CAUSED BY
_______ USED TO PREVENT THE DIALYSIS
MEMBRANE FROM _____.
* Bleeding
* Anticoagulants
* Clotting
