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Nursing 232 - EXAM 3 > Renal - Part 2 > Flashcards

Renal - Part 2 Flashcards

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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
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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
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3
Q

Kidneys shut down completely and permanently

A

*End stage renal disease

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4
Q

Azotemia is?

A

build up of nitrogenous wastes

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5
Q

Uremia is?

A

azotemia (build up of nitrogenous wastes) with clinical symptoms of CKD

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6
Q

3 primary causes of CRF?

A
  • Diabetic nephropathy (Damage of vessels that filter wastes)
  • Hypertension
  • Obesity
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7
Q

Primary cause of ARF?

A

*glomerulonephritis (inflammation and damage to the filtering part of the kidneys)

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8
Q

4 effects of renal failure?

A
  • Fluid-volume excess
  • Electrolyte and acid-base disturbances
  • Accumulated nitrogenous wastes
  • Hormonal inadequacies
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9
Q

3 types of ARF?

A
  • Prerenal failure
  • Intrarenal failure
  • Postrenal failure
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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

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11
Q

4 causes/examples of prerenal failure

A
  • Severe volume depletion/drop in BP
  • Shock
  • Sepsis
  • Heart failure
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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

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13
Q

4 causes/examples of intrarenal failure?

A
  • Drugs
  • Infection
  • Contrast dyes
  • Glomerulonephritis
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14
Q

Two types of drugs that can cause intrarenal failure?

A
  • NSAIDS

* Antibiotics( e.g. vanco, genatmycin)

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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
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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

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17
Q

Glomerulonephritis is usually preceeded by what? How long for symptoms to begin occurring?

A
  • Infection

* within 10 days of infection

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18
Q

In glomerulonephritis, _____ reactions cause glomerular ______ resulting in what five things

A
  • Antibody reactions cause glomerular inflammation
  • PROTEINURIA
  • HEMATURIA
  • EDEMA
  • DECREASED GFR
  • HYPERTENSION
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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

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20
Q

3 examples/causes of postrenal failure

A
  • Urethral/Bladder cancer
  • Urethral strictures
  • Kidney stones
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21
Q

1st phase of ARF? What will be seen?

A
  • Onset/initiation phase

* BUN and CREAT begin to rise

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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
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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
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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
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25
Q

Physical appearance of a client with ARF? What will dehydration cause?

A
  • Critically ill or lethargic

* Dry skin and mucous membranes from dehydration

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26
Q

4 CNS s+s of ARF?

A
  • Drowsiness
  • Headache
  • Muscle twitching
  • Seizures
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27
Q

Physical/Laboratory assessments of ARF?:
Volume of urine? phase?
Specific gravity? Phase?
What happens to sodium in urine during prerenal azotemia

A
  • Scant to normal volume (oliguric phase)
  • Low specific gravity (Diuretic phase
  • Low sodium in urine with prerenal azotemia
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28
Q

Decreased GFR, Oliguria, and Anuria increases patients risk of what electrolyte imbalance

A

*Hyperkalemia

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29
Q

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 _____?
A
  • 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.
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30
Q

3 causes of ARF in older adults? What 2 things should community nurses monitor?

A
  • 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

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31
Q

Treatment for ARF is aimed at ____ and ____.

A
  • Restoring chemical balance

* preventing complications

32
Q 
Management ARF:
Eliminate what?
Maintain what?
Prevent what?
Reduce?
Promote what function?
Provide what when indicated?
What should be treated promptly if present?
A
  • 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
Q

In ARF if signs and symptoms of fluid excess are present, what are two options to give and why?

A
  • Mannitol or Furosemide

* Initiate diuresis

34
Q

In ARF, what two things can be given to restore renal blood flow?

A
  • IVFs

* Blood products

35
Q

3 types of dialysis used in ARF?

A
  • Hemodialysis
  • Peritoneal dialysis
  • CRRT - continuous renal replacement therapies
36
Q

Pharmacologic Therapy for ARF should be aimed at treating? What other type of therapy can be initiated?

A
  • Hyperkalemia

* Nutritional therapy

37
Q

Fifth final stage of chonic kidney disease - Progressive and irreversible decline in kidney function

A

Chronic renal failure or end stage renal disease

38
Q

What develops in ESRD and what does it affect?

A
  • Uremia (raised levels of urea and nitrogen in blood)

* Adversely affects every system in body (Gastrointestinal and neurologic manifestations will be seen)

39
Q

In CKD what diagnostic test will show a decrease?

A

GFR

40
Q

In CKD, what happens to Na and Fluid and why?. What does this do to blood pressure? What does this do the heart? Lungs?

A
  • 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
Q

In CKD, what happens to potassium balance and why? What complication can this cause?

A
  • Hyperkalemia

* Lethal arrhytmias

42
Q

What happens to RBC count in CKD? Why?

A

*Kidneys produce less erythropoietin, leading to low RBC production/anemia

43
Q

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?

A
  • Vitamin D
  • Hypocalcemia
  • Hyperphosphatemia
  • Hyperparathyroidism (Due to lack of calcium)
  • Bone diseases/osteodystrophy
44
Q

In CKD what 3 electrolytes are increased? What 2 are decreased? Which electrolyte may remain normal or decrease?

A
  • Potassium, phosphate, magnesium
  • Calcium, Bicarbonate
  • Sodium
45
Q

What acid/base imbalance occurs with CKD? What are the two reasons?

A
  • Metabolic Acidosis
  • Kidneys cannot excrete hydrogen ions (Acid)
  • Kidneys cannot reabsorb bicarbonate (Base)
46
Q

Two hematologic changes in CKD?

A
  • Decreased H+H (Due to lack of EPO)

* Abnormal bleeding due to altered platelet action

47
Q

Why does preicarditis occur in CKD?

A

*Uremic toxins being retained or infection causes pericardial sac to become inflamed.

48
Q

What 3 common GI changes caused by uremia? What disease may develop?

A
  • Anorexia, N/V, HICCUPS

* Peptic ulcer disease

49
Q

manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin…what are 3 other skin changes that can be seen?

A

*Uremic Frost

  • Yellowish pigmentation of skin
  • severe pruritis
  • Purpa or ecchymosis
50
Q

Elevated phosphorus levels and decreased action of vitamin D causes what?

A

Osteodystrophy

51
Q

In CKD creat may rise as high as? Bun may rise to?

A
  • Creat may rise as high as 15-30 mg/dl

* 10 to 20 times the value of creat

52
Q

Urinalysis for CKD might show ___ with _____

A

*Increased urine specific gravity with oliguria

53
Q

Five general pharmacologic therapies for CKD?

A
  • Calcium replacement/phosphorus binders
  • Antihypertensives/.cardiovascular agents
  • Antiseizure agents
  • erythropoietin
  • Diuretics
54
Q

what type of laxative drugs should CKD clients avoid?

A

*MAGNESIUM containing laxatives and antacids

55
Q

Teaching with Phosphate binders? (2 things)

A
  • Take with meals

* Constipation is a side effect

56
Q

What can be given to reduce excess potassium in CKD? How does it work? How can it be given? What may this cause?

A
  • 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
Q

Depending on the stage a diet given should be low in what? 3 restrictions? What 3 vitamins should be supplemented?

A
  • LOW PROTEIN
  • Restrict Sodium, potassium, phosphorus
  • Supplement Vitamin D, calcium, Iron
58
Q

What is used to perfrom filtering and excretion functions in hemodialysis? What does this remove and restore?

A
  • Artificial semipermeable membrane

* Removes excess fluids and waste and restores electrolyte balance.

59
Q

What four things does an HD system consist of?

A
  • Dialyzer (artifical kidney)
  • Dialysate
  • Vascular access routes
  • Dialysis machine
60
Q

In HD DIALYSATE CONTAINS A BALANCED
MIX OF _____AND______
THAT CLOSELY RESEMBLES _____.

A
  • electrolytes and water

* Human plasma

61
Q 
PROCESSES OF \_\_\_\_\_\_\_AND 
\_\_\_\_\_ARE USED TO DRAW 
EXCESS \_\_\_\_\_\_AND \_\_\_\_\_ OUT 
OF THE \_\_\_\_\_, ACROSS THE 
\_\_\_\_\_\_\_ AND INTO THE 
\_\_\_\_\_\_ TO BE 
DISCARDED.
A
  • Diffusion and Osmosis
  • Fluid and waste out of blood
  • Across the membrane and into diasylate to be discarded
62
Q

Most clients require how much HD a week? What are they given prior and why?

A
  • 3 treatments at 4 hours each

* Heprain to prevent clotting in dialyzer

63
Q

VASCULAR ACCESS IS REQUIRED FOR HD TO ALLOW FOR _______TO FLOW THROUGH THE MACHINE.•

A

300 TO 800 ML/MIN

64
Q

LONG-TERM ACCESS for dialysis requires what? 2 options.

A
  • AV fistula

* AV graft

65
Q 
Complications for HD
•HYPER\_\_\_\_\_
•AN\_\_\_\_/BL
•Respiration?
•Blood pressure?
•MUSCLES?
*Risk for?
•HEAD?
*Sleep?
A
  • HYPERTRIGLYCERIDEMIA
  • Anemia/BLeeding
  • SOB
  • Hypotension
  • Muscle cramps
  • Infection
  • Headache
  • Sleep problems/fatigue
66
Q

What 3 drugs can be washed out during dialysis? What drugs should be held prior to HD?

A
  • Antibiotics, digoxin, water soluble viatmins

* Anti-hypertensives

67
Q

What two things should be obtained prior to dialysis?

A
  • Weight

* Baseline blood pressure

68
Q

In HD,_____ should be monitored post procedure to check for ______. Monitor for _____ post procedure for ____.

A
  • Monitor blood pressure for hypotension (May need to rehydrate)
  • Monitor for bleeding for 6 hours post procedure.
69
Q

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.

A
  • 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
Q

4 possible additives to diasylate?

A
  • HIPA
  • Heparin
  • Insulin
  • Potassium
  • Antibiotics
71
Q

How can peritonitis be avoided in PD?

A

Meticulous sterile technique when connecting and disconnecting bags

72
Q

When can pain occur during PD? How long does it last?

A
  • With inflow of dialysate

* disappears after a week or two

73
Q

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?

A
  • Tunnel and exit site
  • Blood tinged outflow for 1st week or two
  • Reposition client
74
Q

Prior to administration Dialysate bag should be ___? What should not be used?

A
  • Warmed

* Don’t use microwave

75
Q

Normal outflow for PD should look like? What should be done after each exchange?

A
  • Clear/pale yellow

* Measure amount of outflow after each exchange (fill, dwell, drain = 1 exchange.

76
Q

CRRT: Uses_______ to eliminate excess fluids

and nitrogenous wastes when _____and ______ are ineffective. This is better tolerated by?

A
  • Hemofiltration
  • Diuretics and renal dopamine
  • Critically ill patients
77
Q

CRRT: ALL CARRY A RISK OF ______ CAUSED BY
_______ USED TO PREVENT THE DIALYSIS
MEMBRANE FROM _____.

A
  • Bleeding
  • Anticoagulants
  • Clotting

Nursing 232 - EXAM 3 (5 decks)

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