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Nursing 4 Exam 3 > Unit 11 Renal Failure > Flashcards

Unit 11 Renal Failure Flashcards

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1
Q

What is Acute Renal Failure?

A

Sudden decrease in renal function

Build up of waste, fluid, and electrolyte imbalance.

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2
Q

What are the lab values that determine kidney function and their normal ranges?
What about these others?

Serum osmolality 
Creatinine clearance 
Hematocrit and Hgb 
Na+
K+ 
Ph 
Ca
Mg
A

Creatinine (muscle breakdown) 0.6-1.2

BUN 7-20

Serum osmolality 275-295

Creatinine clearance 90-120

Hematocrit and Hgb

Na+ 135-145

K+ 3.5-5.0

Ph 2.5-4.5

Ca+ 8.5-10

Mg 1.5-2.5

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3
Q 
Define the following terms.
Anuria
Oliguria
Polyuria
Dysuria
Nocturia
Proteinuria
Pyuria 
Hematuria 
Enuresis
Azotemia 
Uremia
A

Anuria - no urine/ > 100 ml in 24hr

Oliguria - < 400 ml in 24h

Polyuria - > 3 liters in 24h

Dysuria - painful of difficult

Nocturia - waking to urinate at night

Proteinuria - protein in urine

Pyuria - WBCs in urine

Hematuria - RBCs in urine

Enuresis - involuntary nocturnal urination

Azotemia - concentration urea and nitrogenous waste in blood/build up of waste in blood

Uremia- clinical syndrome RT urea and nitrogen waste/build up results in confusion and fatigue

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4
Q

When is renal replacement therapy (dialysis) indicated?

A

when there are < 20% functioning nephrons

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5
Q

What are the functions of the kidney?

A
  • Urine formation
  • Renal clearance
  • Vitamin D synthesis
  • Excretion of waste
  • Osmolarity/Osmolality
  • Regulation of water excretion
  • Blood pressure regulation
  • Regulation of Acid-base balance (metabolic acidosis in renal failure)
  • Regulation of RBC production (secretes erythropoietin which tells bone marrow to increase RBC production; PT’s possibly anemic in renal failure)
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6
Q

What is considered nephrotic syndrome?

A

> 3.5 protein

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7
Q

What hormone will be suppressed with increased water retention?

A

ADH

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8
Q

What are some characteristics/manifestations of ARF?

A
  • Oliguria/Anuria
  • Possible hematuria
  • Azotemia
  • Low urine specific gravity
  • Decreased urine sodium levels
  • N and V
  • Lethargy/Headache
  • Chances in LOC
  • Fluid overload
  • Tachypnea
  • Muscle twitching
  • Electrolyte imbalance (hyperkalemia,hyperphosphatemia, hypocalcemia)
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9
Q

What are preventions/interventions for ARF?

A

Daily Weights

Adequate hydration or fluid restriction

Low protein diet

Monitor I and Os hourly

Monitor labs

Treat infections promptly

Awareness of nephrotoxic drugs

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10
Q

There are 3 types of Renal Failures, what are the causes of Pre-Renal (perfusion) failure?

A
  • Volume depletion (such as dehydration = hypovolemic)
  • Impaired cardiac efficiency/issue (MI, bleeding = hypovolemic)
  • Vasodilation (sepsis, anaphylaxis)
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11
Q

What are the causes of Intra-Renal Failure?

A

Rhabdomyolysis/Myoglobinuria: breakdown of muscle tissue releasing damaging protein into the blood/ myoglobin in urine

Hemoglobinuria: hgb in urine

Nephrotoxic agents: Contrast, NSAIDS, ACEi, Poison, Antibiotics

Infectious processes

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12
Q

What is/are the causes of Post-Renal Failure?

A

Obstructions from:

  • Calculi
  • Tumors
  • BPH
  • Strictures
  • Blood Clots
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13
Q

What is normal GFR?

A

90 or >

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14
Q

What is normal urine output per day?

A

1-2 liters /a day

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15
Q

What are the phases of ARF and describe them.
Will GFR be increased or decreased?
Will they have fluid volume excess or deficit?
How much urine a day?

A

Onset: initial, ends when s and s’s begin

Oliguric: 7-14 days, <400ml day, BUN/Creatinine increased, decreased GFR, fluid volume increase

Diuretic: hemodialysis, BUN/Creatinine decreased but still abnormal, GFR increased, hypotension, fluid volume decrease, 3-6 L urine a day.

Recovery

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16
Q

How is hyperkalemia corrected in acute renal failure?

How is metabolic acidosis corrected in acute renal failure?

A

-Correct hyperkalemia w/ IV dextrose and insulin then sodium polystyrene sulfonate [Kayexalate]

-Correct metabolic acidosis w/ Bi-carb drip/push
(Select all the apply, method for lower hyperkalemia as well)

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17
Q

What is Chronic Renal Failure/Chronic kidney disease?
What gender has it more?
What race is more likely to have it?

A

irreversible and significant decrease in renal function.

Women more than men

A.A’s

18
Q

What sex is more likely to develop end-stage renal disease?

What race is more likely to develop it?

A

Men are more likely to progress to end stage renal disease than women.

AA’s are 3x more likely to develop over whites

Hispanics 35% more likely to develop than non-hispanic

19
Q

What are causes/risk factors for CRF/CKD?

A

Diabetes***

Hypertension***

Obesity

Family Hx

Heart Disease

20
Q

What are manifestations of CRF (ESRD) in the following systems?

A

Decreased GFR 15 ml/min or <

Sodium and water retention/Edema

Metabolic acidosis

Anemia

Weakness/fatigue

Confusion

Metallic taste

Pruritus

Renal osteodystrophy (bone disease from poor levels of Ca and phosphorus)

21
Q

What are the stages of Chronic Kidney Disease?

A

Stage 1: GFR >90 kidney damage w/normal or ^ GFR

Stage 2: GFR 60-80, mild loss function

Stage 3: GFR 30-59, mild to severe renal insufficiency

Stage 4: GFR 15-29, severe decrease in GFR, severe

Stage 5: GFR <15, ESRD, kidney failure

22
Q

What are the consequences of Renal Failure?

A

Fluid volume overload (crackles, edema)

Anemia (from decrease erythropoietin)

Hypertension (GFR filters less water, thinks BP is low, RAAS initiated so BP increases)

Cardiac dysfunction

Altered LOC

Metabolic acidosis

Decreased appetite

Uremia (uremic syndrome)

Peripheral neuropathy in chronic RF

23
Q

What are signs of hyperkalemia in CKD?

A

Muscle weakness, diarrhea, abdominal cramps

24
Q

What are nursing implications for dialysis access?

A

If arterial venous fistula (AVF) is present check for bruit and thrill

Monitor fluid and electrolytes

Promote self-care

Educate PT’s about requirement of renal diet

Provide clear discharge instructions

25
Q

What is the medication to get rid of excess phosphorus?

A

calcium acetate (Phoslo) - must be given WITH food. If PT NPO do NOT give.

26
Q

What is the renal diet?
What is the fluid restriction included in this diet?
What about when PT is on dialysis?

A

Limit Protein:
• 0.7-1.0g/kg

Fluid Restriction:
• 500-800ml/day + the previous
day’s 24 hour urine output or 1 L a day

-Limit foods high in potassium,
sodium, and phosphorus:

• Potassium (60-70meq/day)- citrus,
tomatoes, melons, potatoes
• Phosphorus (700mg/day)- dairy,
peas, beans, nuts (peanut butter),
and cola
• Sodium (1-2g/day)- Canned and
processed food.

[Increase protein when PT is on dialysis]

27
Q

What is hemodialysis (kidney dialysis)?

A

Cleansing blood through dialysis filter removing waste, by-product and excess fluid.

28
Q

What is Peritoneal Dialysis?

A

Fluid (dialystate) infused into abdomen; through osmosis the waste will leave blood and go into fluid which will drain from abdomen into collection bag.

29
Q

Describe access used for temporary vascular access.

A

2 needs one in vein, one in artery.

For emergency double lumen catheter into subclavian, jugular, of femoral vein.

30
Q

Describe complications of hemodialysis and peritoneal dialysis.

A

Hemodialysis:
-Disequilibrium Syndrome
(rapid change in intracellular fluid while CSF unchanged, s and s’s are N and V, headache, agitation)

  • Dialysis encephalopathy
  • Sepsis
  • Hepatitis
  • Blood Loss

Peritoneal Dialysis:

  • Abdominal pain
  • Peritonitis
  • Sepsis
31
Q

What are the types of renal replacement therapy?

A

Hemodialysis

Peritoneal Dialysis

Continuous Renal replacement therapy (continuous dialysis for PT)

Transplant (on wait list for 4 years)

32
Q

How long does it take a fistula to mature?

A

~4 weeks

33
Q

What kind of PT would get an ateriovenous graft instead of a fistula?
What is it?

A

PT with inadequate vessels to make fistula.

Synthetic graft between artery and vein.

34
Q

What is a Tenckhoff catheter?

A

Soft see through rubber tube placed in abdomen for peritoneal dialysis.

Hollow w/ 3-4 holes

35
Q

What lab is the most reliable diagnostic indictor of kidney failure?
What about kidney function?

A

Creatinine

GFR

36
Q

What is the most common treatment for ESRD?

A

Hemodialysis

37
Q

What do you assess for regarding an AV fistulas and grafts?

A

Auscultate for bruit

Feel for the thrill

38
Q

Describe Uremia/ Uremic Syndrome.

A

Clinical syndrome RT urea and nitrogen waste/build up results in confusion and fatigue

Skin becomes dry, scaly, and a pallid yellowish gray

Uremic frost (a late sign) appears as evaporated sweat leaves urea crystals on the eyebrows.

Calcium is not absorbed from the intestinal tract reulting in hypocalcemia (muscle cramping)

39
Q

What lab values have opposite connections?

A

K+ and Phosphorus are synchronized and calcium is inverse.

So for example, with hyperkalemia there will be Hyperphosphatemia and HYPOcalcemia.

40
Q

For the management of hyperkalemia in kidney failure what medications can you give?

A

Glu/insulin,

Kayexalate,

NaHCO3,

Albuterol Rx,

CaCl2.

Calcium gluconate

Nursing 4 Exam 3 (7 decks)

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