Unit 11 Renal Failure Flashcards
What is Acute Renal Failure?
Sudden decrease in renal function
Build up of waste, fluid, and electrolyte imbalance.
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
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
Define the following terms. Anuria Oliguria Polyuria Dysuria Nocturia Proteinuria Pyuria Hematuria Enuresis Azotemia Uremia
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
When is renal replacement therapy (dialysis) indicated?
when there are < 20% functioning nephrons
What are the functions of the kidney?
- 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)
What is considered nephrotic syndrome?
> 3.5 protein
What hormone will be suppressed with increased water retention?
ADH
What are some characteristics/manifestations of ARF?
- 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)
What are preventions/interventions for ARF?
Daily Weights
Adequate hydration or fluid restriction
Low protein diet
Monitor I and Os hourly
Monitor labs
Treat infections promptly
Awareness of nephrotoxic drugs
There are 3 types of Renal Failures, what are the causes of Pre-Renal (perfusion) failure?
- Volume depletion (such as dehydration = hypovolemic)
- Impaired cardiac efficiency/issue (MI, bleeding = hypovolemic)
- Vasodilation (sepsis, anaphylaxis)
What are the causes of Intra-Renal Failure?
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
What is/are the causes of Post-Renal Failure?
Obstructions from:
- Calculi
- Tumors
- BPH
- Strictures
- Blood Clots
What is normal GFR?
90 or >
What is normal urine output per day?
1-2 liters /a day
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?
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
How is hyperkalemia corrected in acute renal failure?
How is metabolic acidosis corrected in acute renal failure?
-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)
What is Chronic Renal Failure/Chronic kidney disease?
What gender has it more?
What race is more likely to have it?
irreversible and significant decrease in renal function.
Women more than men
A.A’s
What sex is more likely to develop end-stage renal disease?
What race is more likely to develop it?
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
What are causes/risk factors for CRF/CKD?
Diabetes***
Hypertension***
Obesity
Family Hx
Heart Disease
What are manifestations of CRF (ESRD) in the following systems?
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)
What are the stages of Chronic Kidney Disease?
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
What are the consequences of Renal Failure?
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
What are signs of hyperkalemia in CKD?
Muscle weakness, diarrhea, abdominal cramps
What are nursing implications for dialysis access?
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
What is the medication to get rid of excess phosphorus?
calcium acetate (Phoslo) - must be given WITH food. If PT NPO do NOT give.
What is the renal diet?
What is the fluid restriction included in this diet?
What about when PT is on dialysis?
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]
What is hemodialysis (kidney dialysis)?
Cleansing blood through dialysis filter removing waste, by-product and excess fluid.
What is Peritoneal Dialysis?
Fluid (dialystate) infused into abdomen; through osmosis the waste will leave blood and go into fluid which will drain from abdomen into collection bag.
Describe access used for temporary vascular access.
2 needs one in vein, one in artery.
For emergency double lumen catheter into subclavian, jugular, of femoral vein.
Describe complications of hemodialysis and peritoneal dialysis.
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
What are the types of renal replacement therapy?
Hemodialysis
Peritoneal Dialysis
Continuous Renal replacement therapy (continuous dialysis for PT)
Transplant (on wait list for 4 years)
How long does it take a fistula to mature?
~4 weeks
What kind of PT would get an ateriovenous graft instead of a fistula?
What is it?
PT with inadequate vessels to make fistula.
Synthetic graft between artery and vein.
What is a Tenckhoff catheter?
Soft see through rubber tube placed in abdomen for peritoneal dialysis.
Hollow w/ 3-4 holes
What lab is the most reliable diagnostic indictor of kidney failure?
What about kidney function?
Creatinine
GFR
What is the most common treatment for ESRD?
Hemodialysis
What do you assess for regarding an AV fistulas and grafts?
Auscultate for bruit
Feel for the thrill
Describe Uremia/ Uremic Syndrome.
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)
What lab values have opposite connections?
K+ and Phosphorus are synchronized and calcium is inverse.
So for example, with hyperkalemia there will be Hyperphosphatemia and HYPOcalcemia.
For the management of hyperkalemia in kidney failure what medications can you give?
Glu/insulin,
Kayexalate,
NaHCO3,
Albuterol Rx,
CaCl2.
Calcium gluconate
