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104 Cards in this Set
- Front
- Back
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Why does acute renal result
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b/c kidneys aren't able to remove accumulated metabolites
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What happens in Acute renal failure?
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Rapid decline in GFR
Fluid and electrolytes imbalances Azotemia |
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increased levels of nitrogenous wastes
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Azotemia
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When Bun and Creatinine climb together what is indicated?
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Renal failure
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When BUN climbs ALONE, and Creatinine remains stable what is indicated?
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Volume depletion or increased protein catabolism
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Sudden and Severe
Reversible Renal insufficiency (not meeting metabolic demands) Acute uremic episode |
Acute renal failure
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Rising BUN and Creatinine
Falling Urine output = what? |
Acute Uremic episode
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Causes of Acute renal failure?
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Ischemia: Hypoperfusion( not enough volume)
Nephrotoxins |
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Urine in blood
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fluid and electolye blaan
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fluid and electrolyte balance is altered, regulatory&endocrine functions of the kidney are impaired, accumulated metabolic waste products in blood
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People with uremia exibit this
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Early signs symptoms of Uremia
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Nausea, apathy, weakness, and fatigue
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Hematology, Cadio, Resp, Neuro, GI, Integument, Musculoskeletal are systemic effects of what?
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Systemic effects of uremia
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hematology
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anemia and clotting problems
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cardiovascular
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HTN,CHF
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Respiratory
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pulmonary edema
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Neuro
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Neuropathy, Encephalopathy
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GI
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Uremic Fector, N/V, Anorexia, Hiccups
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Integument
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Uremic frost, bronze skin- body is secreting
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Musculoskeletal
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Osteodystrophy(renal ricket)
Calcium issues softening of the bones increased risk of factors |
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Happens before gets to kidney which prevents blood not to flow
decrease perfusion |
Pre-renal
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Conditions that leads to Pre-Renal
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Hemorrahage
Bruns, trauma Hypovolemic CHF- sitting there, no perfusion to kidney Hypoxia |
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Pre-renal results in
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Hypoperfusion
-not enough bld and oxygento the kidney all lead to nephron damage |
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Acute damage to the renal and parenchyma and nephrons
Anything inside the actual kidney itself |
Intrarenal
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Thrombus, stenosis
Glomeulophephritis Pyelonephritis Diabetic Sclerosis ATN Malignant HTN |
Conditions that lead to Intrarenal
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Acute tubular necrosis
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Nephrotoxin (drugs)
Ischemia |
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What is the result of ARF?
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Damaged nephrons, a decreased GFR(creatinin clearance would go down)
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After kidney- effect kidney's backwards
Any condition that prevents urine excretion |
Post renal
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Post renal conditions lead to what 3 things?
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Obstructions
Prostatic disease(most common) Tumors |
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Obstructed urine flow to the kidney causes increased pressure in the kidney which leads to kidney damage...what resulted this?
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Post renal failure
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Name the three stages of renal failure
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Initiation phase (can last minutes to hours
Maintence phase Recovery phase |
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Starts with initiating event (ex. hemorrhage)
Ends w/ tubular injury |
Initiation Phase
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Fall in GFR & tubular necrosis
May develop oliguria Azotemia Electrolyte imbalances Metabolic acidosis Fluid Retention |
Maintenance Phase
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Increased bun and increased creatinine- Nitrogenous wastes
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Azotoemia
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Electrolyte imbalances in the Maintenence phase, What is increased?
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Potassium and Phosphorus
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Electrolyte imbalances in Maintenece phase, What is decreased?
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Sodium and Calcium
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Why do you get metabolic acidosis in the maintenance phase?
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B/c you are retaining hydrogen ion
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Why do you have fluid retention in the Maintenace phase?
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B/C you can't excrete urine leads to chf and pulmonary edema
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can last from weeks to years
tubule cell repair and regeneration if lucky, complete recovery of nephrons GFR goes to normal or pre failure level Diuresis occures because wasn't making alot before |
Recovery Phase
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Assessment: Acute renal failure
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I&O, VS,
Chvosteck-tap infront of ear Trousseau-bp cuff,hand closes -both indicates low calcium ECG- IF K+ is abnormal!!!! Fluid status |
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Fluid status assessment in ARF
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Qd weights
Decreased serum sodium lungs edema |
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What is the first indicator of ARF?
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dropping urinary output and a rising bun&creatinine
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Goal of ARF teatments?
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Increase perfusion
Prevent fluid overload |
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ARF Drugs
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Anti HTN's
K+ lowering agents Erythropoietan Antinfectives Diuretics Phosphate Binders H2 Blocker |
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What types of drugs are these?
-Catapres -Inderal -Apresoline |
Anti-HTN's
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What type of drugs are these?
-Kayexalate -Calcium chloride -Sodium Bicarbonate -Insulin&Glucose |
K+ lowering agents
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This drug helps with loss of K+ in stool
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Kayexalate
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Drive K+ into cell
Drives increased potassium levels down form serum level |
Insulin and Glucose
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Loop (lasix, Bumex)
Osmotic (mannitol) |
Diuretics
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Extracellular to vascular, increasing GRF, increased urine volume and flow
Hypertonic pulls fluid into vascular excrete out No patients with CHF or very dehydrated must be used selectively |
Mannitol
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Binds with phosphate in GI tact: excreted in feces- decreases teh high phosphate levels
Aluminum hydroxide(amphojel, alternagel) |
Phosphate binders
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Increased risk of GI bleed
Famotodine, Rantidine, Prilosec -To prevent ulcer |
H2 blockers
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500ml- Insensible loss+output in previous 24hrs
Monitor weight and serum sodium |
ARF Fluid restriction
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Calories 2x's the normal
Low potassiums and sodium Low protein Need calcium and vitamin supplements |
Renal diet
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Why is the calorie intake 2x's the normal?
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ARF pts have increased metabolism needs
Increase carbs and fats Give protein sparingly so they don't break down there own body protein (protien sparing effect) The goal is to prevent catabolism of their own protein |
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Usually use protein 0.6g/kg
Want foods that high biologic value (ess amino acids) |
low protien
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What does dialysis manage for Acute renal failure?
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Fluids, electrolytes, and waste products
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Three types of dialysis
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Hemodialysis, Peritoneal Dialysis, Continuous AV Hemofiltration
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Blood passes thru a semi impermeable membrane filter outside the body
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Hemodialysis
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Uses perotineum surrounding the abdominal cavity
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Peritoneal Dialysis
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Continuous circulation, highly porus hemofilter
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Continuous AV Hemofiltration
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Hypotention
Hypovolemia Bleeding Infections Hypothermia Dysrhythmias Sepsis Clots |
General Complications of Dialysis
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Hemodialysis-
Filtering of blood via |
pressure gradient
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Dialysate solution has-
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Heparin, gluocse, water, lytes
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What does dialysate solution do?
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Separates: lytes, fluid, and toxins via pressure gradient that is in the filter
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What 3 principles is hemodialysis based on?
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Diffusion
Osmosis Ultrafiltration |
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Hemodialysis Central line (short term) devies
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Mahurkar
Vascath Ashcath |
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Where is the central line placed?
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Jugular, subclavian, femoral vein
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what doest the AV fistula (long term)connect and which arm is it place in?
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It connects the radial or brachial artery to the cephalic vein. It is placed in the non dominant arm
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What does arterial pressure do to the vein?
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dilates/thickens the vein
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Gortex tubing in U shape is used to connect vein/artery. In what type of graft?
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AV-
AV graft is used long term |
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In an AV graft: blood pulled from what, back into what and ran thru what???
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blood is pulled from the artery back into the vein and ran thru the machine
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Dialysis nursing:
Why monitor weights? |
To see if they are following there fluid restriction diet
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Assessing an AV fistula/ graft
Listen for- Palpate for- Assess for- Never do- Never put- |
Bruits(should have)
Thrill Signs of infection NO BP's of BLOOD Drawls for graft arm Pressure onsite (tight clothes) |
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What type of deficit can hemodialysis cause and why?
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fluid deficit
b/c removing fluid and have a rapid change in electrolytes |
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What are the symptoms of a fluid deficit problem.
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n/v, dehydration, muscle cramps, seizures, hypotension
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Fluid deficit problems
Bleeding or Infection at AV graft site Dialysis Disequlibrium Syndrome, Are all Complications of what? |
Hemodialysis
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What causes dialysis disequalibrium syndrome? What can it lead to?
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Cause- Rapid changes in BUN PH
Leads to increase in intercranial pressure (cerebral edema) |
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Symptoms of Dialysis Disequlibrium Syndrome
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Headache,N/V, altered LOC, HTN
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Where is the tenckhoff catheter is placed into what?
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The peritoneum (semi permeable membrane)
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The Dialysate flows into the....?
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Abdomen
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Removes nitrogenous wastes
Water removed by using DEXTROSE as an osmotic |
Diffusion/osmosis
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Dialysis infusion process, dialysis exchange
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dwell time, drain time
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Which is less hazardous? Hemodialysis or Peritoneal dialysis?
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Periotneal dialysis
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Instill 1-2 liters of warm solution over a period of 10min.
Dwell time~ 20-30min Drain time about 30min CONTINUE process UNTIL blood chemistries improve |
Acute Perioneal Dialysis
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Instill 1-2 liters of solution over 10min
Dwell in abdomen- 4-6hrs then drain Do 4-5 exchanges daily Alows for uninteruppted sleep can be done at home adn can have a more liberal diet and fliud intake |
CAPD Continuous Ambulatory Peritoneal Dialysis
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Nursing Care in Perontineal dialysis
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VS & Weight- Empty bladder
Assess site- skin &cath prep Color/Amount of return C+S if cloudy |
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Hypo/hypertension
Abdominal Pain Infection of Site Peritonitis SOB |
Complications of Peritoneal Dialysis
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Symptoms of Peritonitis?
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Abdominal pain, malaise, fever, cloudy peritoneal solution
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What is...
Done through a porous hemofilter, removes fluids and solutes, lytes are replaced, Is done in cases of massive fluid overload and hemodynamic instability or cannot tolerate HD or PD....Done in ICU only! |
Continuous Renal Replacement Therapy
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slow and irreversible, permanent loss of nephrons
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Chronic renal failure
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Primary and secondary causes of renal failure
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1. Diabetes
2. Hypertension |
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Decreased renal reserve
Renal insufficiency Renal Failure End-Stage Renal Disease (ESRD) |
Chronic Renal Failure Stages
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GRF is 50% of normal
Normal BUN and Creatinine NO S/S....Which stage in CRF is thi0? |
Stage #1
Decreased Renal Reserve |
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GRF 20-50% of normal
See: Mild Azotemia Anemia HTN |
Stage #2 Renal insufficiency
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GFR is less than 20%
Increased Azotemia, Edema, metabolic acidosis, and possible uremia Bun creatinine rise sharply Oliguria <400ml |
Stage #3
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GFR <5% of normal
Kidney Atophy, Overt Uremia |
Stage #4 End Stage Renal Disease (ESRD)
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Proteinuria and Hematuria in urine
Inability to concentration urine Hyperkalemia Hypocalcemia Salt and water retention as kidney's worsen Metabolic Acidosis |
Fluid and Electolyte
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Severe Aneima HTN,CHF,dysrhythmias
Resp. Alkalosis |
Cardio/Resp/Hema Effects
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Chronic renal failure nursing goals
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Eliminate factors that decrease renal function
Slow progression Maintain nutr. status Iden. complications and treat Prepare client for treatment Dialysis or Transplant |
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Pharmacotherapy for CRF
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Anti-HTN
K lowering agents (ca chloride Erythropoietan Antiinfectives Diuretics Phos Binders H2 Blockers |
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They harvest renal artery , vein, ureter, and kidney
Donors have more pain than recipient |
Donor/Cadaver Nephrectomy
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In a kidney transplant they have to compare Human Leukeyocyt antigens....how many antigens is a perfect match?
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6
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What happens to a damaged kidney after a kidney transplant?
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it is left in place
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Post op nursing care
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High risk of hemorrhage
Monitor resp status Output monitoring is crucial!! Immunosuppresive meds- dont want body to reject General post op care |
