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104 Cards in this Set

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Why does acute renal result
b/c kidneys aren't able to remove accumulated metabolites
What happens in Acute renal failure?
Rapid decline in GFR

Fluid and electrolytes imbalances

Azotemia
increased levels of nitrogenous wastes
Azotemia
When Bun and Creatinine climb together what is indicated?
Renal failure
When BUN climbs ALONE, and Creatinine remains stable what is indicated?
Volume depletion or increased protein catabolism
Sudden and Severe
Reversible
Renal insufficiency (not meeting metabolic demands)
Acute uremic episode
Acute renal failure
Rising BUN and Creatinine

Falling Urine output = what?
Acute Uremic episode
Causes of Acute renal failure?
Ischemia: Hypoperfusion( not enough volume)

Nephrotoxins
Urine in blood
fluid and electolye blaan
fluid and electrolyte balance is altered, regulatory&endocrine functions of the kidney are impaired, accumulated metabolic waste products in blood
People with uremia exibit this
Early signs symptoms of Uremia
Nausea, apathy, weakness, and fatigue
Hematology, Cadio, Resp, Neuro, GI, Integument, Musculoskeletal are systemic effects of what?
Systemic effects of uremia
hematology
anemia and clotting problems
cardiovascular
HTN,CHF
Respiratory
pulmonary edema
Neuro
Neuropathy, Encephalopathy
GI
Uremic Fector, N/V, Anorexia, Hiccups
Integument
Uremic frost, bronze skin- body is secreting
Musculoskeletal
Osteodystrophy(renal ricket)
Calcium issues softening of the bones increased risk of factors
Happens before gets to kidney which prevents blood not to flow

decrease perfusion
Pre-renal
Conditions that leads to Pre-Renal
Hemorrahage
Bruns, trauma
Hypovolemic
CHF- sitting there, no perfusion to kidney
Hypoxia
Pre-renal results in
Hypoperfusion
-not enough bld and oxygento the kidney

all lead to nephron damage
Acute damage to the renal and parenchyma and nephrons

Anything inside the actual kidney itself
Intrarenal
Thrombus, stenosis
Glomeulophephritis
Pyelonephritis
Diabetic Sclerosis
ATN
Malignant HTN
Conditions that lead to Intrarenal
Acute tubular necrosis
Nephrotoxin (drugs)
Ischemia
What is the result of ARF?
Damaged nephrons, a decreased GFR(creatinin clearance would go down)
After kidney- effect kidney's backwards

Any condition that prevents urine excretion
Post renal
Post renal conditions lead to what 3 things?
Obstructions
Prostatic disease(most common)
Tumors
Obstructed urine flow to the kidney causes increased pressure in the kidney which leads to kidney damage...what resulted this?
Post renal failure
Name the three stages of renal failure
Initiation phase (can last minutes to hours

Maintence phase

Recovery phase
Starts with initiating event (ex. hemorrhage)

Ends w/ tubular injury
Initiation Phase
Fall in GFR & tubular necrosis
May develop oliguria
Azotemia
Electrolyte imbalances
Metabolic acidosis
Fluid Retention
Maintenance Phase
Increased bun and increased creatinine- Nitrogenous wastes
Azotoemia
Electrolyte imbalances in the Maintenence phase, What is increased?
Potassium and Phosphorus
Electrolyte imbalances in Maintenece phase, What is decreased?
Sodium and Calcium
Why do you get metabolic acidosis in the maintenance phase?
B/c you are retaining hydrogen ion
Why do you have fluid retention in the Maintenace phase?
B/C you can't excrete urine leads to chf and pulmonary edema
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
Assessment: Acute renal failure
I&O, VS,
Chvosteck-tap infront of ear
Trousseau-bp cuff,hand closes
-both indicates low calcium
ECG- IF K+ is abnormal!!!!
Fluid status
Fluid status assessment in ARF
Qd weights
Decreased serum sodium
lungs
edema
What is the first indicator of ARF?
dropping urinary output and a rising bun&creatinine
Goal of ARF teatments?
Increase perfusion
Prevent fluid overload
ARF Drugs
Anti HTN's
K+ lowering agents
Erythropoietan
Antinfectives
Diuretics
Phosphate Binders
H2 Blocker
What types of drugs are these?
-Catapres
-Inderal
-Apresoline
Anti-HTN's
What type of drugs are these?
-Kayexalate
-Calcium chloride
-Sodium Bicarbonate
-Insulin&Glucose
K+ lowering agents
This drug helps with loss of K+ in stool
Kayexalate
Drive K+ into cell

Drives increased potassium levels down form serum level
Insulin and Glucose
Loop (lasix, Bumex)
Osmotic (mannitol)
Diuretics
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
Binds with phosphate in GI tact: excreted in feces- decreases teh high phosphate levels

Aluminum hydroxide(amphojel, alternagel)
Phosphate binders
Increased risk of GI bleed

Famotodine, Rantidine, Prilosec -To prevent ulcer
H2 blockers
500ml- Insensible loss+output in previous 24hrs

Monitor weight and serum sodium
ARF Fluid restriction
Calories 2x's the normal

Low potassiums and sodium

Low protein

Need calcium and vitamin supplements
Renal diet
Why is the calorie intake 2x's the normal?
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
Usually use protein 0.6g/kg

Want foods that high biologic value (ess amino acids)
low protien
What does dialysis manage for Acute renal failure?
Fluids, electrolytes, and waste products
Three types of dialysis
Hemodialysis, Peritoneal Dialysis, Continuous AV Hemofiltration
Blood passes thru a semi impermeable membrane filter outside the body
Hemodialysis
Uses perotineum surrounding the abdominal cavity
Peritoneal Dialysis
Continuous circulation, highly porus hemofilter
Continuous AV Hemofiltration
Hypotention
Hypovolemia
Bleeding
Infections
Hypothermia
Dysrhythmias
Sepsis
Clots
General Complications of Dialysis
Hemodialysis-
Filtering of blood via
pressure gradient
Dialysate solution has-
Heparin, gluocse, water, lytes
What does dialysate solution do?
Separates: lytes, fluid, and toxins via pressure gradient that is in the filter
What 3 principles is hemodialysis based on?
Diffusion

Osmosis

Ultrafiltration
Hemodialysis Central line (short term) devies
Mahurkar

Vascath

Ashcath
Where is the central line placed?
Jugular, subclavian, femoral vein
what doest the AV fistula (long term)connect and which arm is it place in?
It connects the radial or brachial artery to the cephalic vein. It is placed in the non dominant arm
What does arterial pressure do to the vein?
dilates/thickens the vein
Gortex tubing in U shape is used to connect vein/artery. In what type of graft?
AV-
AV graft is used long term
In an AV graft: blood pulled from what, back into what and ran thru what???
blood is pulled from the artery back into the vein and ran thru the machine
Dialysis nursing:
Why monitor weights?
To see if they are following there fluid restriction diet
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)
What type of deficit can hemodialysis cause and why?
fluid deficit

b/c removing fluid and have a rapid change in electrolytes
What are the symptoms of a fluid deficit problem.
n/v, dehydration, muscle cramps, seizures, hypotension
Fluid deficit problems
Bleeding or Infection at AV graft site
Dialysis Disequlibrium Syndrome, Are all Complications of what?
Hemodialysis
What causes dialysis disequalibrium syndrome? What can it lead to?
Cause- Rapid changes in BUN PH

Leads to increase in intercranial pressure (cerebral edema)
Symptoms of Dialysis Disequlibrium Syndrome
Headache,N/V, altered LOC, HTN
Where is the tenckhoff catheter is placed into what?
The peritoneum (semi permeable membrane)
The Dialysate flows into the....?
Abdomen
Removes nitrogenous wastes

Water removed by using DEXTROSE as an osmotic
Diffusion/osmosis
Dialysis infusion process, dialysis exchange
dwell time, drain time
Which is less hazardous? Hemodialysis or Peritoneal dialysis?
Periotneal dialysis
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
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
Nursing Care in Perontineal dialysis
VS & Weight- Empty bladder
Assess site- skin &cath prep
Color/Amount of return
C+S if cloudy
Hypo/hypertension
Abdominal Pain
Infection of Site
Peritonitis
SOB
Complications of Peritoneal Dialysis
Symptoms of Peritonitis?
Abdominal pain, malaise, fever, cloudy peritoneal solution
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
slow and irreversible, permanent loss of nephrons
Chronic renal failure
Primary and secondary causes of renal failure
1. Diabetes

2. Hypertension
Decreased renal reserve

Renal insufficiency

Renal Failure

End-Stage Renal Disease (ESRD)
Chronic Renal Failure Stages
GRF is 50% of normal
Normal BUN and Creatinine
NO S/S....Which stage in CRF is thi0?
Stage #1

Decreased Renal Reserve
GRF 20-50% of normal
See:
Mild Azotemia
Anemia
HTN
Stage #2 Renal insufficiency
GFR is less than 20%

Increased Azotemia, Edema, metabolic acidosis, and possible uremia

Bun creatinine rise sharply

Oliguria <400ml
Stage #3
GFR <5% of normal

Kidney Atophy, Overt Uremia
Stage #4 End Stage Renal Disease (ESRD)
Proteinuria and Hematuria in urine

Inability to concentration urine

Hyperkalemia

Hypocalcemia

Salt and water retention as kidney's worsen

Metabolic Acidosis
Fluid and Electolyte
Severe Aneima HTN,CHF,dysrhythmias

Resp. Alkalosis
Cardio/Resp/Hema Effects
Chronic renal failure nursing goals
Eliminate factors that decrease renal function

Slow progression

Maintain nutr. status

Iden. complications and treat

Prepare client for treatment
Dialysis or Transplant
Pharmacotherapy for CRF
Anti-HTN
K lowering agents (ca chloride
Erythropoietan
Antiinfectives
Diuretics
Phos Binders
H2 Blockers
They harvest renal artery , vein, ureter, and kidney

Donors have more pain than recipient
Donor/Cadaver Nephrectomy
In a kidney transplant they have to compare Human Leukeyocyt antigens....how many antigens is a perfect match?
6
What happens to a damaged kidney after a kidney transplant?
it is left in place
Post op nursing care
High risk of hemorrhage
Monitor resp status
Output monitoring is crucial!!
Immunosuppresive meds- dont want body to reject
General post op care