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55 Cards in this Set

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Cause of pre-renal failure
Response to hypoperfusion, renal tissue integrity preserved. Causes: cardiac failure, shock-all types (systemic vasodilation), hypovolemia-dehydration, burns, hemorrhage, vomiting, diarrhea, vascular obstruction, neurogenic injury
Causes of intrarenal failure
Conditions that lead to actual damage of renal tissue->damage of nephrons. Causes: dz of large renal vessels, d/o of renal vasculature, DM, htn, direct trauma to kidney, nephrotoxic drugs, ischemic and nephrotoxic acute tubular necrosis (ATN)
ATN
Acute tubular necrosis, affects glomerulus and tubules. Most common cause of intrarenal failure. Caused usually by strep and e. coli
DM affects what with kidney?
primarily glomerulus
Causes of postrenal failure
Mechanical obstruction of urinary outflow (urethra or bladder), bilateral obstruction of the ureters or unilateral obstruction in pts w/ one functioning kidney, renal calculi, BPH, prostate and bladder cancer, trauma to back pelvis or perineum, strictures, spinal cord dz, tumors
Acute Renal Failure
Quick onset (hrs to days), reversible if caught early, usually due to hypotension, hypovolemia, or nephrotoxic drugs. Three stages: oliguric phase, diuretic, and recovery
Oliguric stage
ARF, UO of <400 cc/day, decrease in GFR, occurs w/in 1-7 days of causative agent.
Diuretic stage
ARF, gradual increase in daily urine output of 1-3 L/day, kidneys have recovered ability to excrete waste but not concentrate urine. Recovery more likely if diuretic phase w/in few wks.
Mgt. of diuretic stage
ARF. Possibility of renal recovery, VERY LITTLE lytes in urine, still need dialysis, careful watch of volemic state (may need IV replacement). I&O, DAILY WEIGHTS, asses for edema
Recovery stage
ARF, GFR increases so that BUN and serum creatinine stabilize, renal function improves w/in first two weeks, continues to get better up to 12 mos.
CRF
Caused by DM, htn, glomerular nephritis (B-hemolytic strep), drug abuse, HIV, nephrotoxin. Three stages: decreased renal reserve, renal insufficiency, end stage renal dz
Decreased renal reserve
Loss of up to 50% renal function, no metabolic or chemical abnormalities, no reserve left if further damage or loss. NO TX!
Renal insufficiency
loss of more than 50% function, chemical and metabolic abnormalities, at risk for volume loss r/t inability to concentrate urine
End stage renal dz
Symptoms of uremia become manifest, GFR <5-15 cc/min. Azotemia->uremia, ALL tissues exposed to nitrogenous wastes and exhibiting symptoms.
Categories of drugs that are nephrotoxic
Antibiotics, heavy metals, poisons, anesthetics, contrast dyes, organic solvents, acetaminophen, NSAIDs, salicylates, heroin, amphetamines
GFR values
Normal: 125mL/minute
Stage 1 >90
Stage 2 60-89
Stage 3 30-59
Stage 4 15-29
Stage 5 <15 (End stage renal dz)
Lab findings in RF (not lytes)
BUN, serum creatinine, phosphorus, and uric acid increase.
Creatinine clearance decreases.
Persistent proteinuria 1st sign CKD
Electrolyte imbalances in RF
K increases-MONITOR CLOSELY. Too high, give kayexalate (gradually, or enema-BEST), Dialyze immediately
Ca-decreases b/c P too high
Mg increases
Na and Cl normal to low
Anemia in RF, causes and tx
Causes: decr. prod. of erythropoieten, decr. lifespan of RBC in uremia, blood loss.
Tx: MUST give human erythropoieten-Procrit to stim. RBC prod.
Acid/Base in RF
Metabolic acidosis-kidney can't reabsorb HCO3. Acidosis causes H dumping and K reabsorption. Monitor K!!! EKG!
Accumulation of acid waste prod. tx w/ sodium bicarb, sodium lactate, or sodium acetate
S/S of metab. acidosis
Low pH, low HCO3 and PaCO2, hyperventilation, stress response followed by lethargy, dyspnea, bradycardia, decr. CO, GI distention, hypotension, n/v
Cause and tx of osteodystrophy
As serum P rises (can't be cleared), decr. in Ca (inverse relat.). Decr. Ca stim. PT to release PTH, mobilizes Ca from bone to facilitate P excretion. Also, kidney no longer activates Vit. D, can't absorb Ca from intestine.
Tx: partial parathyroidectomy.
Hormone changes in RF
Increased insulin half-life, decr. erythropoietin, incr. PTH, some people exhibit incr. GH and prolactin. Sometimes hypothyroidism
Fluid balance mgt.
Accurate I&Os, v.s, postural BP, apical pulses, skin turgor, and mucous membranes q4h, daily weights. Abnormal heart sounds, breath sounds, and mental status. Administer meds w/ meals.
Meds for RF
Sodium bicarb-metab. acidosis
Phosphorus binding agent-decr. P clearence
Ca replacement-incr. P tx
Vit. D-kidney can't activate D
K binding agent and K restriction-acidosis->hyperkalemia
Fluid restriction and diuretics-decr. Na reabsorption->fluid overload
Anticonvulsants-uremia->CNS changes
Steps to prepare for peritoneal dialysis
Surgical insertion of catheter 3-5 in. below umbilicus. Heals w/in 1-2 wks, use small amts of dialysate until then.
Nursing precautions for peritoneal dialysis
Peritonitis: meticulous aseptic technique during handling of catheter, tubing, and dialysate. Give antibiotics (in dialysate and systemic) prn
Catheter complications: displacement and obstruction. Give suppository enema, small volume instillation, hep for fibrin clot, watch for fecal matter->bowel perforation
Dialysis compl: pain from rapid instillation, pH or temp prob, dialysate accum, or excessive suction. Lower back pain r/t bad posture, hernia, etc...
Assessing pt. w/ A-V fistulae
Watch for hand swelling or ischemia, carpal tunnel syndrome, hemorrhage, thrombosis, and aneurysms.
Nursing care for A-V fistulae
Explain procedure to pt, one or two sticks used. If one needle-incr. recirculation of dialyzed blood->less effective clearance.
Therapeutic diet for RF
Changes constantly depending on lab values. Typically, minimal restriction of protein intake though want high biologic value protein. Monitor lytes and adjust intake accordingly, Na usually restricted, K restriction
Complications after kidney transplant
Graft rejection, urinary tract complications (kidney rupture, leaking of urine), cardiopulmonary complications (htn r/t renal artery stenosis, ATN, graft rejection), pneumonia from bacteria and fungi. Cervical cancer.
Spinal cord location
Begins at brain stem ends at L2
Reflexes w/ SCI
Immediately following SCI, EVERYONE flaccid below LOI until swelling subsides. Reflexes return sometimes after spinal shock. LOI below T12, no reflexes (no cord).
May use muscle spasms to achieve voluntary mov't (scratch stomach causes involunt. urination)
Cervical injury char.
Partial C3-may be weaned off vent w/ help
C4-Should be weaned w/ help, depends on smoking and fat. Shoulder shrug
C5-Biceps
C6-Wrists, no finger control
C7-Triceps, hold arm above head
C8-Pinky, ring finger, some grip
Thoracic injury char.
T1-6: Intercostal muscles, breathing, balance
T7-12: Huge risk of aspiration and pneumonia. Assist cough
Lumbar injury char.
L2-4: leg lifted from bed against resistance, knee extended
L5-S1: Knee flexed against resistance, foot plled up against resis.
Saccral injury char.
No reflexes, can't control bowel and bladder, foot is pushed down (accelerator in car).
Anterior cord syndrome
Lesion in anterior spinal cord->complete motor function loss and decr. pain sensation. Deep pressure, proprioception, and 2pt discrim. intact.
Central cord syndrome
Host common w/ hyperextension/hyperflexion injuries, produces more weakness in the upper extremities than lower. Sacral sensation intact
Brown Sequard
Damage to one side of the cord. Ipsilateral paralysis(pain, no proprioception) w/ contralateral loss of pain and temp (but can move)
Who's at risk for SCI?
Males 16-30
What are flexion, compression, extension injuries?
Flexion: whiplash
Compression: dive and hit bottom of pool
Extension:Fall and hit chin
Rotation:
Neurogenic bladder
Neurogenic bladder: can lead to either a spastic bladder bladder (above sacral) or flaccid areflexic/atonic bladder (sacral lesion). Manifests: distension w/ or w/o incontinence
Bladder interventions
ICs, start q4h, if <500 cc, move to q6h p 2days. If LOI above L2, bladder fx eventually returns.Condom cath and meds (Detrol)
Bowel interventions
25 g fiber/day, chemical suppository p meal, drink something hot, clean out rectal vault w/ gloved hand THEN insert, lots of h2o (6-8 glasses), start slow w/ laxatives
Autonomic dysreflexia
Pts w/ T6 and above. Multiple spinal autonomic responses discharge simultaneously. Exaggerated sypathetic response to a noxious stimulus below the LOI. Htn below LOI, pounding HA, flushed face, diaphoresis, myodriasis, bradycardia, nausea. Vasodialtion above LOI
What is spinal shock, duration, and sign of resolution
Copmlete loss of skeletal muscle function, bowel and bladder tone, sexual function and autonomic reflexes. Loss of venous return and hypotn, thermoregulation problems.
Lasts 1-6 wks, resolve w/ return of reflexes, hyperreflexia, emptying of bladder
Skin breakdown location for para and quad
Para: scapula
Quad: sacrum/ischium
Why are SCI pts at risk for hypotn
Inability to vasoconstrict
Why do SCI pts have trouble w/ thermoregulation?
Loss of hypothalmic control over sympathetic nervous system (Above T6)
Cough assist
butterfly hands and place on abdomen over diaphragm. On exhale, press inward and upward as client attempts to cough.
LOI that needs vent?`
Partial C3 may be waned off vent. Above needs vent
Tenodesis
surgical fixation of a tendon or way quad grips at C6
Piloerector response
goosebumps
poikilothermia
inability for thermoregulation. Take on temp of environment, don't sweat or shiver. At risk for overheating or freezing. Temp. above 100 considered fever