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163 Cards in this Set
- Front
- Back
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Definition of Renal Failure
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deterioratio nof renal funciton resulting in accumlation of nitrogenous wastes
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Azotemia
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accumulation of nitrogenous wastes in the blood
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What form are nitrogenous wastes in?
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usually creatinine
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How many ml/d would classifly as oliguria?
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<400 ml in 24 hrs
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How many ml/d would classifly as anuria?
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<100 ml in 24 hours
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The onset of Acute renal failure is ______
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suddenq
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what happens in Acute renal failure if you do not intervene?
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rapid deterioration
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Is Acute renal failure reversible?
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usually
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Chronic renal failure has a _____, _______ onset
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slow, insidious
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Is Chronic renal failure reversable?
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no
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ESRD
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End-stage renal disease
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What is the final stage of Chronic renal failure?
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ESRD
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What is necessary to sustain life with Chronic renal failure?
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dialysis or transplanT
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What are the 3 classifications of Acute renal failure?
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prerenal
Renal (intrinsic, parenchymal) Postrenal |
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Prerenal failure
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Prerenal azotemia....Something above the kidney is causing failure
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What is an example of prerenal failure?
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Heart Failure leading to decreased CO
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Renal Failure (intrinsic; parenchymal)
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The kidney itself is causing failure
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Postrenal failure
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Something is causing obstruction to the outflow of urine
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Blood flow is _________ in prerenal failure
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diminished
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With prerenal failure there is _____________ of the kidney
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Hypoperfusion
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What 3 things can cause prerenal failure?
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Volume depletion
vasodilation (blood pools) Decreased CO |
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If prerenal failure is not treated what can it progress to?
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intrarenal damage
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What are 2 things that could cause postrenal failure?
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stones
benign prostetic hyperplasia |
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WHat is the most common cause of intrarenal failure?
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acute tubular necrosis
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What 3 problems would cause intrarenal etiology?
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glomerular
vascular hematologic |
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What are 3 nephrotoxic agents that could cause acute tubular necrosis?
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Antibiotics
NSAID Dyes |
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What kind of antibiotics cause acute tubular necrosis and thus intrarenal failure?
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aminoglycosides
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What 3 things can cause acute tubular necrosis and thus intrarenal failure?
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Ischemia
Nephrotoxic agents Rhabdomyolysis |
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In prerenal failure the blood supply is ________
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decreased
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What characterizies the initiation/onset phase of ARF?
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time from the event to signs of decreased renal perfusion
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How long does the initiation/onset phase of ARF last?
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a few hours to 2 days
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During the initiation/onset phase of ARF there is ___ intrinsic renal damage and failure is potentially _______
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no, reversible
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What is the maintenance phase of ARF known as?
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Oliguric/anuric phase
2nd phase in ARF |
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What is the 2nd phase in ARF?
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maintenance
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During the maintenance phase of ARF, BUN and creatinine _________ daily
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increase
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How much urine output will there be in a pt in the maintanence phase of ARF?
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oliguria (<400 ml/d)
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What are 3 complications of the maintenance phase of ARF?
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Fluid overload
Electrolyte imbalances Acidoses |
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What phases require dialysis in ARF?
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Maintenance phase and early on in the recovery phase
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How long does the maintenance phase of ARF last?
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8-14 days
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During the maintenance phase of ARF, intrinsic damage is ____________
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well-established
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In what stage of ARF do the tubules begin to function again?
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recovery
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How long does it take for BUN and creatinine to return to normal in ARF?
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4-6 months
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How much function will be regained after ARF?
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70-80%
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Is there residual impairment with ARF?
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yes, 20-30% funciton loss after recovery
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What is the recovery phase of ARF also known as?
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diuretic
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WHat is the most common cause of chronic renal failure?
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diabetes
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Systemic lupus may cause ________ renal failure
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chronic
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HTN could cause...
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chronic renal failure
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Polycystic Kidney Disease may cause...
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chronic renal failure
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Pylonephritis may cause...
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chronic renal failure
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Nephrolithiasis may cause...
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chronic renal failure
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What is the first stage of chronic renal failure?
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decreased renal reserve
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During the "decreased renal reserve" stage of chronic renal failure, renal function is decreased by...
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50-60%
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A pt in the decreased renal reserve stage of CRF will be...
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asymptomatic
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What changes will be seen in the BUN and Cr of a patient in the decreased renal reserve stage of CRF?
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BUN and Cr will be normal or only MILDLY increased
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What is the second stage of chronic renal failure?
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Renal insufficiency
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During the Renal insufficiency stage of CRF how much is renal function decreased by?
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60-80%
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during the Renal insufficiency of CRF BUN and Cr will be...
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fairly significantly elevated
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What will be the renal characteristics during Renal insufficiency stage of CRF?
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polyruia and nocturia
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Erythropoietin and renin secretion is ________ with the Renal insufficiency stage of CRF
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decreased
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What is the final stage of chronic renal failure?
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ESRD
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In ESRD renal function is decreased by...
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80-95%
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What body systems will be affected with ESRD?
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ALL
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If a pt does not have dialysis or renal transplant during ESRD what happens?
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death
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What is the final stage of chronic renal failure?
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ESRD
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What is the most specific diagnostic test for renal failure?
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Creatinine clearance
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In ESRD renal function is decreased by...
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80-95%
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What is the normal creatinene clearance rate?
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80-125 mL/min
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What body systems will be affected with ESRD?
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ALL
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How is creatinine clearance tested?
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24 hour urine
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If a pt does not have dialysis or renal transplant during ESRD what happens?
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death
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With renal failure Creatinine clearance will be...
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decreased
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What is the most specific diagnostic test for renal failure?
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Creatinine clearance
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What is the BUN:creatinine ratio?
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20:1
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What is the normal creatinene clearance rate?
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80-125 mL/min
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If the BUN:creatinine ratio is greater than 20:1 what should you suspect?
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non-renal issues
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How is creatinine clearance tested?
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24 hour urine
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With renal failure Creatinine clearance will be...
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decreased
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What is the BUN:creatinine ratio?
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20:1
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If the BUN:creatinine ratio is greater than 20:1 what should you suspect?
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non-renal issues
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BUN and creatinine will be _______ with renal failure
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elevated
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Serum osmolality will be ______ with renal failure
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decreased
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What is the primary diagnostic study for renal failure?
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renal ultrasound
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What are neuro s/s of Renal failure?
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confusion
vomiting decreased LOC stupor |
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what are the GI s/s of Renal failure?
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nausea
vomiting anorexia gastritis bleeding stomatitis uremic halitosis |
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uremic halitosis
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breath smells like urine
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What are the respiratory s/s of Renal failure?
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kussmaul's respirations, crackles, pulmonary edema
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how will a pt with profound Renal failure breath?
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kussmaul's respirations
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What will you hear in the lungs of a pt with Renal failure?
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crackles
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What are the CV s/s of renal failure?
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tachycardia
CHF dysrhythmias rub preicarditis increased BP edema |
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What will you hear in the heart sounds of a pt with profound Renal failure?
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periacrdial friction rub
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what are the integumentary s/s of Renal failure?
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dry skin
pruritis edema bruising pallor then very bronze uremic frost |
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What color will the pt skin be in early Renal failure?
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pale
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what color will the pt skin be in late Renal failure?
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bronze
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what are the hematological s/s of Renal failure?
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anemia
metabolic acidosis decreased immune system |
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What is the #1 cause of death in ESRD pts?
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infection
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why do patients have kussmaul's respirations with renal failure?
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metabolic acidosis
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What is the normal value for BUN?
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7-20 mg/dL
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What is the normal value for creatinine?
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0.5-1.5 mg/dL
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What is the normal value for serum potassium?
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3.5-5 mEq.L
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A patient with renal failure will be _____kalemic
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hyper
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with Hyperkalemia the T wave will be...
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tall
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with Hyperkalemia the ST segment will be...
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depressed
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with Hyperkalemia the PRI will be...
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prolonged
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with Hyperkalemia the QRS complex will be...
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widened
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what kind of arrhythmia will occur with hyperkalemia?
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ventricular fib
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What is the normal for serum calcium?
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8.5-10.5 mg/dL
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with renal failure a pt will have _____calcermia
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hypo
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Calcium and ______ have an inverse relationship
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phosphate
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What causes hypocalcemia in the pt with renal failure?
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low excretion of phosphorus
decreased Vit D |
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what happens to the CNS with hypocalcemia?
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hyperactivity...seizures, paresthesisas, cramps, weakness, fatigue, etc
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with Hypocalemia the QTI will be...
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prolonged
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Heart blocks and cardiac arrest are complicatons of...
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hyperkalemia
hypocalcemia |
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WHat is the normal serum phosphate level?
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3-4.5 mEq/L
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With renal failure a pt will have _____phosphatemia
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hyper
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What causes hyperphosphatemia in renal failure?
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low excretion of phosphorous
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what are s/s of hyperphosphatemia?
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numbness, tingling, tetany
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WHat is the normal level for serum magnesium?
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1.3-2.1 mg/dL
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what electrolyte follows phophate?
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magnesium, if phosphate is up then magnesium will be up
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with hypermagnesemia the QRS complex will be...
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prolonged
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with hypermagnesemia the PRI will be...
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prolonged
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with hypermagnesemia the BP will be...
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low
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with hypermagnesemia the HR will be...
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bradycardia
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A patient with renal failure will have _____magnesemia
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hypermagnesemia
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with hypermagnesemia the neuromuscular transmission will be ________ and neuromuscular function will be _______
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diminished; depressed
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how many ml of fluid will equal 1 pound?
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500 ml
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When should blood be given to a pt with renal failure?
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before or during dialysis
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How many mL's in 1 kG?
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1000 mL
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What 3 meds are given to Renal failure pt to control BP?
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ACE
ARB's Diuretics |
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Protein intake needs to be monitored in the renal pt because....
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breakdown of protein increases nitrogenous waste
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How much calcium should a renal failure pt have per day?
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800-1200 mg/d
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How much protein should a renal failure pt have per day?
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0.8 g/kg
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How much sodium should a renal failure pt have per day?
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0.5-1 g/d
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How much potassium should a renal failure pt have per day?
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20-50 mEq/kg
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What 2 things reduce intestinal absorption of phosphate?
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TUms
Phos-lo |
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What can be given to increase intestinal absorption of Ca?
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Cacitrol (Rocaltrol)
Vit D |
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Why is a renal pt on seizure precautions?
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severe hypocalcemia
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What 2 things can be given to push potassium into cells rather than in the vascular space?
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glucose and insulin
alkali (sodium bicarb) |
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What can be given to reduce body K content?
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kayexelate
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What can be given to reduce the cellular response to high potassium levels?
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calcium gluconate
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what med can be given to improve fatigue in the renal pt?
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epogen
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How do pressors help with prerenal failure?
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increase constriction which will increase BP
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Are diuretics given in ESRD?
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NO
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What two drugs may be given to increase renal perfusion (even though research doesn't support their use)
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dopamine
lasix |
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What does acetylcystine (mucomyst) and fenoldopam (corlopam) do for the renal pt?
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it protects the kidneys against dye related failure
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What can be hear/felt with AV fistulas, Grafts, and external shunts?
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Bruit and thrill
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how often should you check for bruit/thrill when assessing a fistula or graft?
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q8hr
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Can you draw blood, get BP, give injections, or set an IV in the arm with a fistula?
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NO
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When should you notify an MD when assessing a fistula/graft?
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if there is no pulse, bruit, or thrill
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If a pt is recieving dialysis through a vascath can you use that access for IV fluids, meds or blood samples?
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NO
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What is the most common complication of dialysis?
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volume depletion (hypotension)
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Disequilibrium syndrome usually only occurs...
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after the first few times of dialysis
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During dialysis, blood comes out from the _______ access and goes back in through the ______ access
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arterial; venous
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Should antihypertensive meds be given to a pt scheduled for dialysis?
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no, withhold for several hours prior to dialysis
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What should you do with dialyzable meds in a pt with dialysis
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withhold until after dialysis
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What is the advantage of CVVHD?
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more gradual solute removal
flexible fluid administration minimal heparin done by staff nurse rather than dialysis nurse |
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When giving a pt CVVHD what temp should the tubing be?
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warm
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What kind of embolism is a risk with CVVHD?
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air embolism
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What technique should be used when accessing any dialysis access?
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sterile
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Peritoneal dialysis carries a high risk for...
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peritonitis
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What is the first indication of peritonitis?
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cloudy peritoneal fluid
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what is the most common rejection of kidney?
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acute rejection
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What are the indicators for continuous arteriovenous hemofiltration?
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Used in pts too unstable for hemodialysis; continuous; more gentle
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