Critical Urinary Dysfunction

Front 1

How is electrolyte homeostasis controlled?

Back 1

Electrolyte homeostasis is controlled by balancing the dietary intake of electrolytes wit hthe renal excretion or reabsorption of electrolytes.

Front 2

Sodium

Back 2

Major cation in ECF for maintianing ECF osmolarity. Vital functions: skeletal muscle contraction, cardiac contraction, nerve impulse transmission, normal ECF osmolarity, normal ECF volume. Normal range: 136-145 mEq/l. Stored in the kidneys and released to the ECF. Regulates

Front 3

Potassium

Back 3

Major cation of ICF. Normal range 3.5-5.0 Critical balance is needed for generation of action potentials and transmit impulse, regulation of protein synthesis, regulation of glucose use and storage.

Front 4

Six ways the kidneys contribute to health

Back 4

1. Maintain body fluid volume and composition
2. Filter waste products for elimination
3. Regulate blood pressure
4. Participate in acid-base balance
5. Produce erythropoietin for RBC synthesis
6. Metabolized vit. D to an active form.

Front 5

What percentage of the cardiac output do the kidneys receive?

Back 5

20-30%

Front 6

Glomerular filtration does not occur when systolic BP is below......

Back 6

Less than 70mm Hg

Front 7

Renin regulates?

Back 7

Glomerular filtration rate

Front 8

Changes in the blood volume and pressure are sensed by what structure, and what response to these changes occur?

Back 8

Macula densa, causing the excretion of renin, leading to increases in blood volume and blood pressure.

Front 9

What is the response of the glomerulus to conditions that dilate the afferent arteriole and simultaneously constrict the efferent arteriole?

Back 9

Increased filtration pressure; increased urine output

Front 10

During water reabsorption, the membrane of the distal convulated tuble is more permeable to water due to the influence of which hormone?

Back 10

ADH

Front 11

The calcium level is controlled by what?

Back 11

Calcitonin

Front 12

When does glucose appear in the urine?

Back 12

When serum glucose levels are greter than the renal threshold for glucose (greater than 220)

Front 13

Renal hormones and hormone functions

Back 13

RENIN- Raises blood pressure as result of angiotensin (local vasoconstrictor) and aldosterone (volume expansion) secretion
PROSTAGLANDINS- Regulate intrarenal blood flow by vasodilation or vasoconstriction.
BRADYKININS- Increased blood flow (vasodilation) and vascular permeability.
ERYTHROPOIETIN- Stimulates bone marrow to make RBC.
ACTIVATED VIT. D- Promotes absorption of calcium in the GI tract

Front 14

Hormones that infulence renal function

Back 14

ADH,Vasopressin- Makes DCT and CD permeable to water to maximize reabsorption and produce a concentrated urine.
Aldosterone- Promotes sodium reabsorption and potassium secretion in DCT and CD; water and chloride follow sodium movement.
Natriuretic Hormones- Causes tubular secretion of sodium

Front 15

In what way do prostaglandins affect kidney function?

Back 15

Promote water and sodium excretion.

Front 16

How does bradykinin affect kidney function?

Back 16

Maintians renal blood flow.

Front 17

Why do clients with renal disease become anemic?

Back 17

Erythropoietin is produced and released in response to decreased oxygen tension in the renal blood supply. Erythropoietin triggers RBC production in the bone marrow. When kidney tissue is non-functional, erythropoietin production decreases and the client becomes anemic.

Front 18

In the client with dehydration, laboratory test would show what?

Back 18

BUN rises faster than creatinine level.

Front 19

List three outcomes of a decrease in glomerular filtration rate.

Back 19

1. Hyperphosphatemia
2. Hypocalcemia
3. A bicorbonate deficit causing metabolic acidosis

Front 20

List four interventions to prevent complications from acute glomerulonephritis

Back 20

1. Hypertension management
2. Fluid restriction
3. Protein restriction
4. Potassium restriction

Front 21

Three hormonal changs brought about by tumor cells in renal carcinoma and give outcomes of these chagnes.

Back 21

1. Parathyroid hormone produced by tumor cells can cause hypercalcemia.
2. Increased renin can cause hypertension
3. Increased human chorionic gonadotropin can decrease libido and changes secondary sex features.

Front 22

What is the most common cause of renal failure?

Back 22

Poorly controlled diabetes

Front 23

Three interventions to reverse prerenal azotemia

Back 23

1. correcting blood volume
2. Increasing BP
3. Improving cardiac output

Front 24

What is an early sign of renal tubular damage?

Back 24

Decreased urine specific gravity

Front 25

Symptoms of prerenal azotemia

Back 25

1. Hypotension
2. Tachycardia
3. Decreased urine output
4. Decreased cardiac output
5. Decreased central venous pressure
6. lethargy

Front 26

Symptoms specific to intrarenal acute renal failure.

Back 26

1. Oliguria/anuria
2. Hypertension
3. Shortness of breath
4. JVD
5. Elevated central pressure
6. Weight gain
7. Rales and crackles
8. Anorexia
9. Nausea

Front 27

What drug may enhance renal perfusion or elevate blood pressure?

Back 27

Low-dose dopamine

Front 28

In a client with acute renal failure, what are calcium channel blockers used to do?

Back 28

Maintain cell integrity and improve GFR

Front 29

Clients in acute renal failure have a high rate of catabolism that is related to what?

Back 29

Increased levels of catecholamines, cortisol, and glucagon

Front 30

Three indications for use of continuous arteriovenous hemodialysis and filtration would be used

Back 30

1. Fluid volume overload
2. Resistant to diuretics
3. Hemodynamically unstable

Front 31

What is the cause of sodium depletion seen in early CRF?

Back 31

A diminishing number of functional nephrons to reabsorb sodium

Front 32

Two most common causes of CRF?

Back 32

1. Diabetes
2. HTN

Front 33

How does dialysis affect the dietary needs of the client?

Back 33

The client will need additional protein in the diet due to protein loss during the procedure.

Front 34

Medications commonly ordered for the client with pulmonary edema?

Back 34

1. Loop diuretics
2. Morphine

Front 35

What medications are used to treat dialysis disequilibrium syndrome?

Back 35

1. Barbiturates
2. Anticonvulsants

Front 36

In order to increase graft survival, a kidney transplant recipient receives what two procedures before transplantation?

Back 36

1. Dialysis 24 hours before transplant
2. Blood transfusion of donor-specific blood.

Front 37

Two postop assessments the nurse will use to monitor the kidney recipient.

Back 37

1. Hourly urine output
2. Blood pressure

Front 38

Types of rejections, how are they identified and treated.

Back 38

Hyperacute- within 48hrs pt develops increased temp, increased BP, pain at transplant site. Immediate removal of the kidney
Acute- 1-2 weeks postop pt develops oliguria or anuria, temp over 100f, increased BP, enlarged, tender kidney, lethargy, elevated serum creatinine, BUN, potassium levels, fluid retention. Treated with increased immunosuppressive drugs.
Chronic- months - years pt has a gradual increase in BUN and serum creatinine levels, fluid retention, changes in serum electrolyte levels, fatigue. Treatment: conservative managment till dialysis is required. (CRF again)