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Normal range for
BUN Creatinine BUN/Creatinine ratio |
BUN 10-30 [6-20 in elderly]
Creatinine 0.5-1.5 -(results are higher in men) BUN/Creat ratio: 10/20:1 |
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Normal range for..
Na+ K+ Ca+ |
Na+ :135-145
K+ :3.5-5.0 Ca+ :9-11mg/dl or 4.5-5.5 |
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Normal findings:
Bicarb HCO3- Uric acid |
HCO3- :22-26
Uric Acid female:2.5-5.5 male :4.5-6.5 |
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Normal GFR is ____ml/min
however only ___ml/min is excreted as urine.. why?? |
Normal GFR is _125_ml/min
however only _1__ml/min is excreted as urine.. because the rest is reabsorbed and circulated back into the body |
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pt presents with pain directed in areas of kidneys
as nurse.. what do you do? |
kidneys:
-ascultate for bruit (swooshing sounds ONLY normal in dialysis shunt) -percuss for tenderness and pain in CVA -palpate for size, lump, & tenderness if so your a good nurse :) |
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normal age-related changes in the elderly are..
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decreased kidney fxn
nocturia urine retention NOT incontinence |
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urine culture lab results are in for a pt
findings: 80,000 organisms/ml whats this mean? is it normal? |
Normal..
>100,000 = INFECTION |
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what does a creatinine clearance test for??
what are normal results.. why would results be abnormal? |
creatinine clearance approximates the glomerular filtration rate
normal is 85-135 -decreased in elderly & when kidneys are not fxn'ing |
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KUB
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kidneys-ureters-bladder
x-ray of abdomen if ordered: bowel prep |
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intravenous pyelogram
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intravenous pyelogram
xray using contrast dye pt has to NPO- bowel prep push fluids to get dye out bc can be nephrotoxic |
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renal angiogram
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contrast dye-NPO
a catheter is inserted into femoral artery and passed up the aorta to the level of the renal arteries so, NO heprin, asprin |
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CT scan
renal u/s |
with ALL tests using contrast dye you must assess for iodine sensitivity
CT: contrast dye-NPO renal u/s:can be used safely in pt with renal failure |
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cystogram & voiding cystourethrogram
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cystogram & voiding cystourethrogram
radiology procedure using contrast MEDIUM (not nephrotoxic) via catheter/cystoscope to assess bladder injury and evaluate vesicoureteral reflux to detect calculi, diverticuli, etc complication-UTI |
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cystometrogram
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urodynamic study where fluid is instilled into bladder via catheter to measure bladder pressures
complication-UTI |
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renal biopsy
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LAST CHOICE PROCEDURE
-consent for open or percutaneous -PT/PTT & bleeding time post biopsy care: Bedrest monitor v/s, output, for inc abd pain |
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cystoscopy
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used for dx and tx
visualize bladder, cancer, pain NPO-bowel prep- anesthesia void Q2-3hrs drink alot of fluids burning during first few voids is normal r/t rigid scope |
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whats the difference b/t complicated and uncomplicated infections
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if infection is "complicated" by disease or antibiotics..
first time infections are uncomplicated |
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infectious and noninfectious cystitis.. wtf?
[manifestions] |
infectious
+UA/culture -urinary frequency, urgency, dysuria -elderly may not present with usual s/s NONinfectious -UA/culture -same sx with no bacteriuria -chemical cystitis -radiation cystitis -interstitial cystitis +(aka PBS, tx TCAs) |
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cystitis
dx management |
dx: urine C&S is the gold standard of documenting a UTI
management: --drug therapy-- sulfonamides urinary anti-infectives fluoroquinolones urinary analgesics (pyridium) |
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cystitis
teaching hospital |
teaching:
sitz bath generous fluid intake avoid caffeinated drinks acidify urine empty bladder Q3-4H perineal hygiene hormone replacement or estrogen cream hospital: avoid catheterization if poss maintain aseptic tech during cath maintain closed urinary drainage system |
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pyelonephritis
what is it? sx? tests? tx? |
inflammation of renal pelvis, usually bacterial, sx range mild fatigue, sudden onset of chills, fever, vomiting, malaise, flank pain, dysuria, urinary urgency/frequency, CVA pain, sx will subside w/o tx but bacteriuria & pyura still persist
urine test: WBC, RBC, bacteria + for antibody covered bacteria & leukocyte casts tx: -aggressive AB rocephin/ampicillin -untx -> urosepsis -> ARF -chronic -> CRF -> dialysis |
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renal TB
gimme the whole shebang |
-caused by mycobacterium TB (aka granulomatous nephritis)
-consequence of pulm TB -sx: signs of pulm TB, urinary freq, dysuria, hematuria, pyuria, flank pain -dx:screen for pulm TB, 3 clean-catch first urine specimens for acid-fast bacilli -tx: anti-TB drugs for up to 2yrs |
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renal abscess
what do you know? |
rule out if fever & s/s persist after AB therapy
dx: renal u/s or CT scan management: incision & drainage of abscess and AB therapy |
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glomerulonephritis
[say that 10X fast!] what is it |
inflammation of the glomerulus d/t immunologic processes
glomerulus is the filter of the kidneys & prevents large molecules from being filtered, if inflammed allows passage of proteins & RBCs -> less protein in the system causes edema |
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acute glomerulonephritis
cause & manifestations |
rapid but tx-able
-most common is acute strep can also be d/t staph manifestions: abrupt onset of hematuria, proteinuria, &edema, cola/cocoa/coffee-colored urine, fatigue, anorexia, n/v, GI sx r/t kidney problems |
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glomerulonephritis
rapidly progressive vs chronic |
rapid:
-no specific or identifiable cause -primary or secondary -diffuse damage c irreversible renal failure over wks/months chronic: -cause remains unknown -renal deterioration over 20 yrs leads to atrophied kidneys -primary cause of end-stage renal disease -sx are so vague & next thing ya know you've got atrophied kidneys & ur on dialysis -one of top3 causes for dialysis |
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lupus nephritis
chemical induced nephritis |
lupus nephritis:
seen in pts with systemic lupus eryhematosus, an inflammatory autoimmune d/o chemical induced nephritis: idiosyncratic reaction to drugs & chemical common manifestations of BOTH are: hematuria, proteinuria |
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nephrotic syndrome
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not a specific d/o but a group of clinical s/s assoc. c disease conditions
classic signs: -massive proteinuria (frothy urine) -hypoalbuminuria -hyperlipidemia -edema |
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GU system infections
fever occurs if what is affected |
if lower tract inf : no fever
if systemic: fever |
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goodpastures syndrome
[is this the one about a cow?lol] |
a RARE autoimmune disease where both kidneys and lungs are involved
-18-35yr old males who smoke manifestions: respiratory: hemoptosis, cough, crackles, rhonchi urinary: hematuria, & s/s renal failure |
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dx of glomerulonephritis
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throat/skin cultures
ASO titer ESR (post-strep glom...) KUB biopsy (most reliable) U/A renal fxn tests blood tests cholesterol (nephrotic syn) albumin |
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tx of glomerulonephritis
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pharmacology:
-AB (for strep/staph) -immunosuppressants including steriods -anti-HTN ie ACE inhib/diuretics bc edema -antilipemics other: -Bedrest (severe edema or inf) bc inc metabolic rate inc workload on kidneys -low sodium (nephrotic syn) -low-mod protein diet, adeq cals -check abd girth, monitor I&O, daily wt -plasmapheresis(30min) and dialysis(4hrs) |
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hydronephrosis
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enlarged kidney bc urine has backed up d/t obstruction, painful, post renal ARF
note: kidneys can only hold 3-5ml's |
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hydroureter
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an obstructive d/o when ureter swells with urine, painful, if not relieved will lead to hydronephrosis
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urinary retention
cause dx tx |
cause: d/t obstruction or deficient strength of the bladder to contract (ie: p foley, enlarged prostate)
dx:PVR (normal: 50-75ml), by bladder scanner or str8 cath/foley, if >100ml, leave foley in tx: -behavior therapy (ie dbl void) -cath & tx cause -betanechol chloride (Urecholine) for dec bladder tone p cath -alpha adrenergic blocks for BPH -avoid anticholinergic drugs |
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manifestations & risk factors for acute OR chronic pyelonephritis
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risk factors:
-pregnancy -DM -renal calculi manifestations acute: prognosis is good, fever, chills, flank pain, malaise, signs of UTI (may or may not be present), GI s/s chronic: intermittent low-grade fever and nonspecific flank or abd pain |
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list some types of calculi
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-calcium phosphate &/or oxalate- 75-80%
-struvite (aka triple phosphate stones; staghorn)- always in assoc c UTI's (inf) -uric acid (gout) -cystine (genetic/metabolic) |
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nephrolithiasis & ureterolithiasis
what are they and what are the risk factors? |
formation of stone.. ureters or kidneys
risks factors: increased urine concentration warm climate sedentary lifestyle urine stasis diet family/genetics acidity or alkalinity of urine disease hx |
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what are the clinical manifestations and diagnostic tests for urinary calculi?
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clinical manifestations:
pain, UTI sx, GI sx diagnostic tests: -U/A & urine C&S -KUB, U/S, CT, cystoscopy -24hr urine ca, phosphate, uric acid, oxalate excretion -chemical & crystallographic analysis |
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general management of urinary calculi
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-acute attack-tylenol
-pain &spasm control, hydrate, & ambulate -deal c infection/obstruction pain control: narcotic analgesic (ie: demerol) NSAID- only narcotic analgesic that can be injected (toradol) |
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management of urinary calculi depending on type of stone..
calcium oxalate calcium phosphate uric acid struvite cystine |
calcium oxalate- low calcium low oxalate diet
calcium phosphate -low calcium, low phosphate diet uric acid- low purine diet; alkalinze urine (c food & K+ citrate), give anti-gout (ie: allopurinol) struvite- give antimicrobials or Lithostat, acidify urine bc bacteria thrive in alkaline environment cystine-alkalinize urine c K+ citrate, give alpha penicillamine |
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list foods that are HIGH/mod in purine..
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foods HIGH in purine should be avoided from diet to decrease risk of uric acid stones
(high:)sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweet breads, (moderate:) chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham |
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list foods that are HIGH in calcium
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foods HIGH in calcium should be avoided from diet to decrease risk of calcium oxalate/or phosphate stones
milk, cheese, ice cream, yogurt, sauces containing milk, all beans (except green beans), lentils, fish with fine bones (e.g. sardines, kippers, herring, salmon); dried fruits, nuts, ovaltine, chocolate, cocoa unless you have osteoporosis, then eat up :) |
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list foods that are HIGH in oxalate
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foods HIGH in oxalate should be avoided from diet to decrease risk of calcium oxalate stones
dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beans, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, ovaltine, tea, worcestershire sauce |
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how can you acidify your urine?
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prune juice
cranberry juice plums protein (bc protein breaks down into amino ACIDs) |
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whats the indication for surgery r/t urinary calculi?
& what are some surgical techniques in stone removal? |
indication is size
endourlogic (ie: cystocopy, cystolithalapaxy, percutaneous nephrolithotomy) lithotripsy techniques (ie: laser & ESWL (shockwave)) *preferred technique(s)* open surgery techniques (nephrolithotomy, nephrectomy) |
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what is a urethral stricture?
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narrowing of the lumen of the ureter or urethra resulting from fibrosis, or inflammation , trauma, or congential defect
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explain renal artery stenosis.
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partial occulsion of one or both renal arteries & their major branches. can be d/t atherosclerotic narrowing, or fibromuscular hyperplasia
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what is nephrosclerosis?
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sclerosis of the small arteries and arterioles of the kidney which decreases blood flow, resulting in patchy necrosis of the renal tissue
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explain benign nephrosclerosis
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usually occurs in adults 30-50yrs old, caused by vascular changes resulting from HTN, and atherosclerosis. pt may have normal renal fxn in early stages, sx:HTN
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explain accelerated / malignant nephrosclerosis
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associated with malignant HTN, a complication of HTN characterized by sharp increase in BP c diastolic >130. renal insufficiency progresses rapidly
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what are some cares/concerns for a pt with nephrostomy tube?
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NEVER CLAMP!! irrigate gently using sterile technique with max of 5mL
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tell me about ureteral stents
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placed in the renal pelvis extending down into bladder to promote urine flow
can be left in for up to a wk until ureters are healed (ex for stent- inflammation) |
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what is the most frequent malignant tumor of the urinary tract?
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transitional cell carcinoma of the bladder
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what are risk factors for bladder cancer?
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-carcinogens in the urine (d/t smoking and exposures to dyes/chemicals)
-chronic bladder inflammation/infection |
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what are the manifestations of bladder cancer.. and how is it diagnosed?
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intermittent painless hematuria
biopsy |
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tell me all about the different types of treatment for bladder cancer
hint:4 |
1.)intravesical therapy (into bladder)
-immunotherapy c Bacille Calmette-Guerin (BCG live)<- TB vaccine -chemotherapy 2.)systemic chemotherapy 3.)radiation -radiation cystitis, non-infectious give antiosmotics (ie pyridium turns urine orange) 4.)surgery -depending on depth of invasion into bladder wall -partial or radical cystectomy c urinary diversion for invasive tumor s mets |
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explain incontinent urinary diversions
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incontinent
-requires an external appliance for collection -most common is ileal conduit (when they use part of small intestine, isolated from GI, in this case urine will be mucousy) |
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explain continent urinary diversions
give examples |
internal urinary reservoir or pouch (artifical bladder)
pouches are catheterizable (Q 3-4hrs) kock pouch indiana pouch florida pouch |
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what are the preop and postop care for pts with cystectomy or urinary diversions?
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preop:
bowel prep (neomycin enema to sterilize gut) psychological prep postop: -prevention of complications (ie: paralytic ileus, small bowel obstruction, thrombophlebitis) -stoma care -monitoring I&O |
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what are the triad symptoms of kidney cancer?
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hematuria
/ \\ / \\ / \\ / \\ flank ----------- palpable pain mass |
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what is the most common type of kidney cancer?
how is it diagnosed? |
adenocarcinoma
renal U/S /CT scan |
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what are the risk factors for kidney cancer?
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white males, 55 & over, smoking, occupational exposure to chemicals, renal calculi, obesity, genetic factors
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whats the treatment for kidney cancer?
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radical nephrectomy with regional lymph node resection
sounds scary!! |
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talk about nursing care post nephroectomy
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-pain control & incision care
-prevent ion of resp complicatiosn -maintaining urinary elimination at least 30mL/hr -monitoring for adrenal gland insufficiency -give steriods until other kidney is sufficient note: loosing cortisol (which is responsible for sugar) =hypoglycemia loosing aldosterone (responsible for Na&H2O retention)=dec BP |
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explain what a spastic bladder is
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reflexic, uninhibited, upper motor neuron
bladdering keeps contracting |
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AFR
-definition- |
a rapid deterioration of renal fxn associated with
-azotemia(the accumulation of nitrogenous wastes in the blood such as blood urea nitrogen) -levels of serum creatinine 2-4 weeks duration good prognosis(most recover) oliguria~100 auria<100 |
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causes of prereneal ARF
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(heart)- d/t decreased renal blood flow
-volume depletion(hemorrhage, diuretics, GI losses) -impaired cardiac efficency(MI, CHF, dysrhythmics) -vasodilation (sepsis, anaphalyxis, antiHTN meds) |
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causes of intrarenal ARF
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+acute tubular necrosis is a type
(kidneys)- result of direct parenchymal damage -prolonged(>2hrs) ischemia, (surgery, severe hypovolemia, sepsis, trauma, burns) -nephortoxins(antibiotics{-mycins}, NSAIDs, contrast) -myoglobin(muscle trauma, infection) -hemoglibin (transfusion reactions) |
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causes of postrenal AFR
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(ureter & bladder)- result of an obstruction of urine outflow
-prostate cancer -urinary calculi -bph -external tumors |
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phases or ARF
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-initiating
-oliguric [FVE] --salt/h2o retention --metabolic acidosis(cant produce ammonia to keep normal)-> hyperkalemia(kussmals),^ wt --^K+ can lead to arrhythmias -diuretic [FVD] --^ output --dec Na+ & dec K+, dehydration -recovery when BUN/creatinine are stable -initiating -maintenence -recovery |
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ARF dx
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-hx
-bun & serum creatinine -serum electrolytes metabolic acidosis hyperkalemia dilutional hyponatremia(Na+^ but b/c of retention of fluid= low Na+) -urine osmolality/specific gravity and other tests will help determine the cause of ARF |
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ARF management
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-when a pt is oliguric or anuric, the md initially orders fluid challange(ns 500ml x 4hrs or <)
--dec urine output means pt is dehydrated --no ^ or change in output suggests further testing to rule out renal failure -diuretics -hemodialysis -continuous renal replacement therapy (CRRT)slow dialysis ICU setting -hyperkalemia -fluid and Na restriction -adequate calories and rest- if not pt will burn protein & BUN will ^ |
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****MOST SERIOUS COMPLICATION OF ARF****
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INFECTION
(most common cause of death) -monitior WBC &temp -meticulous skin care (IV site) -avoid unnecessary catheters -hand washing |
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ARF prevention
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monitoring the high risk populants.. who r high risk? -ppl under tx for other problems
preventing exposure toxins -peak and troughs preventing hypotension & hypovolemia |
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CRF
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-a permanent irriversable condition in which the kidneys r unable to remove metabolic waste and excessive water from blood
-gradual onset -fatal s dialysis or transplant -causes --#1 DM (32%) --HTN(28%) --glomerulonepheritis(15%) |
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explain what a flaccid bladder dysfunction is
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a-reflexic, lower motor neuron
lazy bladder doesnt contract= retention |
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what is the most common complication of spastic and flaccid bladder dysfxn
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infection d/t stasis & catheterization
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pt teaching
self cath r/t to bladder dysfxn |
clean technique
use soap & water dry & store in sandwich bag |
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drug therapy for flaccid bladder
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betanechol (URECHOLINE)
stimulates bladder contraction |
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drug therapy for spastic bladder
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propantheline (PROBANTHINE)
relaxes bladder & internal sphincters |
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how can you retrain the bladder
(r/t to bladder dysfxn) |
-tolieting c stimulated reflex voiding using trigger points
-crede & valsalva NOT FOR THOSE C SPINAL CORD INJURY D/T RISK OF AUTONOMIC DYSREFLEXIA -intermittent catheterization |
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what are the 4 types of urinary incontinence & give me the NANDA definitions
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STRESS: intraabdominal pressure c loss of small amounts of urine
URGE: strong uncontrollable urge to void OVERFLOW: overdistention, & frequent loss of small amounts of urine FXN'L: physical, environmental, or psychosocial causes outside of the urinary system |
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what are tests to diagnose urinary incontinence? & how do you tx it?
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PVR urine
urodynamics U/A & urine C&S cystscopy tx underlying cause |
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what are some NON pharmacologic interventions for incontinence??
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-urine containment
-lifestyle changes (ie: diet, wt loss, quit smoking) -pelvic muscle exercises (Kegel) & vaginal cones -voiding techniques (bladder decompression (credes maneuver)/ dbl voiding/ bladder retraining/ prompted voiding -environmental modifications -surgery (stress incont.) |
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what are some pharmacologic interventions for incontinence?
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-drugs the resistance of urethra/bladder outlet or suppresses bladder contraction for urge or stress incont [anticholinergic (muscarinic)]
(ie:vesicare, detrol) -[cholinergic] drugs to bladder pressure/ contraction & dec outlet resistance for overflow incont. |
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CRF stages
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DEPENDS ON LEVEL OF KIDNEY FXN
renal insufficieny -GFR 20-50% of normal rate -azotemia c oliguria and edema end stage renal disease (ESRD) -GFR<5% normal or beow 115ml/min -uremia (RBC have shorter lifespan-normal is 90-100 days) -requires renal replacement therapy |
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clinical manifestations of ESRD
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*ALL SYSTEMS AFFECTED*
F and E cardio (CHF is most likely COD) hemo gi neuro muscolskeletal endo integ immune |
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CRF dx tests
whats high & whats low?? |
urinalysis
-high BUN & serum creatinine -low creatinine clearance other blood chemistry values -high mag -high K -high phosphates -low Na -low Ca -low bicarbs CBC |
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CRF goals of care
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preserve kidney fxn
prolong the need for transplant and diaysis preserve quality of life |
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CRF management
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fluid excess
-monitor I&O --fluid and Na restriction --reduce thirst --check daily wt (1kg= 1 liter; 1lb ~500 ml) -diuretics -lasix -anti-HTN drugs --ACE inhibitors & ARB -dialysis ***** #1 HTN****** wt loss lifestyle change |
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CRF--- common nursing dx
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excess fluid volume
risk for injury activity intolerance imbalanced nutrition <body requirements anticipatory grieving risk for infection potential complications: HTN, hyperkalemia, peripheral neuropathy |
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what are the signs of trauma?
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hematuria or dec urine output, inc abd pain
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possible trauma.. when would you NOT insert foley?
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if blood is present
[hematuria] |
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how do you tx nephrosclerosis & renal artery stenosis?
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antihypertensives
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polycystic kidney disease
risk factors manifestations dx tx |
PKD is a heredity disease which leads to CRF
manifestations include: flank/abd pain, HTN, hematuria, proteinuria, nocturia, polyuria, signs of inf, constipation, severe h/a (berry aneurysm) dx by u/s and renal fxn tests no specific tx, supportive management & genetic counseling |
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what are the three HIV associated renal syndromes and tell me a little about each
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1. proteinuria & nephrotic sydnrome -may be the inital sign of HIV inf in some persons
2. HIV-associated nephropathy- characterized by proteinura, progressive azotemia, absence of HTN, large kidney size, & unusally rapid progression to ESRD 3.Acute renal failure- most common in AIDS pts with HIV-related infection or malignancy |
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what is dialysis?
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a technique in which substances move from the blood through a semi permeable membrane and into a dialysis solution (dialysate)
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hemodialysis requires a vascular access.. give examples
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-AV fistula
-AV graft (feel for thrill or auscultate for a bruit to establish patency) -temporary access (ex Quinton, Tessio catheters) |
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each patient has his/her ___ dialyzer
specific dialysis orders written by ________ |
each patient has his/her _own__ dialyzer
specific dialysis orders written by __nephrologist__ |
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nursing care for pt on dialysis
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monitor v/s
wt change? check for bruit and thrill |
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what are some complications of hemodialysis?
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disequilibrium syndrome
hypotension bleeding muscle cramping steal syndrome |
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CRF management- electrolyte imbalance
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metabolic acidosis
-bicarb supplements hyperkalemia -Na+ polystyrene sulfonae (Kayexalate)- a cation exchange resin(in bowel K+ for Na+) -reduce dietary K+ (potatoes, winter squash, oj, bananas, spinach, milk & caneloupe) hyperphospatemia -reduce phos in diet -phosphate binders (give cmeal) [ie: phoslo(Ca acetate), Tums(Ca caronate), Renagle(sevelamer)] hypermagnesemia -avoid magnesium containing antacids/laxatives(MOM) excess BUN/creatinine -restrict protein to 0.6-0.8g/kg/day -choose ^ biologic value proteins -^ carbs -rest anemia -folic acid and iron supplements (Nephrocap, if not then iron) -erythropoietin (procrit, epogen given IV or SC) - ^ hct & hgb in 2-3 wks s/e: HTN |
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what is disequilibrium syndrome?
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result of very rapid changes in composition of ECF. urea, sodium, and other solutes are removed more rapidly from the blood than the CSF and brain creating high osmotic gradient in the brain, resulting in the shift of fluid into the brain causing cerebral edema
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the following symptoms suggest what problem?
n/v, confusion, restlessness, h/a, twitching, jerking, seizures, muscle cramps, hypotension |
disequilibrium syndrome
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what is steal syndrome?
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distal ischemia b/c too much of the arterial blood is being shunted or "stolen" from the distal extremity
s/s: pallor, numbness, & eventually gangrene usually seen p surgery and may require surgical correction |
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what meds would you hold before hemodialysis?
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meds that produce hypotension, water soluable drugs, dig
DONT hold insulin |
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what is diffusion?
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movement of solutes from an area of greater concentration to an area of lesser concentration
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what is osmosis?
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movement of fluid from an area of lesser to an area of greater concentration of solutes
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what is ultrafiltration?
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water and fluid removal results when there is an osmotic gradient(glucose) or pressure gradient across the membrane
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what is peritoneal dialysis?
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-uses the peritoneum as the semipermeable membrane
-osmosis & diffusion -requires access through anterior abdominal wall -one exchange/cycle (fill-dwell-drain) -uses 1-2L of dialysate c glucose concentrations (1.5, 2.5, & 4.25%) -CAPD (continuous ambulatory PD) is most common- use STERILE technique |
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What are some problems associated with peritoneal dialysis?
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peritonitis
exit site inf abd pain outflow problems hernia lower back problems bleeding protein lost into dialysate hyperglycemia hyperlipidemia |
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what are the advantages of PD over HD?
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-eliminates vascular access and heparinization
-avoids rapid fluctuation in ECF -diet/fluid intake is more liberal -client more able to self-manage -training less complex |
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renal transplant
preop & postop care |
preop:
-immunologic studies -pyschological prep postop: -donor & recipient -donor rejections (most common in first 3months- acute rejection) -immunosuppressive therapy (ie: sandimmune, cytoxan, corticosteriods) |
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What is CRF, how is it diagnosed?
How is CRF staged.. stage1,2,3,4,5 |
CRF
GFR<60mL/min for >or= 3months Stage 1 -normal or ^ GFR >or= 90 Stage 2 -GFR 60-89 Stage 3 -GFR 30-59 Stage 4 -GFR 15-29 Stage 5 KIDNEY FAILURE <15 |
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CRF fluid restriction
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600mL is added to previous days output d/t insensible fluid loss to estimate amount of fluids
pt given 2/3 amt in day shift & 1/3 amt in evening |
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CRF fluid restriction
|
600mL is added to previous days output d/t insensible fluid loss to estimate amount of fluids
pt given 2/3 amt in day shift & 1/3 amt in evening |
