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179 Cards in this Set

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A rapid decline in renal function w/ progressive azotemia and increase levels of serum creatinine?
Definition of Acute Renal Failure
Has an onset of hours to day?
Acute Renal Failure
Urine output is less than 400ml per day in?
Acute Renal Failure
This has an elevation in BUN creatinine and Potassium?
Acute Renal Failure
This usually lasts less than three months?
Acute Renal Failure
In most cases, this is reversible?
Acute Renal Failure
Occasionally, someone will progress from acute renal failure into?
Chronic Renal Failure
How many type of acute renal failure are there?
3 types of ACF
Basically hypoperfusion?
Prerenal Failure
Factors outside the kidney reduce bloodflow and that reduce bloodflow through the glomerlar so their is an increase in glomerular profusion and infiltration is?
Prerenal Failure
Accounts for about 55 to 60% of ACF?
Prerenal Failure
Causes are anything that's going to cause hypoperfusion such as shock, MI, hemorrhage, dehydration, severe FVD, CHF, hypovolemic shock, anaphylactic shock, etc.?
Causes of Prerenal Failure
Fluids to increase the blood pressure, improve cardiac output, may be given digoxin to help increase cardiac output, are treatments for what?
Treatments for Prerenal Failure
This type of ACF is where there is direct damage to the parenchyma that leads to Nephron malfunction?
Intrarenal Failure
This accounts for 35 to 40% of ACF?
Intrarenal Failure
The pt develops acute tubular necrosis which leads to eschemia and the things that cause this are any kind of nephrotixic medications (Vancomycin, Amphotericin B, Aminoglycocides, non-steroidals, ace inhibitors) these things can cause damage to the kidney tissues, kidney diseases, polynephritis, glomerular nephritis, eclampsia, post partum renal failure, autoimmune disorders such as lupus, HTN and DM in?
Intrarenal Failure
Oliguria, increase in blood pressure, weight gain, S&S of FVE, are S&S of?
Intrarenal Failure
Stop anything that is nephrotoxic, treat the HTN or DM, etc. are treatments for?
Treatments for Intrarenal Failure
A mechanical obstruction of urinary outflow?
Postrenal Failure
Accounts for about 5% of ACF?
Postrenal Failure
Causes are treatable if this is identified before kidney damage occurs?
Postrenal Failure
As the flow of urine is blocked, urine begins to backup into the renal pelvis, developing what's called hydro-ureters (enlarged ureters because they are filling with urine) which leads to hydro-nephrosis causing what type of renal failure?
Postrenal Failure
Prerenal Failure
Intrarenal Failure
Postrenal Failure
are types of?
Acute Renal Failure (ARF)
Begins with the cause of the renal failure (or initiating event), can last from hours to days, there is a gradual accumulation of nitrogenous waste products, and it ends with Tubular necrosis where S&S become apparent?
The Initiation Phase of ARF
The initial manifestations of this phase are caused by a decrease in the GFR, it occurs within 1-7 days of the causitive event and lasts, on an average, of 8-15 days, it can last much longer. The pt may have oliguria in which case they have a urine output of 100 to 400ml a day, or they can be non-ologuric inwhich case their kidneys are still producing urine so the amount of urine output may be normal or near normal giving them a better prognosis. They have azotemia, fluid retention, BUN & Creatinine elevates, specific gravity elevates, increase in the potassium, phosporus, magnesium, decrease in bicarb so they have metabolic acidosis, decrease in the calcium and sodium may be normal or a little low?
The Maintenance Phase of ARF
This phase of ARF is characterized by cell repair and regeneration and a gradual return of normal GFR, may start to have Diuresing of 3-10 L/day. BUN, fluid and electrolytes, specific gravity, and acidosis all gradually begin to fall to normal. Renal function improves rapidly the in the first month and can continue up to a year after?
Recovery Phase of ARF
BUN is the end product of what?
Protein metabolism
An increase in what with BUN would indicate renal failure?
Creatinine
This is a question because BUN can increase in other things such as dehydration, GI Bleed, etc. But if there is a rise in Creatinine with a rise in BUN, it indicates renal failure.
If ARF is not corrected, what does it lead to?
Chronic Renal Failure
When is the Recovery Phase of ARF considered to begin?
When increses in the BUN and Creatinine stop.
Urinalysis (protein, blood, specific gravity, cellular debris), BUN and Creatinine, Creatinine Clearance (GFR), ABG's, Lytes, Hg & Hct?
Laboratory Tests to assess Renal Failure
In the laboratory tests to asses renal failure, if there is glomerular damage what will be present in the urinalysis?
Protein
In the laboratory tests to asses renal failure, the specific gravity is going to be fixed at 1.010, the same as plasma, because the tubules aren't going to be able to concentrate, what?
The filtrate
In the laboratory tests to asses renal failure, the BUN and Creatinine will be?
elevated
In the laboratory tests to asses renal failure, Creatinine levels increase rapidly in what timeframe?
24-48hrs.
In the laboratory tests to asses renal failure, when do Creatinine levels peak?
In 5 to 10 days
In the laboratory tests to asses renal failure, if the pt is non-oliguric, the BUN and Creatinine will increase but they will increase how?
More slowly.
In the laboratory tests to asses renal failure, the Creatinine Clearance is the amount of blood that is cleared of creatinine in how long?
One minute
In the diagnostic tests to assess renal failure, what does KUB stand for?
Kidneys, Ureters and Bladder, a non-invasive x-ray.
In the diagnostic tests to assess renal failure, what test is used to identify obstructive causes and to differentiate between acute and chronic renal failure?
Renal Ultrasound
In a Renal Ultrasound, how will the kidneys appear in ARF?
The kidneys will be enlarged.
In a Renal Ultrasound, how will the kidneys appear in CRF?
The kidneys will appear atrophied (small and shrunken).
Is Renal Ultrasound invasive?
No
In diagnostic tests for renal failure this test is used to evaluate kidney size and identify possible obstructions?
Renal CT Scan
In a Renal CT scan, better scans are made using contrast. Contrast is excreted by what, where if they are impaired the contrast will cause more damage.
Kidneys
In Diagnostic Tests used in Renal Failure, this is an invasive procedure, where the pt will have to sign a consent form, are usually made NPO after midnight, need to know what the H&H is prior to the procedure, most of the time done in radiology under fluroscopy to obtain a piece of kidney that can have a pathology run on it, to tell if acute or chronic renal failure?
Renal Biopsy
In Renal Biopsy, the pt will need a pressure dressing and lie on the side being biopsied to what?
Help maintain pressure on the biopsy site.
How often do you check vitals on a pt having a renal biopsy?
Every 15X4, every 30X2, or every 1hX4.
Monitor urine output for quantity and?
Hemotonuria
In a Renal Biopsy, what will a pt need during post procedure?
Fluids
In Diagnostic Tests for Renal Failure, this is an invasive procedure where the entire urinary tract is visualized to identify abnormal size kidneys or to detect renal calculi, the pt needs to sign a content form, NPO at least 8hrs before procedure, BUN & Creatinine levels obtained, bowel emptied, dye is used so fluids need to be increased to wash dye out afterwards?
An Intravenous pyelogram
How is fenoldopam given?
IV
When is fenoldopam given?
The day of the exam that has IV dye used.
When a pt is given fenoldopam, how often do you monitor blood pressure?
Every 15 minutes.
How many hours in advance of the exam is fenoldopam given and how long after the exam does it continue?
Fenoldopam is usually started an hour to an hour and a half before the exam and is usually continued about 4 hours after the exam.
What does the dosage of fenoldopam depend on?
The pt's body weight.
What was Mucomyst original approved for?
Tylenol ovedose.
Mucomyst and fenoldopam increase what?
Profusion of the kidneys.
The dosage for this medication is 600mg BID for 2 days issued 1 day prior to the exam?
Mucomyst(acetylcysteine)
This medication smells like rotten eggs?
Mucomyst
This medication can be diluted in 6-8oz of juice or water?
Mucomyst
This medication helps increase the profusion of the kidneys through vasodilation?
Dopamine
This medication is given in low doses in IV?
Dopamine
This is administered to help restore renal profusion?
Fluids
Will start out with a loop, such as lasix, or they may give an osmotic, such as manitol?
Diuretics
What is the goal for blood pressure in the treatment of a pt with ARF?
120-125 over 70-75.
What is administered to attain the blood pressure goal of a pt with ARF?
Antihypertensives (ACE's and ARB's)
What can ACE inhibitors and ARBs increase, possibly causing a problem in the pt with ARF?
They can increase the Creatinine levels.
A pt with renal failure has an increased risk for GI Bleed in part to impaired stress response and or platelet functioning, so what medications may be ordered?
H2 Blockers or Proton pump inhibitors
Calcium chloride and calcium gluconate, sodium bicarbonate are what?
Electrolyte Modifiers
Dopamine
Fluids
Diuretics
Antihypertensives
H2 Blockers, Proton pump inhibitors
Electrolyte modifiers
Digoxin
are medications used in what?
ARF
This medication is given to increase cardiac output leading to increased profusion of the kidneys?
Digoxin
In fluid restriction in the pt with ARF, urine output plus what equals 24 hour restriction level?
500ml
Fluid balance is carefully monitored using acurate weight and what?
Sodium levels
There is an increased rate of catabolism and a decreased rate of anabolism in?
The pt with Renal Insufficiency
The renal failure pt needs adequate nutrients and calories to prevent what?
The breakdown of body proteins.
In the renal insufficient pt, what is going to be restricted to 0.6g per kg per day?
Proteins
In the renal insufficient pt why are carbohydrates increased?
To maintain adequate caloric intake and provide a protein sparing effect.
Parenteral Nutrition is high in what?
Amino Acids
When is the decision to start dialysis generally made?
When the GFR <15.
Hemodialysis
Continuous Renal Replacement Therapy
Peritoneal Dialysis
are what?
Different ways to perform dialysis.
This dialysis uses the principles of diffusion and ultrafiltration to remove the waste products, excess fluids and electorlytes from the body?
Hemodialysis
This dialysis is done when Hemodialysis cannot be tolerated by the pt and is usually done in the ICU setting?
(CRRT) Continuous Renal Replacement Therapy
In this dialysis the peritoneal membrane serves as the dialysing surface?
Peritoneal Dialysis
Medications they need to take or avoid (they need to watch out for anything that may be neprotoxic)
Diet
Fluid Restriction (in terms the pt can understand)
Dialysis
Home care (if the pt is going to have someone come in)
Appointments
are what for the pt with ARF?
Patient Teaching
Kidney damage, structural or functional, for greater than 3 months with or without decreased GFR
or
GFR 60ml/min/1.73ml squared, or less, for greater than 3 months with or without kidney damage.
are the definitions for?
Chronic renal failure defined
Gradual onset, usually an 85% loss in nephrons, it is permanent, fatal w/o dialysis?
Chronic Renal Failure
DM, HTN, glomerulonephritis, cystic kidney disease, chronic polynephitis, lupus and others can cause?
Chronic Renal Failure
Depression, psychosis, insomnia, restless legs, seizures and coma are what type of S&S for CRF and uremia?
Neurological S&S of CRF and uremia
HTN, CHF, MI, Pericarditis and Atherosclerotic Heart Disease (ASHD) are what type of S&S for CRF and uremia?
Cardiovascular S&S of CRF and uremia
Kussmaul respirations, dyspnea, pleuritis, pleural effusions and respiratory infections are what type of S&S for CRF and uremia?
Respiratory S&S of CRF and uremia
Anorexia, N/V, diarrhea/constipation and uremic fetor are what type of S&S for CRF and uremia?
GI S&S of CRF and uremia
Cramps, weakness, bone pain and fractures are what type of S&S for CRF and uremia?
M/S S&S of CRF and uremia
Proteinurea, hematuria, nocturia and GFR <10% are what type of S&S for CRF and uremia?
Urinary S&S of CRF and uremia
Anemia and bleeding tendencies are what type of S&S for CRF and uremia?
Hematologic S&S of CRF and uremia
Hypothyroidism and hyperparathyroidism are what type of S&S for CRF and uremia?
Endocrine S&S of CRF and uremia
Decreased sexual functioning is what type of S&S for CRF and uremia?
Reproductive S&S of CRF and uremia
Pallor, petichiae/ecchymosis, yellowish discoloration, Pruritis, calcium/phosphorus deposits in the skin and sensory neuropathy are what type of S&S for CRF and uremia?
Integumentary S&S of CRF and uremia
Urine like breath with a metallic taste in their mouth?
Uremic fetor
Why would you administer electrolyte modifiers in a patient with CRF?
To reduce mild acidosis.
Why are anti-hypertensives used in the pt with CRF?
To maintain the blood pressure, slow the progression of the CRF and to prevent complication of coronary heart disease..
Why are diuretics used in the pt with CRF?
To reduce hypertension and lower potassium levels.
0.6-0.8 gms/kg/day is the restriction for what in the pt with CRF?
Protein
35 kcal/kg/day is an increase for what in the pt with CRF?
Carbohydrates
1-2 liters/day restriction for what in the pt with CRF?
Fluids
2 gm/day restriction for what in the pt with CRF?
Sodium
How much potassium a day should a pt with CRF receive?
60-70 mEq/day potassium
Phosphorus intake should be what in the pt with CRF?
Restricted
How would you monitor tissue perfusion in the pt with CRF?
Monitor I&Os, daily weights, orthostatic VSs.
Fluid restriction
Monitor Labs
Monitor respiratory status and
time activity periods to allow rest
What type of Nursing Care for CRF is:
Monitor dietary intake
daily weight
anti-emetics
oral care
frequent small meals?
Nutritional Nursing Care for CRF
What is movement of fluid and molecules across a semipermeable membrane from one compartment to another to correct fluid and electrolyte imbalances, removes waste products and medications?
Dialysis
What uses diffusion and ultrafiltration?
Hemodialysis
Is a Dialysis Catheter usually temporary or permanent?
Temporary
Where are the locations that a dialysis catheter can be inserted?
Subclavian
Juggular
Femoral
This is where they suture the arterie and the vein together?
AV fistula
This is where a synthetic graft is implanted that connects the arteries and the veins?
AV graft accesses
Feel the thrill and hear the brui?
If the pt has an AV fistula
If you don't feel the thrill and hear the brui in a pt with an AV fistula, what do you do?
Call somebody because something is wrong.
Assess for Thrill and Bruit
Neuro-circulatory check of extremity
Infection
No IV, lab draw
No B/P
No constriction in the limb with fistula
are related to?
Care of Access Devices
When a pt recieves a fistula, what arm would it be initially tried in?
The non-dominate arm
Why can a pt with a fistula not have any kind of constriction (like B/P, restrictive clothes) on the arm where they have their fistula?
It can cause the fistula to clot.
What is the most frequent complication related to hemodialysis?
Hypotension
Why is bleeding a problem in hemodialysis?
They use heparin during hemodialysis.
Hypotension
Anticoagulation
Infection
Graft occlusion
Pulmonary air emolism
Disequilibrium syndrome
are complications of?
Hemodialysis
What is done for a pt who cannot tolerate hemodialysis?
Continuous Renal Replacement Therapy
What does CAVH stand for?
Continuous arteriovenous hemofiltration (CAVH)
What does CAVHD stand for?
Continuous arteriovenous hemodialysis (CAVHD)
What does CVHD stand for?
Contiuous venous hemodialysis (CVHD)
Continuous arteriovenous hemofiltration (CAVH)
Continuous arteriovenous hemodialysis (CAVHD)
Continuous venous hemodialysis (CVHD)
are types of what?
Continous Renal Replacement Therapy
The arterial blood circulates through a hemofilter, then is returned to the body?
Continuous arteriovenous hemofiltration (CAVH)
Arterial blood circulates through a hemofilter surrounded by dialysate, then returns to the pt through a venous line?
Continuous arteriovenous hemodialysis (CAVHD)
Arterial blood circulates through a hemofilter surrounded by dialysate, then returns to the pt through a double lumen venous catheter?
Continuous venous hemodialysis (CVHD)
What must a pt who is going to receive peritoneal dialysis have put in?
A peritoneal catheter.
Where is a peritoneal catheter inserted?
Throught the subcutaneous tissue, down into the peritoneal cavity.
What is a peritoneal catheter made of?
Silicon
Dialysate is instilled into the peritoneal cavity, the metabolic waste products diffuse into the dialysate while its sitting in the peritoneal cavity, the water movements controlled by the amount of dextrose that is in the dialysate, then the fluid is drained out of the peritoneal cavity?
Peritoneal Dialysis
What is the period of time called where the dialysate sits in the peritoneal cavity?
The Dwell Time
How often is Peritoneal Catheter done a day?
Every 6 hours another cycle of peritoneal dialysis begins.
What is meant to do a "dry weight" on a pt that is having peritoneal dialysis?
In the morning they will have the fluid drained off, then they will weigh, then they will start he peritoneal dialysis.
1.5%, 2.5%, 4.25% glucose concentrations are dialysates for what?
Peritoneal Dialysis
Who orders the dwell time for Peritoneal dialysis?
The physician
What is the fluid called that is taken out during peritoneal dialysis?
Effluent
What do you monitor on the fluid that is taken out (Effluent) during peritoneal dialysis?
Color and amount
Pain
Leakage
Infection (fever, cloudy effluent, abdominal tenderness)
are complications of?
Peritoneal Dialysis
Urolithiasis means?
Urinary Stones
*What is very important for people who have renal impairments to know?
*Report low urine outputs
Watch out for nephrotoxic medications (how is it going to affect their kidneys)
When the stone forms in the kidney it is called?
Nephrolithiasis
When the stone forms anywhere except the kidneys it is called?
Ureterolithiasis
Why would a stone be called a "Stag Horn"?
Because of the way it is shaped.
What is the most common type of stone?
Calcium stone
Hypercalcemia, Hyperparathyroidism
Immobility
Bone Disease
Dehydration
can all cause?
Calcium stones
What is the main treatment for calcium stones?
Thiazide diuretics
Thiazide diuretics
Phosphates
Decrease foods high in Ca and oxalate
Increase fluids and exercise
are what for calcium stones?
Management
Which stone type accounts for 5-10% of all stones?
Uric Acid stones
Gout
Increased purine intake
increased acid urine
can cause what type of stones?
Uric Acid Stones
Allopurinol
A low purine diet
and hydration
are treatments for which type of stones?
Uric Acid Stones
Which stone type accounts for 15-20% of all stone types?
Struvite
Which type of stone type is Staghorn?
Struvite
What does the Staghorn fill?
The pelvis of the kidney
UTI's cause which type of stones?
Struvite stones
Antibiotics are used to treat which type of stones?
Struvite stones
Lithotripsy is used to remove which type of stone?
A staghorn stone
Which stone is the uncommon type of stone?
Cystine
Genetic defects and acid urine are the causes of what type of stones?
Cystine Stones
Sodium restriction and hydration are the treatment for which type of stone?
Cystine Stones
Renal colic
Flank pain
Nausea/vomiting
Hematuria (Microscopic, Gross)
Oliguria or Anuria
are S&S of what?
Stones
Obstruction
Hydroureter
Hydronephrosis
Infection
Renal failure
are complications of?
Stones
Urinalysis
Stone pathology
KUB
Renal ultrasound
Retrograde pyelography
Renal CT scan
Cystoscopy
are what for stones?
Diagnostic Tests
In pain management for Stones, what narcotic analgesic is administered around the clock usually with a PCA?
IV Morphine
Indomethacin is what type of medication used in the management of pain relating to stones?
Anti-inflammatory medication
Pro-banthine is what type of medication used in the management of pain relating to stones?
Anti-spasmotics
Fluroquinolones, Levofloxcin (Levequin), Ciprofloxcin (Cipro)
Cephalosporins, Cephazolin (Ancef, Kefzol), Cephelexin (Keflex)
Sulfonamide, Co-trimoxazole (Bactrim)
Nitrofurantoin, Furadantin, Macrodantin
are used for what type of management in stones?
Infection Management
Fluids, fluids, fluids
Administer IV fluids
Force fluids
Inspect urine
strain urine
Assess for FVE
VSs
are what type of nursing management for stones?
Other nursing managment
Using sound or shock waves to crush the stone(s) is called?
Lithotripsy
Opening into the kidney is called?
Nephrolithotomy
Opening into the pelvis of the kidney is called?
Pyelolithotomy
Opening into the ureter is called?
Ureterolithotomy
Assess for >30cc urine per hour
Check for hematuria (ketchup not good)
Daily wt
Splint incision while turning or coughing
Check dressing
are used when?
Post op kidney surgery
Preven urinary stasis
Maintain acidic urine
Avoid stressful activities (contact sports, horseback riding)
No heavy lifting for 6 months
Report wt gain, decrease urine output, flank pain, hematuria
Avoid medications or procedures that can cause nephrotoxicity
3000ml daily
Diet
Medications
S&S of UTI
are what in the treatment of stones?
Post-op discharge teaching