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118 Cards in this Set
- Front
- Back
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What are the functions of the kidneys?
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Urine formation and elimination
Electrolyte balance Acid/base balance Blood Pressure regulation Blood component production |
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What are the components of the nephron?
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Bowman's capsule
Proximal convoluted tubule Loop of Henle Distal convoluted tubule |
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What is the primary function of the renal system?
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Maintain volume and composition of ecf controlled by glomular filtration, tubular reabsorption and secretion
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How does the renal reabsorption take place?
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Reabsorption and secretion takes place thru active and passive transport.
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What does water reabsorption depend on?
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ADH
Aldosterone for sodium (NA) reabsorption and Potassium (K) secretion |
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What regulates Calcium (CA) and HPO4 reabsorption?
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Parathyroid Hormone
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What three classes of substances are filtered?
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Lytes
nonlytes-amino acids, glucose water |
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What is acute renal failure?
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Sudden, rapid, but potentially reversable deterioration in renal function sufficient to cause nitrogenous waste accumulation in body fluids.
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What is chronic renal failure?
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Substantial and irreversable decrease in renal failure to less than 20% normal. Less than 30ml hour output
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What disease is the leading cause of chronic renal failure?
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Diabetes Mellitus and Hypertension
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What are the common renal studies?
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CBC: infection
BUN: 8-20 Creatinine: 1-2 UA with microscopic: cast, RBC, Blood Urine and serum osmolarity Ultrasound, IVP, renal scan (isotope base) Renal biopsy |
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What is a common cause of protein in the urine?
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Increased capillary permeablity involving glomerulus.
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What would be considered heavy protein in the urine?
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3.5
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What does the presence of protein in the urine indicate?
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Renal disease
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What is the significance of renal test?
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UA: Hematuria
Specific gravity: used as a guide to osmolariy GFR: Best indicated by creatinine clearance end product of protein metabolism- 24 hour urine and blood sample Normal 125ml/min |
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What does microscopic UA show?
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RBCs
WBCs bacteria cast |
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What is the most common type of renal failure?
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Acute renal failure
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What is the etiology of prerenal acute renal failure?
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Hypovolemia: dehydration, hypotension, hemorrhage
Reduced cardiac output; cardiac failure Decreased SVR- sepsis Impaired renovasular blood flow- emboli, thrombi |
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What is the patho of acute renal failure?
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Perfussion: low
Body initiates compensatory and autoregulatory mechanisms Tubules: functionally intact Urine: low output of NA free urine related to maximum reabsorption of H2O and NA |
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What is the treatment for acute renal failure?
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Treat underlaying cause
increase fluid volume increase perfusion Renal dose dopamine Diuretics |
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What is the etiology for acute renal failure Renal?
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Acute tubular necrosis
Nephrotoxins infections process Vascular disorders: thrombotic states: DIC |
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What is the most common cause of acute renal failure in critical care patients?
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Acute Tubular Necrosis
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What is a cause of Acute tubular necrosis?
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Nephrotoxic: durgs, chemicals, poisons.
Ischemia: prerenal, transfusion, trauma |
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What medication would you need to stop prior to any dye study?
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Metforman
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What is the renal patho or acute renal failure?
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Perfusion: normal or obstructed
Tubules: increased pressure in collecting tubules results in hydronephrosis and tubular damage Urine: loss in tubular function results in obstruction, loss of concentration, secretion and reabsorption abnormalities |
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What is the treatment for Renal: acute renal failure?
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Prevention
Monitoring durg levels Adequate hydration and elimination of contrast media Adequate treatment of infection Treatment or D/C offending cause |
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What is the etiology of postrenal acute renal failure?
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Obstruction
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What is the patho of postrenal acute renal failure?
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Perfusion: normal intiailly
Tubules: damaged if pressure increases Urine: flow is obstructed resulting in hydronephrosis Bilateral obstruction results in anuria |
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What is the treatment of posrenal acute renal failure?
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Treat underlaying cause
Remove obstruction |
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If Acute renal failure is not treated what can it result in?
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Acute tubular necrosis
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What are the manifestaions of Acute renal failure?
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Decreased urine output (50-400ml/day)
Decreased specific gravity Urine osmolarity approximates serum osmolarity ( 280-320mo) May have increased urine sodium Dyness, pruritis, pallor, purpura |
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What are the signs and symptoms of acute renal failure?
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Anorexia, N/V/D/C, stomatitis
H/a, drowsiness, irritability, confusion, decreased concentration, personality changes Peripheral edema, Kussmauls breathing, SOB |
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What would an elevated K, urea nitrogen and creatinine level indicate?
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Acute renal failure
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What are the four phases of Acute renal failure and Acute tubular necrosis?
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Phase 1: initiating
Phase 2: Oliguric: most dangerous, causes of death-infection & GI bleeding Phase 3: Diuretic Phase 4: Recovery |
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What do you see in the oliguria stage of acute renal failure?
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Inability to excrete metabolic wastes or fluid loads and regulate lytes
Hypervolemia hypernatremia hyperphosatemia hypermagnesemia |
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What do you see in the diuretic phase of acute renal failure?
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Urine output is greater than 400-500 ml/day
rarely exceeds 4L/d Hi volume related to hi blood urea concentration & impaired ability of tubules to conserve salts & water Hi volume related to |
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What are the treatments taken to prevent chronic renal failure?
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Control Blood Pressure: target DM 125/75
Dietary Protein restriction Hyperlipidemia management Avoid NSAIDS, other renal toxic drugs |
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What is a sign of chronic renal failure?
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GFR < 15 or dialysis
GFR greater than 15= Dialysis |
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What do you see in phase 3 of chronic renal failure?
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Decreased renal reserve: 40-70% loss of nephrons:asymptomatic
ESRD: retain <15% of normal function. lyte imbalance marked increase in BUN/creatinine, elevated K, decreased CA increased PO4 |
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What are the manifestations of Chronic renal failure?
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A/N/V/D/C
Metallic taste amonia breath stomatitis, esophagitis, gastritis Restless leg syndrome, decreased memory & attention, apathy, drowsiness, irritability, confusion, coma, seizures, eeg changes |
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What would cause NA overload?
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Chronic renal failure: as the # of functioning nephrons decrease ability to excrete NA decreases leading to NA overload
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What would you expect to see related to skin condition with chronic renal failure?
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Yellow bronze skin, dry scaly, severe itching purpura, ecchymosis, uremic frost, thin brittle nails, dry brittle hair, hair may fall out.
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What would you do for a patient in chronic renal failure with decreased cardiac output?
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Assess heart sounds, breath sounds, VS, JVD, pressures, PMI, compare peripheral and central pulses, CXR, Pulse ox
Dialysis, limit heparin, Administer NSAIDS or steroids Prepair for pericardiocentesis Fluid challange if suspected tamponade |
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What are the symptoms of hyponatemia?
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Dry mucous membranes, poor skin turgor, wt loss, hyptension, dizziness, NA <135, altered mental status, tremors, Sz
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What are the nursing orders for hyponatremia?
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Assess
Push fluids as ordered Sz precautions |
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What are the signs and symptoms of hypokalemia?
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K <3.5, flattened T wave, U wave, constipation, muscle weakness, fatigue
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What are the nursing orders for hypokalemia?
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assess EKG
Bowel sounds administer K watch for alkalosis |
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What are the signs and symptoms of hypomagnesemia?
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hyperirritability
tetany leg and foot cramps confusion arrhythmias Sz Trousseau's & Chvostek's signs |
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What are the nursing orders for hypomagnesemia?
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Assess
Administer Mg Watch EKG Sz precautions |
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What is the function of Lasix?
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Loop diuretic
Enhances excretion of sodium and potassium by direct action @ ascending loop of Henle |
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What lab value should you monitor before, during and after giving Lasix?
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Monitor K
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What is a major side effect of Lasix?
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Autotoxicity
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What medication should you hold prior to dialysis?
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Any blood pressure medication
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What is the cause of renal osteodystrophy?
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Secondary to hyperparathyroidism
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What is the treatment for renal osteodystrophy?
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Start low phosphate diet when GFR 1/3
Give phosphate gel binders: amphojel, basogel, alucaps-take with meals, albumin phosphate secreted with stool |
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What is the diet treatment for Chronic renal failure?
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Provide complete proteins
GFR 10: Protein 40g/d GFR 5- Protein 25-30 g/d |
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How do you manage fluid and electrolytes with chronic renal failure via IV?
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Acute: Continuous renal Replacement therapy CRRT
Chronic: Hemodialysis, Peritoneal dialysis, CAPD |
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How is CAVH driven?
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Blood pressure
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How is CVVH driven?
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Venous pump driven
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What are the indications for CAVH?
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Fluid overload, hypovolemic states with hypotension-cardiogenic shock
Acute lyte imbalance, drug removal & poisoning better corrected with hemodialysis Requires MAP 60-70 Anticoagulation w/heparin- PTT: 45-65 sec |
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What are the indications for dialysis?
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BUN>120
Encephalopathy-flapping tremor Pericarditis pH <7.25 K>6 Coma |
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What is the most common hemodialysis access?
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AV fistula: internal
Assess for bruit & thrill |
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What is dialysis disequilibrium syndorme?
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R/T rapid solute removal
Leads to mental confusion, decreased lOC, seizures Occurs during 1st few treatments |
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What is peritoneal dialysis?
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Catherter in the peritoneal
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What are the three steps involved with peritoneal dialysis?
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Inflow
Dwell Outflow |
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What is a risk factor for peritoneal dialysis?
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Infection
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Peritoneal dialysis can be monitored by.
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Heparin or antibx may be added to dialysate
Return solution should be clear Major complications: peritonitis, cloudy, drainage, fever, rebound, leukocytosis |
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What does CAPD consist of?
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Instilled by gravity, bag rolled up, 4h dwell & drain, disadvantage peritonitis, pt ability to preform.
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Which of the following represents the only two physiological functions unique to the kidney and that are clinically important?
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Production of urine and excretion of water soluable waste products.
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Which is least likely to be seen in non-oliguric renal failure?
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Urine specific gravity of 1.028
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Glomerular filtration rate varies according to which of the following?
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Age
Sex Diet Muscle Mass |
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Which pharmacectical agents are not traditionally associated with iatrogenic acute renal failure?
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Benzodiazepines
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Which strategy commonly is used in the prevention of contrast-induced nephropathy?
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Use of oral N-acetylcysteine prior to the study
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The value of ultrasound in the evaluation of renal failure is that it may:
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Show the size and contour of the kidneys as evidence for chronic renal failure
reveal dilation of the renal collecting system evaluate renal artery perfusion |
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The most common reason for acute dialysis in the renal failure patient is:
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hypervolemia and fluid overload
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Delaying the progression of renal disease may be facilitated by all but which of the following?
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Aggressive blood sugar control utilizing metformin
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Which medication strategy may be used to drive potassium back into the cells in the management of hyperkalemia?
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Insulin followed by D50
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Peritonitis in the patient receiving peritoneal dialysis may present as all of the following except:
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Hematuria
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According to the American Burn Associtation (ABA), there are how many burn injuries annually in the United States? More than
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1 million
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According to the ABA, how many deaths are related to byrns and fire annually in the United States? More than:
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4,500
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According to the ABA, how many people are hospitalized with burn injuries each year in the United States?
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45,000
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The treatment for burns without blistering or deeep skin damage is:
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Moisturizing lotion
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Laryngeal edema following inhalation injury is progressive for how many hours following the incident?
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18-24
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To reduce the risk of infection and allow for better inspection of the burn injury, any hair within how many inches of the wound should be shaved?
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Three to four
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Patients being transported to a burn center should be covered with a clean, dry sheet because
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Airflow over the affected areas can be painful
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Among the most common types of burns are those caused by
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Scalds
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Patients with facial burns should be treated with
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Bacitration (baciguent) ointment
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After the inintial application, hydrocolloid dressings on burn wounds should be changed every
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five to seven days
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Which of the following may need aggressive fluid resucitation? A patient with burns
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On the hands or face
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Massive fluid shifts can lead to hypovolemia within how many hours of a burn injury?
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24-48
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Which intravenous solution is recommended for fluid resuscitation in burn patients?
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Lactated Ringer's Solution
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Fluid resuscitation in adults should be administered at a rate sufficient to maintain urine output at
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30-50ml/hr
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Escharotomy may be necessary to release fluid buildup underneath circumferential burns on all of the following except:
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Face
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The gold standard for pain relief of burn injurys is
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Morphine
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A burn that extends into the deep layers of derma and leaves the skin red to pale, with moderate edema, is a
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Second degree, deep partial thickness
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Patients caring for burn wounds at home should contact their doctor if they have any of the following Except
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itching around the wound
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What are the three phases of inhalation injury?
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Acute pulmonary insufficiency- 0-36hrs
Pulmonary edema- 6-72hrs Bronchopneumonia 3-10 days |
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What is Silvadene?
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Treatment for infection of burn pts with full or deep partial thickness burns
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What are the adverse effects of Silvadene?
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Transient lukopenia
Psudoeschar |
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What is Sulfamylon?
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Adjunct in the treatment of partial or full thickness burns to prevent septicemia
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What are the adverse effects of Sulfamylon?
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Metabolic acidosis; pain or burning (may use 1/2 strength)
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When should you remove Aquacel Ag?
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Never it will fall off within 14 days of application
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How often should wet dressings be moistened?
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every 4 hours
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How should you wrap extremities with gauze rolls?
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Loosly from distal to proximal, check pulses and capillary refill after wrapping to ensure circulation isn't compromised
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When is Aquacel used?
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Superficial/partial thickness burns
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What is impregnated into a Aquacel dressing?
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Ionic Silver
Cover with dyr gauze for 24 hrs Do not get wet |
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What are contractures related to burn pts?
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Abnormal process from excessive wound contraction that causes a fixed deformity
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What is hypertonic scaring?
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Raised scars that do not extend beyond the wound
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What are Keloids?
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Excessive amounts of tumor like scar tissue that extends far beyond scar line; itch, bleed, and may be painful
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What position should you place a burn pt in?
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Elevation of extremities
When not exercised maintain inmaximal extension, using splints prn Particular attention to hands and neck prone to rapid contractures |
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What is autograft?
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Self; taken from unijured area; permanent; split or full thickness
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What is allograft?
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Taken from another person;temporary
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What is Heterograft?
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Taken from another species; pig; temporary
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What is a pinch graft?
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Small bits of skin
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What is a Thiersch graft?
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epidermas & patient of dermis = full thickness
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What are the most reliable indicators of adequate resuscitation in a child?
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Mental Clarity
Pulse pressure ABGs distal extremity color Capillary refill Body temperature |
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What are the signs of adequate resuscitation in an adult?
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Clear sensorium
Pulse <120 bpm Urinary output 30-50ml/hr Systolic BP 100 Ph: 7.35-7.45 |
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What does RACE stand for in the initial response to a burn?
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Rescue
Alarm Contain Extinguish,evacuate |
