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74 Cards in this Set
- Front
- Back
Acute Renal Failure
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Sudden onset, affects 50% of nephrons, lasts 2-4 weeks, good prognosis
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Chronic Renal Failure
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Gradual onset, affects 90-95% nephrons, permanent damage, poor prognosis, dialysis, transplant, fatal
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Prerenal causes
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Hypovolemia, decreased cardiac output, systemic vasodialation, hypotension & hypoperfusion
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Intrarenal causes
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Tubule/nephron damage, infection, tumors, nephrotoxins
Vascular changes, low carb diets |
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Nephrotoxins
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NSAIDS (intra and prerenal)becasue the drugs affect prostaglandins.
COX 2 inhibitors Acyclovir, mycins, IVP dye, chemo, ASA |
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Post renal causes
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Ureter and bladder obstruction
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Epidemiology of Acute Renal Failure
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Id patients at risk for renal disease early to help protect kidney function
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Phases of acute rental failure
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Onset
Oliguric Diuretic Recovery |
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Onset
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Initial phase of injury to the kidney, reversal or prevention of kidney dysfunction is pssible at this stage
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Oliguric Phase
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Follows within 24 hours after the onset, urine output is less than 400 ml/24 hrs, F&E imbalance occurs, generally lasts 8-15 days
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Diuretic Phase
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Urine output increase to 4 to 5 liters per day, Bun/Creatinine improves, potential for F&E imbalance still exists, lasts approximately 10 days
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Recovery Phase
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F&E values start to stabilize, may last up to 12 months, may experience a slight decrease in kidney function
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Hyperkalemia
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> 5, s/s irritability, paresthesia, muscle weakness, ECG changes, ventrical fig, irregular pulse, hypotension, abdominal cramping, diarrhea, N/V
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TX of hyperkalemia
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Mild 5-6 loop diurentics, dietary potassium restricted
Moderate to severe > 6.3, hemodialysis, sodium polystyrene sulfonate (Kayexalate mixed with sorbitol) |
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Emergency measures for hyperkalemia
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10% calcuim gluconate IVP
Sodium bicarbonate IV Regular insulin |
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Hyponatremia
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Occurs when levels < 136, develops because of water retention
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S/s of hyponatremia
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Mental status changes, Nausea, muscle twitching and abdominal cramping, muscle weakness, HA
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TX of hyponatremia
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Limit fluids, diuretics
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Metabolic Acidosis
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pH < 7.35 and serum bicarb < 22, kidneys loose the ability to secrete the hydrogen ions, bicarb ion production deminishes, lungs try to compensate by increasing the depth and rate of respirations
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S/S of metabolic acidosis
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Kussmals respiration, confusion, decreased DTR, hypotension, lethargy, dull HA, GI disturbance
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TX of Metabolic Acidosis
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Sodium Bicarb IVP, dialysis
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Complications of ARF
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Fluid & Electrolyte imbalances, pulmonary edema, cardiac arrest, CHF, hypertension, Chronic renal failure
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Chronic Renal Faiule
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Damage is progressive and irreversible, DM 40%, Hypertension 27%, Glomerulonephritis 11%
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Pathophysiology of CRF
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Hypertrophy of remaining functioning nephrons, solute load becomes greater than can be reabsorbed once 3/4 nephrons are destroyed
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S/s of Chronic Renal Failure
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Oliguria occurs resulting in retention of wast products
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Stage 1 CRF
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GFR > 90, diminished renal reserve
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Stage 2 CRF
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GFR 60-89, decreased renal reserve, kidney damage present
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Stage 3 CRF
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GFR 30-59 Renal insufficiency, metabolic wastes begin to accumulate and treatment with loop diuretics and supportive care provided
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Stage 4 CRF
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GFR 15 - 29, renal failure, response to diuretics lessen and may need dialysis
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Stage 5 CRF
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GFR < 15, end-stage renal disease
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Sensipar
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Enhances calcium receptors in parathyroid gland and suppresses PTH secretion. Only recommended for patients with dialysis.
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Hyperphosphatemia
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Serum phosphorus > 4.5, low phosphorus diet, phospate binders given with meals, Tums,
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Aluminum Toxicity
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Never use aluminum-based phosphate binders because risk of aluminum toxicity leading to anemia, osteomalacia, and encephalopathy
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Hypocalcemia
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< 9.0 die to inverse relationship with phosphorus, decreased activation of Viatamin D by the kidneys, TX Vitamin D supplements, calcuim supplements (<2000), IV clacium chloride
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Anemia
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Due to kidney production of erythropoietin is diminished.
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TX for anemia
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Epoetin Alfa (procrit) takes time, SE HTN, keep eye on BP
Aransep lasts longer than procrit |
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Other TX for anemia
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Iron fupplements, folate and Vitamin B 12
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GI disturbances
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Urea is broken down into ammonia, ulceration and bleeding can occur. Smell and tast of ammonia causes eating disorder
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TX of GI disturbance
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Vinegar mouthwashes neutralizes acid, antiacids ever 2-4 hours
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Neurologic Manifestations
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HA, Weaknses, Drowsiness, Muscle Twitching, Convulsions, Coma, Shortened attention span, peripheral neuropathy
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Cardiovascular Manifestations
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Hypertension, high cholesterol, CAD, CHF, Cardia Arrhythmias, Pericarditis, Cardiac Arrest, Edemam, Anemia, Abnormal Bleeding
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Hypertension
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Target BP is 125/75 or less. Watch serum creatinine closely and tell HCP if it increases 35% of its premedication value.
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High Cholesterol and lipids
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Use statins or lipitor to treat cholesterol
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CAD
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Modify risk factors if diabetic keep HGB A1C < 7%
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Anemia
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Heep HCT between 33-36%
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Hyponatremia
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Occurs when levels < 136, develops because of water retention
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S/s of hyponatremia
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Mental status changes, Nausea, muscle twitching and abdominal cramping, muscle weakness, HA
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TX of hyponatremia
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Limit fluids, diuretics
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Metabolic Acidosis
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pH < 7.35 and serum bicarb < 22, kidneys loose the ability to secrete the hydrogen ions, bicarb ion production deminishes, lungs try to compensate by increasing the depth and rate of respirations
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S/S of metabolic acidosis
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Kussmals respiration, confusion, decreased DTR, hypotension, lethargy, dull HA, GI disturbance
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TX of Metabolic Acidosis
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Sodium Bicarb IVP, dialysis
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Complications of ARF
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Fluid & Electrolyte imbalances, pulmonary edema, cardiac arrest, CHF, hypertension, Chronic renal failure
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Chronic Renal Faiule
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Damage is progressive and irreversible, DM 40%, Hypertension 27%, Glomerulonephritis 11%
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Pathophysiology of CRF
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Hypertrophy of remaining functioning nephrons, solute load becomes greater than can be reabsorbed once 3/4 nephrons are destroyed
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S/s of Chronic Renal Failure
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Oliguria occurs resulting in retention of wast products
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Stage 1 CRF
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GFR > 90, diminished renal reserve
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Stage 2 CRF
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GFR 60-89, decreased renal reserve, kidney damage present
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Stage 3 CRF
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GFR 30-59 Renal insufficiency, metabolic wastes begin to accumulate and treatment with loop diuretics and supportive care provided
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Stage 4 CRF
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GFR 15 - 29, renal failure, response to diuretics lessen and may need dialysis
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Stage 5 CRF
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GFR < 15, end-stage renal disease
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Epogen
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RBC production
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Iron Supplements
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Buildup for anemia
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Laxatives/ stool softeners
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constipation
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Diet
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Reassess every 1 - 3 months
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Type of diet
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Low protein, low potassium, low sodium, low phosphorus, limit dairy , fluid restruction 900 ml for insensible losses, high carbs
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Hemodialysis
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Involves movement of fluid and particles across a semipermeable membrane based on difussion, osmosis, and ultrafiltration
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Purpose of Dialysis
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Restore f&E balance
Control Acid-Base balance removes toxic substances and metabolic wastes |
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Peritonitis
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Elevated temperature, chills, abdomen pain or tenderness, N/V, cloudy or brown outflow of solution
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Hypovolemia
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Hypotension, tachycardia, restlessness, diaphoretic, dizziness, N/V
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Hemodialysis NI
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Hold antihypertensives prior to hemobialysis, can lead to severe hypotensive episodes, try to schedule meds around HD times, so minimal interruption will occur
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NI for vascular access device
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Assess patency Postie bruit and thrill, No BP in arm or venipuncture in access arm, assess s/s of infection, avoid compression of fistual
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Advantage of hemodialysis
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more efficient procedure, can remove toxic waste more quickly/rapidly
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Complications of Hemodialysis
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disequilibrium syndrome, Hypovolemia & shock,
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CRRT Dialysis (continuous renal replacement therapy)
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Slow, gentle process,client is unstable and critically ill and needs a slow gentle process to remove excess fluids and wastes.
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