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74 Cards in this Set

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