Acute Renal Failure

Front 1

What is acute renal failure?

Back 1

The sudden, rapid deterioration in kidney function

Front 2

What is acute renal failure characterized by?

Back 2

* accumulation of nitrogenous waste products
ex. creatinine and urea
* decreased urine output

Front 3

What laboratory values are monitored for acute renal failure?
Which one is the best indicator?

Back 3

1) BUN and Creatinine
2) Best indicator- Creatinine

Front 4

What is Azotemia?

Back 4

The accumulation of BUN and creatinine

Front 5

Three types of renal failure and what is their etiology?

Back 5

1) Prerenal- decreased blood flow to the kidneys

2) Postrenal- obstruction of flow below kidneys

3) Intrarenal- direct damage to nephrons and kidney parenchyma from disease or nephrotoxic substances

Front 6

What are the two most common causes of prerenal failure?

Back 6

Hypovolemia (ex. hemorrhage, burn patient)

Heart failure

Front 7

What is produced as the body's natural response to hypovolemia?

Back 7

Angiotensin II- powerful vasoconstrictor

Front 8

Are NSAIDS and ACE inhibitors dangerous for those who have renal problems?

Back 8

YES

Front 9

What lab value is important to know before a test procedure that uses contrast dye?

Back 9

Creatine b/c contrast dye can cause renal failure, esp. in diabetes.

The kidneys have to work extra hard to get the dye out.

Front 10

What is used prophylactically before procedures that use contrast dye?

Back 10

Mucomyst

Front 11

What is chronic renal failure?

Back 11

It is a progressive, irrreversible deterioration in kidney function leading to:
1) the inablility to eliminate waste
2) inability to maintain F&E blalance

Front 12

What are the two main causes of Chronic Renal Failure in the US?

Back 12

* Diabetes Mellitus
* Hypertension

Front 13

What are some clincal cardiac manifestations of CRF?

Back 13

Cardiac
*HTN (b/c fluid overload)
*hyperkalemia (changes in EKG)
*Pericarditis
- Cardiac Tamponade

Front 14

What is the triad symptoms of pericarditis?

Back 14

1) JVD
2) muffled heart sounds
3) narrowing pulse presssure

[difference between diastolic and systolic gets closer]

Front 15

What are the pulmonary manifestations of CRF?

Back 15

*Pulmonary edema
*Pleural effusions

Front 16

Acute renal failure is generally recognized by what clincal observations?

Back 16

AnsweR: Fall urinary output and increase in BUN and.or creatinine; oliguria is common

Front 17

Acute renal failure follows three phases, what are they?

Back 17

1) Initiation phase: begins with the onset of the event causing tubular necrosis; this phase ends when tubular injury occurs.

2) Maintenance phase: Begins w/i hours of the initiation phase and typically lasts 1-2 weeks; characterized by persistent reduction in GFR and tubular necrosis.

3) Recovery phase: Begins when GFR and tubular fx have recovered and there is not further elevation of the BUN and creatinine; renal fx. improves rapidly the 1st 5-25 days and continues up 1 year.

Front 18

What should be included in the nursing assessment when caring for a pt. with acute renal failure?

Back 18

Answer:
1) Wight
2) VS -- watch for orthostatic hypotension due to diuretics)
3) hydration status
4) I&O
5)pain status and eefect of meds.

Front 19

What are the common signs and symptoms of renal failure?

Back 19

1) Skin- yellow,edema, ecchymosis, uremic frost
2) ENT- urinous brath
3) Pul- crackles, effusion, tachypnea
4) CV- HTN, S3 or S4, dysrhythmia
5) GI- bleeding
6) Neuro- changes in LOC
7) Neuromusc- tremors, hyperreflexia.

Front 20

What would the diagnostic tests show in acute renal failure?
1) Electrolytes
2) BUN and Creatinine
3) ABGS
4) CBC
5) UA

Back 20

Answer:
1) Electrolytes (hyperkalemia, hyponatremia, hyperphosphatemia)
2) BUN and Creatinine (both elevated)
3) ABGS (metabolic acidosis)
4) CBC (anemia)
5) UA (fixed specific gravity, protein, casts)

Front 21

Why is Creatinine a more accurate test than BUN when assessing renal fx,?

Back 21

Answer: Creatinine is more accurate than BUN because it is not affected by proteins in the diet or fluid status; the BUN to creatinine ratio should be 10:1; the cratinine does not increase unless one-quarter of nephrons ar enot fx.

Front 22

When should you weigh an ARF patient?

Back 22

Answer: At the same time each day to document fluid volume status. Restrict fluids as ordered.

Front 23

What position should you put an ARF in to enhance cardiac and respiratory fx?

Back 23

Answer: Semi-folwer's position

Front 24

Why is it important to monitor the skin status of an ARF pt.?

Back 24

Answer: It is important to monitor the skin status because increased edema can decrease tissue perfusion and increase the risk for skin breakdown.

Front 25

What are the most common causes of chronic renal failure?

Back 25

Answers:
*Diabetic neuropathy
*HTN
* glomerulonephritis
*cystic kidney disease
* urologic disease

Front 26

Describe the treatment that would be given to a renal failure patient for hyperkalemia.

Back 26

Answer:
1) Sodium polystyrene sulfonate (Kayexalate); works w/i 1-4 hours and binds with K+ in the bowel and is excreted in the feces. Calcium gluconate is used to prevent cardiac disfx but does not lower K+

2) Insulin in DSW forces K+ back in to cells because potassium follows insulin into cells

3) NaHCO3 (sodium bicarb) is infused to promote excretion of K+ in urine. Controls metabolic acidosis.

Front 27

What are the three types of dialysis?

Back 27

Answer:
1) Hemodialysis
2) Continuous renal replacement therapies
3) Peritoneal dialysis

Front 28

For hemodialysis, how soon do the AV fistulas or AV grafts take to be used for dialysis after surgery?

Back 28

Answer:
1) AV fistula is anatomic (join artery and vein together)-- can't be used for 1-3 m/o after surgery
2) AV grafts are synthetic-- an can't be used for 2-4 weeks after surgery.

Note: In the mean time...have to use a temporary access point: Subclavian, IJ, femoral caths.

Front 29

What is an important teaching for those who have a AV graft or fistula?

Back 29

Answer: Do not wear constrictive clothing on limb w/ access device. do not sleep on or carry anything heavy on area of access device.

Front 30

How do you know if the AV graft or fistula is working?
(2 ways)

Back 30

Answer:
1) Palpate "thrill"
2) Auscultate bruit

Front 31

Where do you draw blood and place BP cuff on a dialysis pt?

Back 31

Answer: On limb that does not have the access device.