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31 Cards in this Set
- Front
- Back
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Word of the Week... Puritis |
Itchiness- someone with advanced renal failure may get itchy
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Whats Renal Failure? |
- Occurs when the kidneys cannot remove the bodies metabolic wastes -Can cause disruptions in endocrine, metabolic functions and fluids, electrolytes, and acid base balance -Has a systemic effect Lethargic, dry mucous membranes d/t dehydration, drowsy, twitching muscles, headache, seizures |
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What do the Kidneys do? |
- Produce hormones that regulate essential body functions like blood pressure
- Remove excess water from the body or retain it when needed - Responsible for erythropoietin (production of RBCs) |
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Whats Acute Renal Failure |
- Sudden and almost complete loss of kidney function (GFR) over a period of hours to days - Get oliguria or anuria |
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Whats Oliguria Whats Anuria |
-produce less than or equal to 400cc of urine -Produce less than or equal to 50cc of urine |
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Whats an early indicator of renal failure? |
- Increased levels of creatinine and urea in the blood through doing a CBC. |
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What are some causes of Acute Renal Failure |
- Hypovolemia - Hypertension -Reduced cardiac output - Obstruction of the kidney or lower urinary tract tumour/clot/stone - Bilateral obstruction in the renal arteries or veins |
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What are the categories of Acute Renal Failure? |
1. Pre Renal 2. Intra Renal 3. Post Renal |
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Whats Pre Renal Phase? |
- Upstream blockage, hypo perfusion of kidneys, impaired cardiac function (MI), vasodilation (from sepsis, anaphylaxis, antihypertensive meds), cardiogenic shock, volume depletion resulting from haemorrhage, dysrhythmias |
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Whats Intra Renal Phase? |
Acute damage to the kidney (nephrotoxic drugs or trauma (renal ischemia), or infection |
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Whats Post Renal Phase |
Downstream occlusion (enlarged prostate), therefore urine can't pass and it backs up into the kidneys causing damage. Or Urinary tract obstruction |
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Phases of Acute Renal Failure |
Initition - initial insult leads to oliguria Oliguria - first symptoms appear with waste products Diuresis (excessive urine production) - GFR recovers Recovery - up to a year, function returns May experience lethargy, headache, seizure, muscle aches. |
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How do you Manage Acute Renal Failure |
Fluid Balance (S&S edema (pitting or non pitting), pulmonary edema (crackles, low o2 sat, dyspnea bounding pulse, increased bp, increased respiratory rate), restrict fluid intake to a minimum - Diuretics -Diet: Low protein and high carb - Adjust medications: might need to lower it because they aren't excreting as much. |
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How to Treat Hyperkalemia |
Kayexalate - Lowers potassium levels (p.o or rectal) |
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Whats insulin and IV D50 do for ARF |
IV D50 - increases glucose levels in hypoglycemics and provides carbohydrates Insulin - lowers BG levels |
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Whats Chronic Renal Failure or ESRD? |
-Progressive, irreversible deterioration -Uremia (increased urea in blood) and azotemia (increased waste products and nitrogen in blood) - it affects every system in the body - Greater the build up of waste products the more severe the symptoms - Estimated 1.9 million Cdns have CKD but do not know it -20% of all CKD were >75 yrs of age |
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Whats the leading cause of CRF |
Diabetes |
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Manifestations of Chronic Renal Failure |
-Its not renal disease that typically kills the client but they die from heart attack or heart failure - Fluid build up (edema, pull edema, bounding pulse, increased BP, dyspnea, increased RR) - Dermatologic puritis (itchy skin) - GI: N.V, hiccups, constipation - Altered LOC, inability to concentrate, muscle twitching, agitation, confusion, seizures |
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Assessing Chronic Renal Failure |
GFR decreases... Creatinine clearance decreases ... Serum creating and BUN increase. BUN = blood urea and nitrogen level |
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Assessment and Diagnostics for Chronic Renal Failure |
Risk for anemia because the kidneys are responsible for erythropoietin Decreased acid secretion and cannot excrete ammonia or bicarbonate therefore Acidosis Calcium and Phosphorous imbalance (Increase phosphorus = decreased calcium puts them at risk for renal bone disease) |
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Is there a cure for Chronic renal failure? |
No, so you slow down the process (control diabetes and HTN) and provide people with education and therapy to live with kidney disease |
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What are management considerations for Chronic kidney failure? |
-Calcium and phosphate binders (decrease the absorption of phosporous)
-Hypertension -Anti seizure medication - Erythropoietin -Nutrition: protein, fluids, sodium, potassium |
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What are the treatment options for Chronic Kidney Failure? |
1. Hemodialysis 2. Peritoneal Dialysis 3. Transplantation 4. Conservative measures |
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Pros and Cons of Hemodialysis |
Con: done every other day, complications include: thrombosis, fistulas and they are MORE likely to experience hypotension than peritoneal dialysis Pros: arteriovenous fistula created for blood draw, used for short term days to weeks for the acutely ill. 3x a week for 4-5 hours |
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Pros and Cons of Peritoneal Dialysis |
More autonomy, self control and self management, less fluid restriction
Complications include: peritonitis (cloudy diasylate, abdonminal pain and tenderness not when the abdomen is ousted down but when it is coming back up), infection |
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What is Transplantation? |
You can get it from a living donor or from a deceased donor but you need to be on dialysis to get on this list |
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Pros and Cons of Renal Transplantation |
Pros: Life without dialysis, can resume normal healthy diet, no fluid restrictions, feel better than when on dialysis Cons: No guarantees, sometimes the kidneys wear out, don't know how old the kidney was, and people are out living their kidneys, and anti rejection meds (immunosuppressant meds) |
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Whats Conservative Management for Chronic Renal Failure? |
A nephrologist will try to prolong the life of a kidney as long as possible Multidisciplinary team is there to support the person and family Renal team works with family doctor and facilities referrals. |
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Whats the most common cause for INTRA RENAL ARF? |
acute tubular necrosis |
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What are the four phases of Acute Renal Failure? |
1. Initiation period - initial insult period and ends when oliguria develops 2. Oliguria period is accompanied by serum increase of the waste product that are usually excreted int other urine 3. Diuresis period marked by a gradual increase in urine output which signals that glomerular filtration is starting to recover 4. Recovery period signals the improvement of renal function and may take 3-12 months. |
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About half of all patients who develop ARF are.. |
above the age of 60, mostly due to dehydration bed rest, nephrotoxic drugs. |
