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118 Cards in this Set

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