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81 Cards in this Set
- Front
- Back
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the inability of the nephrons to function |
renal failure |
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acute renal failure (ARF) |
-sudden and rapid decrease in renal function |
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ARF treatable? Y/N |
-potentially reversible with early , aggressive treatment of contributing factors |
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CRF Chronic Renal failure |
-progressive and irreversible damage to the nephrons , may take months or years to develop |
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prerenal disorders |
nonurological conditions that disrupt renal blood flow to the nephrons affecting their filtering ability |
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hypovolemic shock cardiogenic shock 2nd to CHF septic shock anaphylaxis Dehydration renal artery thrombosis stenosis of artery cardiac arrest lethal dysrthythmia |
prerenal disorders that disrupt renal blood flow to the nephrons affecting their ability to filter |
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intrarenal conditions |
conditions in the kidney itself that destroy the nephrons |
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ischemia nephrotoxicity acute and chronic glomerulonephritis polycystic disease untreated prerenal and postrenal disorders myoglobinuria 2nd to burns hemoglobinuria 2 to transfusion |
intrarenal disorders in the kidney itself that destroy the nephrons |
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post renal disorders |
obstructive problems in structures below the kidney that have damaging repercussions for the nephrons above |
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uretal calculi prostatic hypertrophy ureteral stricture ureteral or bladder tumor |
postrenal disorders |
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ARF progesses through four phases |
Initiation phase Oliguric phase Diuretic phase Recovery phase |
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acute tubular necrosis is, where |
death of cells in the collecting tubules of the nephrons where reabsorption of water, electrolytes, and excretion of protein wastes and excess metabolic substances occurs |
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acute renal failure initiation phase 2 |
-begins with precipitating event -reduced blood flow to the nephrons to the point of acute tubular necrosis |
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causes of prerenal failure 7 |
-is outside the kidney -intravascular volume depletion -dehydration -decreased cardiac ouput -decreased peripheral vascular resistance -decreased renovascular blood flow -prerenal infection or obstruction |
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causes of intrarenal failure 5 |
-is within the parenchyma of kidney -tubular necrosis -prolonged prerenal ischemia -intrarenal infection or obstruction -nephrotoxicity |
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postrenal causes |
-is between the kidney and the urethral meatuas -bladder neck obstruction -bladder cancer -calucli -post renal infection |
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oluguric phase major characteristics 3 |
-oligura -begins 48 hours after initial cell injury -lasts 1-14 days or longer |
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s/s oliguric phase 10 |
-oliguria -excess fluid volume -azotemia -low specific gravity of urine -hyperkalemia -metoabolic acidosis -uremia -hypocalcemia -hyperphosphatemia -normal or low sodium |
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oluguric phase manifestations fluid volume excess, hypervolemia leads to these 7 |
-edema -hypertension -dysrythmia -CHF -plueral and cardial effusion -pulmonary edema -pericarditis |
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s.s oliguric phase azotemia and problems it cause |
-is marked accumilation of urea and other nitrogenous wastes in blood (urea & creatinine), decreased GFR -seizures, coma , death (above 18 BUN) |
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some clients with ARF have urine volumes of greater than 500 ml per day why? |
-there are better treatments for the prerenal causes of ARF. But the urine has a very low specific gravity less than 1.003 beause it lacks normal amount of excreted substances |
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respirations with oliguric phase? why |
Kussmal's respirations due to metabolic acidosis Deep, labored breathing -pH < 7.45 -HCo3 > 28 -PaC2 >45 |
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neurological changes with oliguric phase 3 |
-tingling of extremities -drowsiness to disorientation -coma |
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s/s pericarditis with oliguric phase 3 |
-fruction rub -chest pain with inspiration -low grade fever |
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lab oliguric phase renal disease acute |
-BUN elevated more than 18 -Creatinine serum elevated more than -decreased glomular filtration rate below 90 -hyperkalemia 5.5 above -hyponatremia or normal below 135 -hypervolemia -hypocalcemia below 8.8 -hyperphosphatemia (below .81) -uremia (toxic state caused by accumilation of nitro wastes) |
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diuretic phase begins |
as the nephrons recover - there is an increased water content of urine but excretion of wastes and electroytes continues to be impaired , BUN, K, Phosphate levels still elevated , hyponatremia , hypovolemia , diuresis |
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s/s diuresis |
-urine output rises slowly, followed by diureses 4-5 l/ day -dehydration -hypovolemia -hypotension -tachycardia -hyponatremia -hypocalemia -gradual decline in BUN, Creatinine but still elevated above normal -low creatinine clearance |
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recovery phase |
-may take 3-12 months or longer while normal glomular filteration and tubular function are restored |
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all clients make a full recovery t/f ARF |
false. some clients recover completely while others develop varying degrees of permanent renal dysfunction . The older adult is less likely than a younger adult to regain kidney function |
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s/s recovery phase 5 |
-urine volume returns to normal -memory improves -strength increases -increased GMR -stable or continued decline of BUN & Creatinine |
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older adults are more susceptible to ARF 3 |
-decline in the GFR -loss of nephrons that function -reduced glomeruli |
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Chronic renal disease |
-slow, progressive, irreversible loss in kidney function with a GFR less than or equal to 60 ml/min for 3 months or longer, kidneys are so damaged they do not remove protein by-products and electrolytes from the blood and do not maintain acid-base balance |
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slight kidney damage with normal or increased filtration ; a GFR of more than 90 |
stage 1 |
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mild decrease in kidney function with a GFR of 60-90 |
stage 2 renal disease |
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moderate decrease in kidney function with a GFR of 30-59 |
stage 3 |
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severe decrease in kidney function with GFR of 15-29 |
stage 4 |
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kidney failure (ESRD) requiring dialysis or transplantation with GFR less than 15 |
stage 5 |
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CRF more associated with and complication of 2 |
-intrarenal conditions -diabetes mellitus -lupus erythmatosus |
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reduced renal reserve nephron function loss |
40-75% loss of nephron function |
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renal insufficiency nephron function loss |
75-90% loss of nephron function |
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end-stage renal disease nephron function loss |
less than 10% nephron function |
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ESRD to maintain life this is required |
-dialysis -kidney transplantation |
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rise of this adversely impacts all body symptoms in CRD |
rise of UREMIA, AKA Azotemia , rise of urea in blood |
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uremic frost |
-skin becomes the excretory organ for the substances the kidney usually clears from the body and a precipitate forms on the skin |
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why does metabolic acidosis develop in CRF |
tubles cannot convert carbonic acid the blood to water and bicarbonate irons |
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conditions that affect chronic renal disease 6 rsk nursing |
-Anemia -risk for infection -Edema & hypertension -dysrythmia from hyperkalemia -osteodystrophy risk for fracture -pruitis and dry scaley skin |
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what causes the osteodystrophy risk for fracture CRF |
bones become demineralized, from hypocalcemia and hyperphosphatemia . The parathyroid glands secrete more calcium to raise the blood level of calcium but is stealing it from bones |
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LAB for CRF |
-elevated BUN & Creatinine -hyperkalemia -hypermagnesium -hyperphosphatemia -hypocalcemia -decreased hematocrit, hemoglobin, RBC -pH acidic blood -low specific gravity of urine |
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test to show destruction of nephrons |
percutaneous renal biobsy |
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dye excretion delayed with (IVP) |
severe renal failure |
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nurse measures to prevent ARF for clients at risk 5 |
-treat shock with IV fluids and blood replacement -monitor risk for dehydration and prevent -treat infections promptly to prevent sepsis -monitor for toxic drug effects -continuous monitor of renal function to prevent ARF |
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when ARF first hits measures are taken quickly to remedy the primary cause of renal failure and limit damage 4 |
-parental fluids to increase plasma volume -vasodilators -dopamine infusion (Intropin) to improve cardiac output and perfuse renal arteries -diuretics |
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for emergency or temporary measure, hemodialysis uses |
-double-lumen catheter or -twin central venous catheter |
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to reduce complications and keep client alive during 2-3 weeks while tubules are regenerating in ARF , tx |
hemodialysis |
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CCRT COntinuous rental replacement therapy |
filtration of blood through an extracorporeal circuit for clients who are unstable , continous via large veins , such as femoral, internal jugular and subclavian veins. Done in intensive care unit or hemodialysis unit in hospital |
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Kayaxalete (Sodium polystyrene sulfanate ) prescribed route and why |
-oral -rectal -ion exchange resin for hyperkalemia |
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fast or slow way to treat hyperkalemia |
ER = Hemodialysis (but usually no time) FAST= glucose and insulin IV to facilitate movement of K within the cell for hyperkalemia (nurse watch for dysrythmia EKG for peak T ) Maintenence= Kayaxalate Oral or Enema , watch for diarrhea like stool to see if effective) for dysrythmia from hyperkalemia and hypocalcemia = calcium gluconate IV |
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to restore acid-base balance tx |
IV sodium bicarbonate |
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mgnt tx for CRF vs ARF |
lifelong unless kidney transplant |
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tx for anemia for CRF |
Epogen instead of blood transfusions because it stimulates bone marrow production of RBC and Iron supplements |
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goal of nutrition therapy for ARF |
-prevent or minimize malnutrition -nutrition therapy is probably benificial but has not been proven to speed recovery or improve survival |
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protein recommendation ARF not in dialysis or catabolic state and protein for normal person RDA allowance |
.8-1.2 g/kg of weight normal person .8 g/kg |
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ARF sodium and K allowance per day during diuretic phase? |
2-3 g per day , during diuretic phase more K allowed to replenish losses |
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these allowances are indivualized 3 |
-calcium -phosphorus -calories |
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fluid allowances for ARF |
volume of urine produced plus an additional 500 mL to compensate for insensible losses |
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objectives of nutrition therapy for CRF 6 |
-reduce blood nitrogen level -reduce hypertension and edema -prevent body catabolism -improve renal function -prevent or delay the onset of complications -diet adjusts frequently according to labs and symptoms |
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pure sugars and heart healthy fats CRF |
used liberally for calories to spare body and dietary protein |
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cornerstone of nutrition therapy for CRF |
protein restriction , ranges from 0.6-0.75g/kg most protein from animal sources because of higher biological value than plant proteins |
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make diet difficult to maintian 5 |
-Americans normally consume twice as much protein as required -sodium and K restrictions -fluid restrictions -anorexia -taste alterations |
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help clients maintain diet CRF 5 |
-strong social support -frequent self-monitoring of protein intake -low-protein foods -guidelines to increase calorie intake so they remain hopeful -renal diet lists "choices" |
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"choices " 3 main ideas |
-foods grouped according to their content of protein, sodium, K, sometimes fluid & phosphorus -portion sizes specified so all servings have equal amounts of those 3 main nutrients -any item can be chosen but one item cannot be substitued for another |
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Once dialysis begins nutrition |
-protein restrictions liberalized to 1.2-1.3 g/kg to account for nutritional losses through diasylate -K, Na, fluid determined on individual basis |
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for peritoneal diaylsis nutrition |
adjust their calorie intake downward to compensate for the calories absorbed from the glucose in diasylate |
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medications to avoid with CRF 3 |
-acetylsalicylic (Asprin) is excreted by the kidneys -spirolodactone (Aldactone) & tramterene (Dyrenium) potassium-sparring diuretics |
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avoid foods high in potassium for CRF |
-avacados -bananas -cantaloupes -carrots -oranges -strawberries -spinach -spinach -tomatoes -raisins -potatoes -fish -pork, beef, veal |
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donors for transplant are selected |
-from compatible living donors -from living relatives or friends -brain dead individual who's family allows it |
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excluded from donating kidney |
-hx of hypertension -hx of malignent disease ? -hx of diabetes |
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first intervention nurse assessment Kidney failure 4 |
-nurse attempts to learn the cause -acute vs chronic -prognosis of renal disorder -maybe get information from family because renal failure can effects thought processing |
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9 teaching for CRF |
-fluid intake by physician (usually limited) -no salt substitute (have K ) -no non prescription drugs unless dr approve -measure input/output -avoid ppl w/ infection -tepid water w/shower, apply lotion , no scratching -mild laundry detergent w/ vinegar to rinse -daily weight record -take frequent rests, avoid heavy exercise |
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contact physician immediately tell client if CRF 8 |
--inability to urinate -slow or decrease in urine output -weight gain more than 5 lb in 24 -child, fever, sore throat, cough -blood in urine or stool -easy brusing, -lethargy or extreme fatigue -headache that does not go away -nausea , vomit, diarrhea |
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