Renal Flashcards

Question

What are the risk factors for AKI?

Answer 1

HEMODYNAMIC CHANGES RESULTING IN DECREASED FLOW TO KIDNEYS - HTN - Trauma - diabetes - nephrotoxic agents - exposure to heavy metals - recent hypotensive episode - tumor/vascular obstruction - infection/sepsis - age

Answer 2

Changes in amount and concentration depending on injury Usually oliguria, which causes fluid to buildup in body

Answer 3

Pulmonary edema with fluid buildup Increased RR as body tries to compensate for metabolic acidosis

Answer 4

Metabolic Acidosis decreased excretion of nonvolatile acids via urination and decreased renal synthesis of bicarbonates

Answer 5

* Potassium excess (high) * Sodium imbalance (normal, high or low) * Calcium deficit (low) * Phosphate excess (high)

Answer 6

* Anemia (EPO production) * Urea decreases clot formation

Answer 7

Related to increased ICP (excess fluids), or increases uremia (build up of nitrogenous waste) Symptoms: Headache, confusion, irritability, seizure, asterixis (hand tremor)

Answer 8

Fluid overload/HTN MI - clotting with hypocalcemia

Answer 9

Uremic frost; dry itchy pale skin – buildup of urea

Answer 10

N/V secondary to acidosis malnutrition ulcers (urea is irritating)

Answer 11

The glomerular damages leads to incresed permeability across membrane, leading to proteinuria The decrease proteins in the blood decreases oncotic pressuure so fluids leak into interstitial spaces causing edema

Answer 12

1500/2000ml/day ; 1-2ml/kg/hr 0.5ml/kg/hr

Answer 13

Normally BUN and Creatinine ratio ~ 10:1 or 15:1 * A 20:1 ratio of BUN / Creatinine may indicate AKI * BUN/Cr ratio can be used to diagnose

Answer 14

Creatinine is not elevated until ~25% of the nephrons are not functioning

Answer 15

A decrease in creatinine clearance rate indicates a decrease in glomerular function

Answer 16

a decrease in GFR of about 50%

Answer 17

Kidneys control own filtration rate dependent upon fluid volumes and BP Normal = 125 ml/min

Answer 18

When renal function is altered: Urine osmolality increases and urine specific gravity increases * How much stuff and how heavy the urine is (how concentrated the urine is)

Answer 19

Serum (blood) osmolality may stay the same * Electrolytes (serum & urine) Give insight into what is being filtered or not

Answer 20

1. restore perfusion 2. fluid overload 3. electrolyte imbalance 4. infection prevention 5. acid-base imbalance 6. Impaired gas exchange 7. acute confusion 8. coagulopathies 9. diet challenges

Answer 21

* Diuretics * Fluid restriction as prescribed * HR, BP, lungs, heart, ECG * STRICT Intake and output * Daily weights * Watch for electrolyte imbalances * Monitor for evidence of heart failure with fluid overload that has been happening; has heart been able to compensate?

Answer 22

Potassium: acidosis and decreased excretion causing hyper - arrhythmias (wide QRS) Sodium: dependent on fluid status hypo: early due to lack of reabsorption because of lack of healthy nephrons to resorb hyper: later on which causes cellular dehydration

Answer 23

toxin buildup alters inflammatory response * Changes in leukocyte function * Altered immune response and function * Diminished inflammatory response * Protective mechanisms lost

Answer 24

Kidneys unable to excrete acid load; defective regeneration and absorption of HCO3 * Metabolic Acidosis

Answer 25

Pulmonary edema

Answer 26

* Increased ICP in fluid overload (hyponatremia) * Toxic effects of azotemia

Answer 27

* Bleeding (EPO deficiency) * Toxic buildup reduces platelet adhesion

Answer 28

* High state of catabolism (breaking proteins down into amino acids) * Therefore: high calorie, low protein, AVOID K, Na * Lack appetite

Answer 29

* Refractory acidosis (not responsive to correction) * Electrolytes (refractory; severe increased K+) * Acute intoxication on salicylic acid, lithium, magnesium laxatives, ethylene glycol * Overload with fluid (pulls fluid off without having to administer diuretics that may be damaging to kidneys) * Uremic complications (pericarditis, platelet dysfunction leading to bleeding)

Answer 30

Slow, progressive, irreversible loss of renal function, affecting nearly all organ systems

Answer 31

* Primary renal condition (polycystic kidney disease, glomerulonephritis) * Other diseases that produce a long-term renal insult (diabetes, hypertension)

Answer 32

1. diabetes 2. HTN 3. proteinuria 4. family history 5. increasing age/wear out over time

Answer 33

* Excess glucose stiffens efferent arteriole causing it to stiffen and narrow so blood cannot leave glomerulus * Leads to hyperfiltration and increased glomerular pressure, expanding size and stiffness of glomerular

Answer 34

* Narrowed lumen and thickened walls mean less blood and oxygen delivered to the kidney causing ischemic injury

Answer 35

Sodium/Water Imbalance - HTN - increased vascular volume/edema - HF Impaired Potassium Balance -Hyperkalemia Impaired nitrogenous waste elimination/uremia - coagulopathies (urea increases bleed rx) - pericarditis - impaired immune function - skin disorders - GI manifestations - neuro manifestations - sexual dysfunction Decreased EPO production - anemia A/B imbalance - acidosis Lack of Vit D activation/phosphorous elimination - hypocalcemia - hyperPTH - osteodystrophies

Answer 36

1. Phospohate - is retained - binds to calcium, decreasing serum levels 2. Calcium - decreased production of active vit D - decreased absorption, decreasing serum levels Both of these things cause PTH release PTH release releases calcium stored in bones (bone demineralization and density loss) Serum caclium increases Phosphate binds again (hyperphosphatemia in AKI) which furthers metastatic calcifications that can lodge in organs in vessels

Answer 37

hemolysis, bone marrow suppression, decreased erythropoietin and iron Decreased platelets - bleedings

Answer 38

1. Dialysis 2. HTN management 3. Nutrition 4. hypoxia 5. infection risk 6. metabolic acidosis 7. drugs to treat * Hyperkalemia * HTN * CKD-mineral and bone disorder * Anemia * Dyslipidemia

Answer 39

* Low protein diet, sodium, potassium, phosphate restrictions

Answer 40

associated with anemia with decreased RBC carrying capacity

Answer 41

Buildup of nitro waste, azotemia effecting response

Answer 42

when kidneys are functioning at < 10-15% of their normal rateT

Answer 43

* Doesn’t cure kidney disease or make kidneys well * Doesn’t fully replace kidney function * (CKD) must continue to have dialysis for rest of life (unless transplant)

Answer 44

* Hemodialysis (AKI, CKD) 2 types: * Intermittent (generally 3 x 4hr “runs” per week) * Continuous renal replacement therapy (CRRT) – AKI patients * Peritoneal dialysis (CKD)

Answer 45

* Dissolved particles are transfused across a semipermeable membrane from one fluid compartment to another * Corrects fluid, electrolyte and acid-base imbalances, and removes waste products

Answer 46

* Used in both types of dialysis * Uses osmosis & oncotic pressure to transfer fluids/particles back and forth across the semi-permeable membrane * Specific solution prescribed based on patient’s current bloodwork to facilitate diffusionA

Answer 47

Can be done on a regular basis so that fluid and electrolyte shift is less dramatic Can be done at home (don’t need to be in hospital) Relieves uremic symptoms Greater flexibility with treatment (can do other activities/work while dialysis happens; can travel)

Answer 48

Considerable infection risk (peritonitis) Permanent catheter in abdomen Can’t get wet (no swimming) Dialysis a daily part of life Slow (slower than hemo) Abdominal discomfort

Answer 49

* Blood Compartment * Contains electrolytes, wastes, toxins, excess water * Exerts oncotic and hydrostatic pressure * Dialysate Compartment * Contains electrolytes similar to plasma * Circulates on the outside of the tubing system * Has a semi-permeable membrane; forces movement of waste from blood into dialysate * Adjustable

Answer 50

* High risk!! Clots, bleeds, infection * DO NOT take BP or blood work on the arm of a fistula! * Inspect the AV fistula for redness, bruising, pustules, swelling, bulging * Palpate for a thrill (should have)

Answer 51

Relieves uremic symptoms Quick and efficient Requires min. 3 treatments/week (4-8hrs) Most individuals have suitable vessels to establish an access site

Answer 52

New medications, restricted intake of fluids Requires vascular access each time and anticoagulation Must plan around hemodialysis schedule Travel to dialysis unit Restricts activity level

Answer 53

* For patients who are hemodynamically unstable * Has less hemodynamic side effects than intermittent hemodialysis * Useful in AKI * Allows for more gradual removal of excess electrolytes/fluid * Critical care setting ONLY * Uses different methods to clear excess fluids, fluids and solutes, electrolytes, creatinine, and urea.

Renal Flashcards

(77 cards)