Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
What is acute renal failure?
|
The sudden, rapid deterioration in kidney function
|
|
What is acute renal failure characterized by?
|
* accumulation of nitrogenous waste products
ex. creatinine and urea * decreased urine output |
|
What laboratory values are monitored for acute renal failure?
Which one is the best indicator? |
1) BUN and Creatinine
2) Best indicator- Creatinine |
|
What is Azotemia?
|
The accumulation of BUN and creatinine
|
|
Three types of renal failure and what is their etiology?
|
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 |
|
What are the two most common causes of prerenal failure?
|
Hypovolemia (ex. hemorrhage, burn patient)
Heart failure |
|
What is produced as the body's natural response to hypovolemia?
|
Angiotensin II- powerful vasoconstrictor
|
|
Are NSAIDS and ACE inhibitors dangerous for those who have renal problems?
|
YES
|
|
What lab value is important to know before a test procedure that uses contrast dye?
|
Creatine b/c contrast dye can cause renal failure, esp. in diabetes.
The kidneys have to work extra hard to get the dye out. |
|
What is used prophylactically before procedures that use contrast dye?
|
Mucomyst
|
|
What is chronic renal failure?
|
It is a progressive, irrreversible deterioration in kidney function leading to:
1) the inablility to eliminate waste 2) inability to maintain F&E blalance |
|
What are the two main causes of Chronic Renal Failure in the US?
|
* Diabetes Mellitus
* Hypertension |
|
What are some clincal cardiac manifestations of CRF?
|
Cardiac
*HTN (b/c fluid overload) *hyperkalemia (changes in EKG) *Pericarditis - Cardiac Tamponade |
|
What is the triad symptoms of pericarditis?
|
1) JVD
2) muffled heart sounds 3) narrowing pulse presssure [difference between diastolic and systolic gets closer] |
|
What are the pulmonary manifestations of CRF?
|
*Pulmonary edema
*Pleural effusions |
|
Acute renal failure is generally recognized by what clincal observations?
|
AnsweR: Fall urinary output and increase in BUN and.or creatinine; oliguria is common
|
|
Acute renal failure follows three phases, what are they?
|
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. |
|
What should be included in the nursing assessment when caring for a pt. with acute renal failure?
|
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. |
|
What are the common signs and symptoms of renal failure?
|
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. |
|
What would the diagnostic tests show in acute renal failure?
1) Electrolytes 2) BUN and Creatinine 3) ABGS 4) CBC 5) UA |
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) |
|
Why is Creatinine a more accurate test than BUN when assessing renal fx,?
|
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.
|
|
When should you weigh an ARF patient?
|
Answer: At the same time each day to document fluid volume status. Restrict fluids as ordered.
|
|
What position should you put an ARF in to enhance cardiac and respiratory fx?
|
Answer: Semi-folwer's position
|
|
Why is it important to monitor the skin status of an ARF pt.?
|
Answer: It is important to monitor the skin status because increased edema can decrease tissue perfusion and increase the risk for skin breakdown.
|
|
What are the most common causes of chronic renal failure?
|
Answers:
*Diabetic neuropathy *HTN * glomerulonephritis *cystic kidney disease * urologic disease |
|
Describe the treatment that would be given to a renal failure patient for hyperkalemia.
|
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. |
|
What are the three types of dialysis?
|
Answer:
1) Hemodialysis 2) Continuous renal replacement therapies 3) Peritoneal dialysis |
|
For hemodialysis, how soon do the AV fistulas or AV grafts take to be used for dialysis after surgery?
|
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. |
|
What is an important teaching for those who have a AV graft or fistula?
|
Answer: Do not wear constrictive clothing on limb w/ access device. do not sleep on or carry anything heavy on area of access device.
|
|
How do you know if the AV graft or fistula is working?
(2 ways) |
Answer:
1) Palpate "thrill" 2) Auscultate bruit |
|
Where do you draw blood and place BP cuff on a dialysis pt?
|
Answer: On limb that does not have the access device.
|