acute renal failure

Question 1

what is not a function of the kidney?

Answer 1

synthesize cholesterol, that’s the liver’s job

Question 2

Functions of the kidneys

Answer 2

-regulate blood pressure
-secretion of prostaglandins
-release erythropoietin

Question 3

best approximation of Kidney function?

Answer 3

24 hour urine

Question 4

is a minor increase in creatinine alarming?

Answer 4

yes

Question 5

what is CKD

Answer 5

-kidney damage or a decrease in GFR for 3 or more months
-associated with decreased quality of life
-can progress to ESKD

Question 6

manifestations of CKD

Answer 6

increased creatinine
anemia
fluid retention
electrolyte imbalances

Question 7

CKD interventions

Answer 7

-keep BP below 130/80
-control cardiac risk factors
-treat hyperglycemia
-manage anemia
-smoking cestation
-weight loss

Question 8

which lab test is the best approximation of kidney function?

Answer 8

creatinine clearance

Question 9

which lab value indicates if someone is dehydrated?

Answer 9

specific gravity

Question 10

Acute Nephritic Syndrome clinical manifestations

Answer 10

-hematuria
-edema
-azotemia
-proteinuria
-cola-colored urine
-HTN

Question 11

Acute Nephritic Syndrome treatment

Answer 11

-corticosteroids
-manage HTN
-ABX is infection still present
-I&O
-fluids as needed

Question 12

Nephrotic syndrome

Answer 12

-increased glomerular permeability leading to massive proteinuria
-hypoalbuminemia
-hyperlipidemia
-hypercoagulable state
-edema

Question 13

Nephrotic syndrome treatment

Answer 13

-diuretics
-ACE-Is
-lipid lowering agents
-sodium restriction

Question 14

ESKD

Answer 14

-can be mistaken for stroke like symptoms
-uremia develops, the more build up the greater the symptoms
-metabolic acidosis occurs

Question 15

ESKD complications

Answer 15

-anemia
-calcium - phosphorus imbalance
-hyperkalemia
-HTN
-pericarditis, pericardial effusion, pericardial tamponade

Question 16

ESKD medications

Answer 16

-calcium & phosphate binders
-antihypertensives
-cardiovascular agents (ion tropics)
-erythropoietin

Question 17

Hemodialysis goal

Answer 17

extract nitrogenous substances from the blood and to remove excess fluid

Question 18

HD access

Answer 18

-arteriovenous fistula (preferred, vein to artery)
-arteriovenous graft (synthetic connection vein to artery
-HD catheter (double-lumen catheter that only dialysis can touch

Question 19

how often do you assess artery/venous graft/fistula?

Answer 19

every 8-12 hours

Question 20

what complications are you looking for for a patient who received HD?

Answer 20

bleeding at fistula/graft - apply pressure
infection central line

Question 21

CRRT

Answer 21

-continous HD for patients too unstable for HD
-can be run on a critical care unit by trained critical care RN

Question 22

Peritoneal Dialysis

Answer 22

-pt has PD catheter inserted on abdomen
-dwells dialysate into peritoneum
-drainage of dialysate into drainage bag

Question 23

can you manipulate the catheter for peritoneal dialysis?

Answer 23

no

Question 24

complications of peritoneal dialysis

Answer 24

peritonitis
leakage
bleeding

Question 25

criteria for AKI

Answer 25

50% of greater increase in serum creatinine above baseline

Question 26

what is pre-renal AKI?

Answer 26

-volume depletion (severe blood loss) -impaired cardiac efficiency -vasodilation

Question 27

what is a intrarenal AKI?

Answer 27

-physical injury (trauma to kidney) -hypoxic injury (prolonged ischemia) -chemical injury (ACE-inhibitors) -immunologic injury

Question 28

Post renal AKI?

Answer 28

-urinary obstruction (kidney stone, BPH, tumors, SCI)

Question 29

AKI stages

Answer 29

-initiation (when urine output starts to slow down) -oliguria (400 mLs or less in 24 hours) -diuresis -recovery (can take months)

Question 30

AKI complications

Answer 30

-fluid retention (daily weights) -electrolyte imbalances -uremia

Question 31

AKI focused assessment

Answer 31

-dyspnea -rhonchi -tachycardia -JVD -edema -decreased urine output -ekg changes

Question 32

AKI prevention

Answer 32

-monitor renal function -monitor vital sign changes -watch for signs/symptoms of sepsis -provide & treat infections promptly -provide adequate hydration to patient at risk for dehydration

Question 33

Risk factors for kidney disease

Answer 33

-advanced age -bph -diabetes

Question 34

nutritional considerations

Answer 34

-utilize daily weights during the oliguric and diuresis phase to determine appropriate dietary requirements