Acute Renal Failure Flashcards
(55 cards)
1
Q
Functional unit of the kidney
A
Nephron
2
Q
Percentage C.O
A
up to 20%
3
Q
Renal structure
1- outer layer
2- inner layer
A
- cortex
- medulla
4
Q
how many liters of filtrate per day
A
180 L
5
Q
how much concentrated urine
A
1-2 L
6
Q
GFR
A
125 ml/min
7
Q
Acute Kidney Injury
A
- decline of GFR in 48 hrs or less
- fluid retention
- Retention of waste products normally filtered out
- can turn into acute renal failure
8
Q
why is UO not always a reliable indicator of GFR
A
because of diuretic treatment
9
Q
what is not excreted by injured kidneys
A
Creatinine
10
Q
Other S/S of injured kidneys
A
- unbalanced I/O
- weight gain
- crackles in lungs
- edema
11
Q
RIFLE Criteria
A
R-risk I-Injury F-Failure L-Loss E-End-stage kidney dz
12
Q
AKIN Criteria for renal failure
A
- Serum Cr increased by 0.3 mg/dl
- more than 50% incr. creatinine level
- UO 6hr
13
Q
Lab draws how many times
A
2 x in 48 hrs
14
Q
Factors on the prognosis
A
- depends on cause
- depends how quickly treatment is started
- how sick pt is
- length of stay
- mortality 15-60%
- can lead to permanent dialysis
15
Q
Pre-Renal Causes
A
- hypoperfusion
* blood loss and dehydration
16
Q
Pre-Renal S/S
A
- GFR decreases
- UO decreases
- AZOTEMIA: build up of protein
- can be fixed quickly if caught early
17
Q
Intra-Renal Causes
A
Acute Kidney tissue is damaged
18
Q
Intra-Renal S/S
A
- harder to treat than pre-renal
- ATN- acute tubular necrosis
- Infection
- antibiotics
- kidney failure
- contrast
19
Q
Post-Renal Causes
A
OBSTRUCTION
- tumor
- ureter
- bladder
- abdominal
20
Q
Post-Renal Causes
A
urine cant leave the ureters
21
Q
Functions of the Kidney
A
- Waste Removal
- BP regulation
- RBC production (erythropoietin)
- Vitamin D activation
- Prostaglandin synthesis
- Acid base balance (buffer system)
- Fluid balance
- Electrolyte imbalance
22
Q
Systemic Effects of Renal Failure:
-CARDIOVASCULAR
A
- excess fluid
- edema and HTN
- BP regulation: renin: HTN , stroke, organ damage
- Arrythmias-solutes in blood (K+) irritate the heart
23
Q
Systemic Effects of Renal Failure:
-HEMATOPOIETIC
A
no erythropoietin –> anemia
24
Q
Systemic Effects of Renal Failure:
-RESPIRATORY
A
fluid overload–>crackles, dyspnea
Rapid Respirations-> acid/base imbalance
25
Systemic Effects of Renal Failure:
| -GASTROINTESTINAL
-can alter GI motility d/t electrolyte imbalance (nausea/vomiting)
26
Systemic Effects of Renal Failure:
| -NEUROMUSCLULAR
- electrolyte imbalances
27
Systemic Effects of Renal Failure:
| -INTEGUMENTARY
- edema --> stretched, weak tissue
| - uremic crystals
28
Systemic Effects of Renal Failure:
| -ENDOCRINE
Renin (RAAS) erythropoietin- kidney damage = no secretion
| -no prostaglandin release to regulate renal blood flow: vascular permeability
29
Systemic Effects of Renal Failure:
| -SKELETAL
- impaired Ca++ absorption
| - weak bones, impaired blood clotting
30
Values that DECREASE
Albumin- moves extracellular
Na- dilutional hyponatremia
Ca- d/t phosphorus increasing
Hct- d/t fluid retention and anemia of kidney disease
31
what to be aware of when taking labs
Be aware of meds pt is taking
32
Medical Management:
| -FLUIDS
- replacement for early pre-renal AKI treatment
- Restriction -prevent complications
- Removal-dialysis if kidneys not functioning
33
Medical Management:
| -medications
d/c or reorder with renal dosing
- diuretics
- phosphorus binders
- electrolyte replacement/ removal
34
Renal Failure Nutrition:
- low K diet
- low phos diet
- fluid restrictions
35
Renal Failure medication education
- tell them about the mechanism of action
| - EX) phosiov binds with phosphorus in food so eat with meds
36
Hemodialysis:
| -tonocity
Osmolality- measures the number of particles in a solution
37
Hemodialysis:
| -hydrostatic pressure
movement from an area of high pressure to low pressure
38
Hemodialysis:
| -Osmotic pressure
movement of fluid from an area of low particle concentration to high concentration
-or fluid staying in high concentration
39
Hemodialysis:
| -blood pushed in one direction
+ hydrostatic pressure
40
Hemodialysis:
| -dialysate pushed in opposite direction
- hydrostatic pressure
41
Hemodyalisis Access:
| -Temporary
- IJ
- subclavian
- femoral
- emergency HD
- failed access or ARF
42
Hemodialysis Access:
| -tunneled catheter
- not permanent but long term
| - internal jugular but looks subclavian
43
Hemodialysis Access:
| -AV fistula
- artery and vein connected
- needs time to ripen
- bruit and thrill
- NO BP or blood draws
44
Hemodialysis Access:
| -AV GRAFT
-synthetic material between vein and artery
| _NO BP OR LABS
45
Continuous Renal Replacement CRRT
continuous hemodialysis
removes large amounts of fluids
** removed in 24 hrs rather than 4 which is better for patients hemodynamically
46
Slow continuous Ultrafiltration SCUF
FLUID REMOVAL ONLY
| -used in fluid overlaod pts , HF, not responding to diuretics
47
Continuous Venous hemofiltration CVVH
REMOVES FLUID BUT NO COUNTER CURRENT
- takes out LARGER MOLECULAR WEIGHTS
* CONVECTION
48
CVVH
| how many liters removed
5-20 ml/min (7-30 L/24 hrs)
49
Continuous Venovenous Hemodialysis CVVHD
REMOVES FLUIDS & COUNTERCURRENT
- takes out LOW MOLEC. WEIGHT (urea, cr, K)
- * DIFFUSION
50
CVVHD
| -how long
```
24 hr (2-10 days)
hemodynamically safer to use
```
51
Continuous Venous Hemodiafiltration CVVHDF
COMBO
*CONVECTION AND DIFFUSION
maximal fluid and solute removal
52
CVVHDF
pre-filter
countercurrent
- increases + hydrostatic pressure
| - neg hydrostatic pressure
53
Problems with dialysis
-infection
-clots
-acid base imbalance
-blood loss: dislodge catheter
-air embli
cardiac arrest d/t E/I imbalance
54
PERITONEAL dialysis
- who uses it
- location
- how does it drain
- chronic KF
- abdomen and dwell time
- drains by gravity
55
PERITONEAL high risk
```
peritonitits
incr temp
abdominal tender
cloudy fluid in drain
site red and oozing
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