Class 4 chapter 26 Flashcards Preview

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Flashcards in Class 4 chapter 26 Deck (16)
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1
Q

When kidneys fail

A
1. Poor filtration of blood
Waste buildup
Electrolyte imbalances
Acid/base imbalances
2. Blood volume/BP changes
3. Decreased activation of vitamin D
4. Decreased erythropoietin (hormone secreted by the kidneys that increases rate of production of RBCs in response to falling levels of O2 in the tissues)
2
Q

Prerenal Failure

A
Due to decreased blood flow to kidney
Hypovolemia
HF, cardiogenic shock
Sepsis
Medications, toxins
Reversible if caught early
3
Q

Prerenal Failure manifestations

A

Marked decrease in urinary output
Elevation of BUN in proportion to creatinine to 20:1 (normal is 10:1) - BUN not excreted enough
Azotemia (Abnormally high levels of nitrogen containing compounds - most common indicator of ARF)

4
Q

Intrinsic Renal Failure

A
1. Disorder within kidney structure
Prolonged ischemia
Injury to tubular structures
Intratubular obstruction
Infection
Nephrotoxic agents
5
Q

Radiocontrast Agents

A

Giving N-acetylcysteine reduces ARF risk by 50%

6
Q

Acute Tubular Necrosis – 3 phases

A

Destruction of tubular epithelial cells
D/t sepsis, nephrotoxins, medication, obstruction, infection
Coagulation process and rbc lysis = crystals, toxins
Results in hypoxia and ischemia
Often reversible!

1. Onset phase
Hours to days
2. Maintenance phase
Marked decreased GFR and urinary output
Edema, pulmonary congestion, htn
Retention of urea/K/sulfate/creatinine
CNS symptoms d/t toxin build up 
3. Recovery phase
Gradual increased output
7
Q

Postrenal Failure

A

Obstruction of urine output
Ureter (calculi, strictures)
Bladder (tumours, neurogenic bladder)
Urethra (BPH - common)

8
Q

Treatment of all types of Renal Failure

A

Prevention!
Early diagnosis!

Fluids – be careful!
Electrolytes
Calories
Dialysis
Continuous renal replacement therapy
9
Q

Chronic kidney disease

A

Stage 1 - kidney damage, decreased GFR
to
Stage 5 - kidney failure, minimal GFR

10
Q

Chemical changes in renal failure

A

Increased - K, Cl, H, Mg, NH, PO, PTH

Decreased - EPO, vitamin D, calcium

11
Q

Clinical Manifestations of Chronic Kidney Disease

A
1. Altered fluid and electrolytes
Dehydration or fluid overload
Sodium/salt wasting (late stage)
Hyperkalemia (release d/t trauma, acidosis
2. Altered acid-base balance
H ion buildup 
3. Vitamin D deficiency
4. Bone disease
Decreased calcium absorption (d/t vitamin D deficiency), increases PTH, breaking down bone
5. Anemia (common and early sign)
D/t chronic blood loss, hemolysis, impaired erythropoietin, iron deficiency
6. CV complications
Htn (increased PVR, increased RAAS)
7. Accumulation of nitrogenous wastes
Azotemia – elevated BUN (early sign)
Uremia (urine in blood)
8. Impaired drug elimination 
9. Integument (d/t platelet dysfunction)
Platelet dysfunction = bruising, pruritus
12
Q

Cardiovascular Consequences of RF

A

Decreased blood viscosity
Increased blood pressure
Decreased oxygen supply

13
Q

Management of Chronic Kidney Disease

A
1. Dialysis
Hemodialysis
Peritoneal dialysis
2. Dietary management
3. Transplantation
14
Q

Hemodialysis

A

Allows all molecules (except for blood cells and plasma proteins) to move from blood to dyalysate and back
2-4 x/week for 3-4 hours

15
Q

Hemodialysis side effects

A

Hypotension, chest pain (weight gain common between treatments)
NV
Restless leg syndrome, cramps
Dialysis disequilibrium syndrome (DDS)

16
Q

Peritoneal Dialysis

A

Temporary way to regulate electrolytes and fluids

Slow exchange process