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ARCHIVED: Assessment > Exam 2: Renal and Heme > Flashcards

Exam 2: Renal and Heme Flashcards

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1
Q

Voluntary avoidance of these foods is a subtle sign of renal disease:

A

High protein

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2
Q

Voluntary avoidance of these foods is a subtle sign of renal disease:

A

High protein

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3
Q

Normal GFR:

A

125 ml/min

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4
Q

Blood flow to the kidney:

A

25% of CO

95% to cortex, 5% to medulla

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5
Q

Conditions requiring dialysis:

A 
GFR 10-15% of normal
Hyperkalemia
Fluid overload
Oliguria
Severe acidosis
Metabolic encephalopathy
Pericarditis
Coagulopathy
Refractory GI symptoms
Drug toxicity
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6
Q

Vessels used for AV fistula:

A

Cephalic vein

Radial artery

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7
Q

Pre-op timing of dialysis:

A

Day of or day before surgery

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8
Q

Expected weight drop post-dialysis:

A

2-4%

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9
Q

Post-dialysis serum K+ should be:

A
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10
Q

Drugs cleared by dialysis:

A

Low molecular weight
Water-soluble
Non-protein-bound

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11
Q

S/s of uremic encephalopathy:

A 
Asterixis
Myoclonus
Lethargy
Confusion
Seizures
Coma
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12
Q

Describe disequilibrium syndrome:

A

Transient CNS disturbance after rapid ↓ in ECF osmolarity (relative to ICF) due to dialysis
Dementia-like
Associated with rapid change from acidotic to alkalotic

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13
Q

Typical hgb in renal failure:

A

6-8 g/dL

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14
Q

Effect of renal failure on bones:

A

↓ VitD production leads to ↓ Ca++ absorption
↓ Ca++ leads to ↑ PTH
Bone marrow replaced with fibrous tissue
More prone to fracture

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15
Q

Factors causing rightward shift in renal failure pts:

A

Metabolic acidosis

↑ 2,3-DPG

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16
Q

Factors causing impaired platelet function in renal failure:

A

↓ platelet factor 3

↓ adhesiveness/aggregation

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17
Q

Normal GFR:

A

125 ml/min

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18
Q

Blood flow to the kidney:

A

25% of CO

95% to cortex, 5% to medulla

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19
Q

Conditions requiring dialysis:

A 
GFR 10-15% of normal
Hyperkalemia
Fluid overload
Oliguria
Severe acidosis
Metabolic encephalopathy
Pericarditis
Coagulopathy
Refractory GI symptoms
Drug toxicity
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20
Q

Vessels used for AV fistula:

A

Cephalic vein

Radial artery

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21
Q

Pre-op timing of dialysis:

A

Day of or day before surgery

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22
Q

Expected weight drop post-dialysis:

A

2-4%

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23
Q

Post-dialysis serum K+ should be:

A

K

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24
Q

Drugs cleared by dialysis:

A

Low molecular weight
Water-soluble
Non-protein-bound

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25
S/s of uremic encephalopathy:
``` Asterixis Myoclonus Lethargy Confusion Seizures Coma ```
26
Describe disequilibrium syndrome:
Transient CNS disturbance after rapid ↓ in ECF osmolarity (relative to ICF) due to dialysis Dementia-like Associated with rapid change from acidotic to alkalotic
27
Typical hgb in renal failure:
6-8 g/dL
28
Effect of renal failure on bones:
↓ VitD production leads to ↓ Ca++ absorption ↓ Ca++ leads to ↑ PTH Bone marrow replaced with fibrous tissue More prone to fracture
29
Factors causing rightward shift in renal failure pts:
Metabolic acidosis | ↑ 2,3-DPG
30
Factors causing impaired platelet function in renal failure:
↓ platelet factor 3 | ↓ adhesiveness/aggregation
31
Factors causing impaired platelet function in renal failure:
↓ platelet factor 3 | ↓ adhesiveness/aggregation
32
Hematologic problems in renal failure:
Impaired platelets Impaired WBC function Defective vWF Hypocomplementemia d/t dialysis
33
CV changes in renal failure:
``` ↑ CO compensating for anemia HTN --> Na+ retention, RAAS activation LV hypertrophy CHF w/ pulmonary edema when compensatory limits reached Ca++ deposition into conduction system/valves Arrthymias Uremic pericarditis Accelerated CAD/PVD ```
34
Fluids to use in renal patients:
NO LR: K+ in it NO D5: most are diabetic Use NS - small bag - microdrip
35
Pulmonary changes in renal failure:
Minute ventilation increased to compensate for metabolic acidosis Interstitial edema --> widened alveolar/arterial O2 gradiant Butterfly wings on CXR 2/2 inc capillary permeability
36
Ventilatory considerations in renal failure:
Don't use NO | Use 100% FiO2
37
Endocrine changes in renal failure:
Insulin resistance/poor glucose tolerance Hyperparathyroidism Abnormal lipid metabolism/accelerated atherosclerosis Increased circulating hormones/proteins
38
GI/liver changes in renal failure:
GI hemorrhage (10-30%) Anorexia N/V Hypersecretion of gastric acid, delayed emptying
39
Anesthesia considerations with GI/liver changes:
RSI | Hold off on transfusions unless critical to minimize antigens (transplant potential)
40
Examples of drugs contraindicated in renal failure:
Gallamine Phenobarbital LMWH Succinylcholine
41
NMB of choice in renal failure:
High dose roc; give it 60-90 seconds
42
Lab tests for patients in renal failure:
``` Chemistry panel Osmolarity BUN/Cr + GFR Creatinine clearance (24 hr) Urine SG/osmo ```
43
Normal BUN:
10-20 mg/dL
44
BUN indicative of ↓ GFR:
50 mg/dL+
45
Non-renal causes of abnormal BUN:
High protein diet GI bleed Febrile illness
46
Lag time between ∆ GFR and ↑ Cr:
8-17 hr
47
Source of Cr:
Skeletal muscle
48
Cr levels in elderly:
Tend to stay normal d/t ↓ muscle mass and GFR both
49
Best indicator test for renal function:
24-hr creatinine clearance
50
Interpreting CrCl:
``` Normal 100-120 ml/min ↓ Renal Reserve 60-100 ml/min Mild Renal Impairment 40-60 ml/min Moderate Insufficiency 25-40 ml/min Renal Failure ```
51
Electrolyte derangements in renal failure:
``` Hyponatremia Hyperkalemia Metabolic acidosis Hypermagnesemia Hypocalcemia Hypoalbuminemia Hyperglycemia ```
52
Five treatments for hyperkalemia:
``` Calcium gluconate 10% Sodium bicarbonate Glucose + insulin Dialysis Ion exchange resin ```
53
Describe calcium gluconate for hyperkalemia:
Ca gluconate 10% 10-20ml IV Antagonizes K+ effects on cardiac muscle Immediate onset, brief duration Avoid with digoxin
54
Describe sodium bicarb for hyperkalemia:
50-100 mEq IV Shifts K+ into cells Prompt onset but short duration Can cause Na+ overload
55
Describe glucose + insulin for hyperkalemia:
``` 50ml of D50 + 10U regular insulin Shifts K+ into cells Prompt onset, 4-6 hr duration Best option for urgent case! Can cause glucose derangement ```
56
Describe dialysis for hyperkalemia:
Removes K+ from body Immediate effect Need vascular access, though
57
Describe ion exchange resins for hyperkalemia:
Removes K+ from body Onset 1-2 hours Can cause Na+ overload
58
Normal Hct:
40-54% male | 38-47% female
59
Normal Hgb:
13.5-18 g/dL male | 12-16 g/dL female
60
Normal WBC:
5,000-10,000
61
Transfusion indications for renal patients:
Hgb
62
Normal plt:
150,000 - 400,000
63
Regional anesthesia usually not done on renal patients due to:
Coagulopathies | Peripheral neuropathies
64
Treatment for coagulopathy in the renal patient:
Desmopressin 0.3 - 0.4 mg/kg IV over 30 min | Cyro 10 units IV over 30 min
65
CaO2 =
Hgb * 1.39 * SaO2 + (PaO2 * 0.003)
66
Factors that increase oxyhemoglobin affinity:
``` Alkalosis ↓ PCO2 ↓ temperature ↓ 2,3-DPG Carboxy-/methemoglobin Abnormal hgb ```
67
Factors that decrease oxyhemoglobin affinity:
``` CADET, face right! ↑ CO2 Acidosis ↑ 2,3-DPG ↑ temperature ```
68
Major compensatory mechanism for anemia until
Increase in 2,3-DPG which causes a right shift and decreased affinity/increased O2 delivery
69
Other compensation for anemia:
``` ↓ SVR ↑ HR/CO ↑ plasma volume Redistribution of blood flow to organs with higher extraction ratio ↑ extraction ratio in vascular beds ```
70
Anemia risk factors:
``` GI bleeding Heavy menses Cancers (esp. bone) Chronic infections Nutritional deficiency ```
71
Factors to consider in anemic patients when deciding what Hbg/Hct is acceptable:
``` Duration of the anemia Etiology Fluid volume status Urgency of surgery Anticipated blood loss Co-existing disease ```

ARCHIVED: Assessment (11 decks)

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