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4th Semester > Kidney Exam 3 > Flashcards

Kidney Exam 3 Flashcards

(75 cards)

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1
Q

Where do the kidneys begin

A

T12-L3

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2
Q

What do kidneys do?

A

Regulate Na and water
Regulate electrolytes
Regulate BP through angiotensin system
Regulates peripheral vascular resistance
Regulates RBC production thru production of erythropoietin

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3
Q

What do kidneys stimulate

A

The production of RBC’s from bone marrow ( homeostasis mechanism)

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4
Q

When blood flow to the kidneys decreases, what ABG decreases accordingly?

A

PaO2

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5
Q

What do kidneys excrete

A

Metabolic waste products
Toxins
Hormones

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6
Q

What is the smallest part of the kidneys

A

The nephrons which secretes urine through the glomerular filtration system

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7
Q

What’s the normal GFR rate for men

A

90 - 140 men

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8
Q

What’s the normal GFR rate for woman

A

80-125

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9
Q

What is GFR

A

It is a time sensitive test

It is slightly different based on gender need to be maintained at a constant rate

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10
Q

What’s the most reliable indicator for progressively damaged kidneys

A

GFR

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11
Q

What is the creatinine clearance test

A

A measurement of the rate of removal of creatine from plasma
It is a time sensitive test

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12
Q

What is creatinine

A

It is the protein that is produced by muscle tissue and removed by the blood

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13
Q

What creatinine lab value is indicative of renal damage

A

If below 29 mm/min that is a indicator of renal damage. By this time the patient will be symptomatic.

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14
Q

How often should critical care patients urine output be monitored

A

Monitor it Q 1 hour

Rather than output be based on 30 ml/ HR urine output is based on the patients weight.

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15
Q

Is everyone who is diagnosed with AKI, in renal failure

A

Everyone who is in AKI is NOT in renal failure

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16
Q

What is Normal output

A

1500 ml/ day

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17
Q

What is considered polyuria

A

Urinating more than 2500 ml/ day

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18
Q

What is considered oliguria

A

100-400 ml/ day

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19
Q

What is considered Anuria

A

Less than 100ml of urine output per day

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20
Q

What does BUN reflect

A

BUN reflects the breakdown of protein into amino acids and nitrogen waste products. It is not a good indicator as GFR and Cr bc it reflects the persons protein intake and nutritional status.

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21
Q

What are some things BUN is affected by

A

TPN

MALNUTRITION

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22
Q

What is essential for kidney function

A

Adequate perfusion is essential for kidney function

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23
Q

Approx how much CO goes to the kidneys

A

About 25% of CO goes to the kidneys

Anything that decreases CO will affect renal perfusion

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24
Q

MAP

A

A good indicator of renal perfusion

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25
What is the target MAP for adequate renal perfusion
80 | When the kidneys sense low BP, arterioles will constrict as a way to self regulate
26
What are normal creatine levels
0.6-1.2
27
What can creatinine levels be affected by
Trauma | Malnutrition
28
How long can the kidneys compensate
The kidneys can compensate and continue to function with the pt. asymptomatic until 50-50% of functioning nephrons are destroyed
29
What's the BUN creatinine ratio
Helpful to identify different stages of renal disease
30
What tests diagnose renal status
1. GFR 2. Cr 3. BUN 4. H&H 5. Urinalysis to check for protein and glucose in urine 6. Biopsy of kidney can tell if kidney is damaged or malignant 7. KUB ( X-ray of kidneys, ureter, bladder) 8. Pyelogram IVP ( inject contrast into vein and look at kidney)
31
What is AKI
Sudden Acute Abrupt loss of renal function
32
What are the 2 criteria for AKI for 6 consecutive hours
1. Cr...if creatinine increases 1.5x's the baseline | 2. Urine output....if UO decreases .5 ml/kg/hr for
33
What do older ppl have in relation to the kidneys
Older adults have diminished kidney reserve With age you loose nephron function By age 70, 40-50% of nephrons are damaged
34
What ppl are at risk for AKI
Diabetics Pre existing renal disease ( poly cystic kidney disease) HF, LIVER FAILURE nephrotoxic drugs such as NSAIDS, DIURETICS, AMINOGLYCOSIDES chemo therapy patients Prolonged HTN trauma which leads to hypovolemia,
35
What are the 3 levels of kidney injury
1. Pre renal renal injury 2. Intra renal renal injury 3. Post renal renal injury
36
How many ppl develop pre renal renal injuries
50-60% of AKIs
37
What is pre renal renal injury a result of
It is due to temporary periods of hypovolemia and hypotension It is due to a lack of perfusion
38
Is pre renal injury treatable
It is easily reversible and treatable
39
What is intra renal renal injury
Actual damage to kidney tissue
40
What is treatment for intra renal renal injury
The pt. may need dialysis for life or temporary dialysis
41
What are causes of intra renal renal injury
Prolonged hypotension Hypovolemia Nephrotoxic drugs SLE
42
What is post renal renal injury
Obstruction of outflow of urine causing urine to back up,in the kidney IT IS A URGENT SITUATION
43
What are causes of post renal renal failure
Renal calculate | BPH
44
How long can the kidneys go without perfusion
The kidneys can't go longer than 25 min without perfusion before permanent damage takes place
45
What does a protein calorie deficit result in
Kidney injury
46
What are signs and symptoms of pre renal and intra renal renal injury
Oliguria
47
When would a person need permanent dialysis
If kidney injury doesn't improve in a year | some patients may need to go on a ventilator
48
In what ways would hyperkalemia reflect on a EKG
1. Peaked T waves 2. Wide QRS 3. Prolonged PR interval
49
What is the albumin test
Tests 3 month nutritional status
50
What is the pre albumin test
A current reflection of s patients protein stores
51
What fluids are given for kidney injury
0.9% NS | Based on intake and output
52
What can colloids interfere with
Heart function
53
Before you give colloids, what should the nurse do first
Make sure the heart is functioning adequately
54
What are drugs to increase UO
Norepinephrine | NEVER GIVE DOPAMINE TO IMPROVE CO
55
What is hyperkalemic treatment
``` Insulin IV with dextrose ( bc insulin will draw K+ into the cells Na bicarbonate Ca IV ALBUTEROL NEBULIZER dialysis RRT ```
56
What is IHD
Intermittent hemodialysis
57
What does IHD run the risk of
Hypotensive events
58
What is RRT
Renal replacement therapy
59
What are advantages of RRT
Reduces risk of hypotensive events bc it runs so long 12-15 hrs Drug doses don't need to be reduced Patients dietary intake is not limited or adjusted Not as much electrolyte shifting during and after treatment Preserves hemodynamic stability Doesn't require a fistula ( double lumen vascular access)
60
What are disadvantages of RRT
It is not available on a out patient basis
61
What is CRRT and RRT not indicated for
Post renal renal injuries
62
Who r ppl that need RRT
Critical K+ values Burns with K+ loss Drug overdoses
63
What is RRT vascular access
Veno venous | Arterio venous
64
Which kind of base produces more burns
Alkali produces more burns than acid base
65
What is veno venous
The most common type of RRT vascular access It involves 2 veins There is 1 puncture site in which a dual lumen into a central vein, blood is removed from one lumen cleaned through the machine and put back into the other lumen.
66
Can RRT vascular access be used for anything else
No MEDS NO FLUIDS NO LAB WORK NOTHING
67
What is dialysis classified as
Crystalloids The solution is very similar to plasma It contains glucose, electrolytes, buffering solutions like bicarbonate
68
What type of access is needed for a IHD
A fistula or a graft | It takes a week to 10 days to heal
69
Peritoneal dialysis
Not as common Not as effective as other methods Requires a catheter into the abdomen TAKES HOURS
70
What does refractory mean
Doesn't respond to treatment
71
Where are the 2 burn centers
West penn | Mercy
72
What is true of burn patients
They are extremely hypovolemic with edema, and fluid shifts
73
What does TBSA mean
Total body surface area
74
What does insensate mean
Not sensitive to touch
75
How do you get tar off
Dawn dishsoap | Oil

4th Semester (18 decks)

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