Renal 2

Question 1

the increased fluid in renal failure causes

Answer 1

risk for heart failure

Question 2

describe the electrolyte imbalance of renal failure

Answer 2

• potassium levels increase in the blood (hyperkalemia and acidosis- Kussmol breathing)
• phosphorus increases

Question 3

this is caused by renal deficiency (inadequate calcium and phosphorus levels)

Answer 3

renal osteodystrophy

Question 4

what electrolytes are inversely related

Answer 4

calcium and phosphorus

Question 5

what is a healthy glomerulous filter rate (GFR)

Answer 5

> 90 mL/min

Question 6

broadly describe acute kidney disease

Answer 6

• oliguric phase, diuretic phase, recovery phase
• expect pt to recover
• kidneys injured by prerenal, intrarenal, or postrenal

Question 7

describe oliguric phase of AKD

Answer 7

• <400 mL/day
• occurs within 1-7 days of kidney injury
• metabolic acidosis
• hyperkalemia and hyponatremia
• increased BUN and creatinine
• fatigue

Question 8

describe diuretic phase of AKD

Answer 8

• 1-3 L/day
• manage fluid volume deficit (loss)
• hypovolemia, dehydration
• hypotension
• BUN and creatinine normalize

Question 9

describe recovery phase of AKD

Answer 9

• begins with GFR increase
• BUN and creatinine levels plateau then decrease
• can occur up to a year after injury

Question 10

broadly describe chronic kidney disease

Answer 10

• progressive, irreversible kidney disease

- glomerular function excessively decreases in BOTH kidneys

Question 11

what is azotemia

Answer 11

increased nitrogen wastes (common in CKD)

Question 12

GFR in ESRD

Answer 12

GFR<15 mL/min

• *kidney is NOT functioning in end stage
• NEED to implement dialysis or transplant

Question 13

what is important to remember about GFR

Answer 13

parameters differ by race and gender

Question 14

if pt at stage 1 of kidney failure what is goal

Answer 14

lengthen amount of time until getting to stage 5 (lifestyle changes)

Question 15

metabolic changes of CKD

Answer 15

• increase in BUN and Cr
• increase in hydrogen
• elevated potassium (7 or 8)- leads to cardiac arrest
• elevated sodium in later stages
• decreased Ca, increased phosphorus (inversely related)

Question 16

describe peritoneal dialysis

Answer 16

• easy access
• fewer hemodynamic complications
• infections and adhesions can occur
• less effective
• protein loss and peritonitis
• uses intra abdominal cath (often done at night)

Question 17

describe hemodialysis

Answer 17

• specific facility (3-4 day a week)
• short time treatment
• better clearance
• disequilibrium
• muscle cramps
• hemorrhage
• restricted diet
• moves a lot of blood, FAST

Question 18

describe AV graft

Answer 18

• can use it in 2 wks

- for chronic dialysis pt who does not have adequate blood vessels for the creation of a fistula

Question 19

describe AV fistula

Answer 19

• natural way
• surgical connection of artery and vein
• fistula matures high pressure system

Question 20

important to remember for AV fistula

Answer 20

• do NOT take BP or blood draws from arm with fistula

- don’t compromise access site

Question 21

describe continuous ambulatory peritoneal dialysis (CAPD)

Answer 21

• 20 min process, every night
• catheter is in cavity, not any organ
• take dialysate(made specifically for individual)

Question 22

how do you do a CAPD

Answer 22

inflow, clamp, dwell, unclamp, flow out with toxins and fluids

Question 23

automated peritoneal dialysis

Answer 23

• preferred by most pts on peritoneal dialysis

- can perform exchange while sleeping

Question 24

complications of peritoneal dialysis

Answer 24

• peritonitis (contaminated catheter will cause cloudy outflow)
• pain esp in back (d/t fluid)
• poor outflow and leakage

Question 25

important to remember for peritoneal dialysis

Answer 25

whatever goes in should be coming out
ex/ if 200 mL in, 200 mL needs to come out
turn pt side to side to get out

Question 26

interventions for peritoneal dialysis

Answer 26

• Sterile procedure

- warm temp of dialysate (prevent cramping and constriction)