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Flashcards in Renal Deck (87):
1

Avoid all invasive procedures within ___ to ____ hours after hemodialysis.

4 -6 

2

What does Kayexelate do to decrease K+ ?

It causes exchange of Na+ & K+ in the bowel.

3

Complications of Dialysis

  • Hypovolemia
  • Shock
  • Disequilibrium syndrome

4

Hematological Changes of Chronic Kidney Failure

  • Anemia because…
    • Decreased erythropoetin
  • Iron and folate deficiencies
  • Uremic toxins interfere with platelet adhesion.
  • Less survival time of RBC

5

condition that results when kidneys unable to remove body’s metabolic waste or perform regulatory functions and return of these functions are not expected 

Chronic Renal Failure

6

What is the #1 way to manage kidney failure?

eliminating the underlying cause

7

occurs when the body is dumping fluid but still retaining electrolytes

High Output Kidney Failure

8

cause of acute renal failure that stems from problems that interfere with renal perfusion, causing renal hypoperfusion

Pre-Renal Causes

9

Causes of Chronic Kidney Failure

  • Diabetes - leading cause
  • Chronic glomerulonephritis
  • Pyelonephritis
  • Uncontrolled HTN
  • Hereditary lesions (polycystic kidney dx)
  • Vascular lesions
  • Urinary tract obstructions•Infections
  • Drugs
  • Toxic agents
  • Environmental agents

10

Pre-Renal Causes of Acute Renal Failure are:

  • Decreased cardiac output
  • Vascular obstruction
  • Hypovolemia
    • Hemorrhage (Trauma)
    • Hypotension (Severe dehydration)
  • Septicemia

11

type of transplant rejection that occurs slowly over months to years with symptoms of renal failure including fever, graft tenderness, anemia, and malaise

Chronic Rejection

12

After dialysis, take the BP every ___ minutes X4 then every ____ minutes.

15; 30

13

GI Changes in Chronic Kidney Failure

  • Anorexia
  • Nausea/ Vomiting
  • Bitter, metallic taste
  • Breath smells like urine
  • Ulcers (gastrin accumulation)
  • Constipation (due to meds like phosphate binders)

14

Sudden decline in kidney function that causes disturbance in fluid, electrolyte, & acid-base balance because of loss in clearance of small solutes & decreased GFR

Acute Renal Failure or Acute Kidney Injury

15

Assess all patients at risk for ____________ or ____________ for adequacy of kidney perfusion.

dehydration or hypovolemia

16

Acute Renal Failure is an abrupt loss of kidney function over a period of ______ to _______.

a few hours to a few days

17

The main indications for beginning dialysis are:

  • high/rising K+
  • fluid volume overload
  • increased acidosis
  • pericarditis
  • severe confusion

18

What interventions are performed to decrease K+ ?

  • IV Insulin and Glucose
  • Kayexelate
  • Dialysis
  • K+ restriction

19

Complications of Peritoneal Dialysis

  • Peritonitis
  • Low back pain
  • Leakage 
  • Glucose absorption
  • Bleeding 
  • Disturbed Body image
  • Hernias

20

Phase of Renal  Failure in which the event causes injury

Onset Phase

21

In Severe Kidney Disease, GFR = ______ mL/min

15-29 mL/min

22

type of dialysis in which a machine is programmed to run the fluid bags in and out (usually during the night while patient is sleeping) 

Cycler Peritoneal Dialysis (CPD)

23

Factors influencing increasing mortality rates for Acute Renal Failure

  • increasing age
  • co-morbidities

24

Treatment for Chronic Transplant Rejection

  • Continuing immunosuppressive therapy
  • Measures to support renal function until dialysis is necessary

25

Metabolic Changes in Chronic Kidney Failure

  • Increased BUN and Creatinine
  • Increased uric acid
  • Changes in insulin requirement
  • Elevated serum triglycerides
  • Metabolic acidosis

26

What does IV Insulin & Glucose do to decrease K+ ?

–Insulin increases activity of Na+ / K+ pump

–Moves K+ into the cell long enough for us to perform other definitive treatment

27

Treatment for Acute Transplant Rejection

  • High dose steroids
  • Monoclonal antibody (OKT3)
  • Polyclonal antibody (ALG(
  • Antilymphocyte (ALS)

28

Post-Operative Interventions for Kidney Transplant

  • Assess for threatened rejection
  • Assess for infection/ septicemia
  • Assess BP for hypotension
  • Monitor urinary function
  • Provide psychological support
  • Educate regarding follow-up

29

What should the nurse do immediately if Disequilibrium syndrome is suspected after dialysis?

Raise HOB and call the physician

30

Integumentary Changes in Chronic Kidney Failure

  • Severe intractible pruritis
  • Dry skin (atrophy of sweat glands)
  • Increased bruising (bleeding tendency)
  • Pallor (gray) of anemia
  • Skin orange-green or gray
  • Brittle hair and nails

31

Pre-Operative Interventions for Kidney Transplant

  • Bring metabolic state as close to normal as possible
  • Antibody screen – ensure good match
  • Immunosuppressive drugs started
  • AHD (dialysis) day before transplant
  • Reassess for infection

32

Intrarenal (Intrinsic) Causes of Acute Renal Failure are:

  • Acute tubular necrosis
  • Prolonged ischemia
  • Transfusion reaction
  • Myglobinuria
  • Nephrotoxic agents
  • Glomerulonephritis

33

Kidney transplant patients must have a normally functioning ____________.

lower urinary tract

34

What kind of management can ...

•Preserve renal function

•Delay need for dialysis/transplant

•Improve body chemistry values

•Alleviate extra-renal manifestations

•Provide optimal quality of life

medical management

35

Immunological Changes in Chronic Kidney Failure

  • Immunosuppression
  • Depression humoral antibody formation
  • Decreased chemotactic function of leukocytes

36

When kidney function is less than ____%, the body cannot maintain homeostasis.

25%

37

complication of dialysis that usually only happens after the first treatment in which electrolyte levels are so high that when they are pulled of, they are pulled out of cerebral fluid leading to headache or seizures

Disequilibrium Syndrome

38

In End-Stage Kidney Disease, GFR = ______ mL/min

< 15 mL/min

39

phase of renal failure in which renal function improves during a 3 - 12 month period  and the onset is when lab values return to normal

Period of Recovery

40

Systemic disease in which the kidneys are unable to remove body’s metabolic wastes or perform regulatory function which interferes with meeting human need for urinary elimination and maintaining homeostasis

Renal Failure

41

How is Kidney Failure diagnosed?

  • History and physical
  • Electrolytes, including BUN/Creatinine
  • CBC; ABG
  • Urinalysis
  • Renal ultrasound
  • CT scan
  • Renal biopsy
  • Renal markers

42

Why does metabolic acidosis occur in kidney failure?

kidneys cannot excrete hydrogen or conserve bicarb

43

What is onset of the recovery period of kidney failure?

when labs are normal

44

In Renal Replacement Therapy, the artificial kidney only holds _______ mL and runs for ____ hours.

250; 24

45

access to circulation for dialysis in which the radial artery is surgically connected to the cephalic vein so that arterial blood shunts into the vein to makethe  walls stronger to support dialysis

Fistula

46

Kayexelate is given in a __________.

retention enema

47

type of dialysis that combines pressure gradients with true dialysis requiring exchanges of 2 L of dialysate at 30 - 60 minute intervals

Intermittent Peritoneal Dialysis (IPD)

48

Electrolyte Imbalances in Chronic Kidney Failure

  • Hyperkalemia
  • Hypocalcemia
  • Hyperphosphatemia
  • Hypermagnesemia

49

50

Advantages of Renal Transplant

  • Eliminates dialysis
  • Less restricted diet
  • More normal life
  • Cost-effective after first year

51

In period of oliguria, lab work will show...

  • Increase in BUN & creatinine
  • Increase in Uric acid
  • Urine electrolytes
  • Hyperkalemia
  • Hyperphosphatemia & Hypocalcemia
  • Hypo- or Hyper-naterima
  • Acidosis

52

Teach patients on immunosuppressive therapy to assess themselves daily for ________, _________, ________, or __________.

fever, malaise, nausea or vomiting

53

In Moderate Kidney Disease, GFR = ______ mL/min

30-59 mL/min

54

Synthetic vessel placed between an artery and vein in order to access circulation for patient whose vessels are not strong enough for fistula

Graft

55

Musculoskeletal Changes in Chronic Kidney Failure

  • Bone re-absorption (renal osteodystrophy)
  • Muscle cramps

56

Cardiovascular Changes in Chronic Kidney Failure

  • Hypertension (renin-angiotensin cycle)
  • Volume Overload
  • Chest pain (due to anemia)
  • Arrhythmias (due to electrolytes)
  • Atherosclerosis
  • Pericarditis

57

therapy used for acutely ill renal patients that does not produce rapid fluid shifts and does not require a hemodialysis nurse

Renal Replacement Therapy

58

Use a higher dose of _______ in a dialysis catheter.

heparin

59

What medications are given to kidney failure patients?

  • Fluids
  • Diuretics
  • Dopamine (to perfuse kidneys)
  • Steroids (inflammatory)

60

phase of renal failure in which urinary volume less than 400 mL/24 hours and there is an increase in urea, creatinine, uric acid, organic acids, intracellular cations

Period of Oliguria

61

the body can adapt to renal failure until __/__ of the nephrons are destroyed

3/4

62

Respiratory Changes in Chronic Kidney Failure

  • Pulmonary edema (due to fluid overload)
  • CHF
  • Pleuritis
  • Pneumonitis
  • Respiratory Rate Increase (compensate for metabolic acidosis)

63

The nurse should assess a fistula by palpating a _______ and auscultating a _______ over the site.

thrill; bruit

64

type of transplant rejection that occurs at the point of revascularization up to 48 hrs post-op caused by circulating antibodies destructingthe new kidney and must result in immediate removal of the kidney (very rare)

Hyperacute Rejection

65

phase of renal failure in which there is a gradual increase in UOP, the glomerular filtration rate is recovering, fluid volume may be normal, function may be abnormal, and renal tubules begin to heal

Period of Diuresis

66

Cause of renal dysfunction caused by obstruction to outflow of urine from kidney

Post-renal Causes

67

The longer a patient is in the period of oliguria, the higher the risk for _________.

irreversibility

68

The best indicator of fluid volume in a renal patient is _________.

daily weights

69

Post-renal Causes of Acute Renal Failure

  • Any Urinary tract obstruction
    • calculi
    • tumors
    • BPH (benign prostatic hypertrophy)
    • strictures

70

Renal Diet consists of...

  • Low protein (only high biologic value protein)
  • Limited Na+, K+
  • High calorie

 

71

The most common route for access to circulation is the _______ vein.

jugular

72

type of transplant rejection that occurs usually within 6 weeks after transplant (3 months most common but also up to 2 years) with symptoms of fever, malaise, elevated WBC, acute hypertension, graft tenderness, and decreased renal function

Acute Rejection

73

type of dialysis that uses surface of peritoneum as diffusing surface so that there are not high swings of electrolytes like hemodialysis

Continuous Ambulatory Peritoneal Dialysis (CAPD)

74

MAP Formula

        SYSTOLIC BP + (DIASTOLIC BP x 2)

          ----------------------------

           3

75

Cause of Acute Renal Failure involving renal parenchyma (changes in renal tissue)

Intrarenal (Intrinsic) Causes

76

Neurological Changes in Chronic Kidney Failure

  • Peripheral neuropathy
    • Burning feet
    • Restless leg syndrome
    • Gait changes
    • Footdrop
  • Forgetfulness
  • Inability to concentrate
  • Short attention span
  • Impaired reasoning
  • Twitching
  • Seizures
  • Coma

77

Non-functioning kidney may not be removed during transplant if it not producing ______/_______.

renin/angiotensin

78

In Mild Kidney Disease, GFR = ______ mL/min

60-89 mL/min

79

Fluids for a Renal patient should be ____ to _____ mL more than 24 hour UOP.

500 - 600 mL

80

The most common test to measure GFR

creatinine clearance / 24 hour urine

81

Manifestations of Chronic Kidney Failure

All systems affected!

82

Reproductive Changes in Chronic Kidney Failure

  • Menstrual irregularities
    • Amenorrhea
    • Infertility
  • Impotence
  • Decreased libido

83

After initial kidney injury, labs won't change for ____ hours.

24

84

Psychosocial Changes in Chronic Kidney Failure

  • Physiologic alterations
  • Extreme stress
  • Life style alterations
  • Role reversal
  • Curtailed employment
  • Depression

85

The concerns during period of diuresis

  • Fluid Volume Deficit
  • Hypokalemia
  • Hyponatremia

86

Contraindications for Peritoneal Dialysis

  • Adhesions
  • Chronic backache
  • Ostomies
  • Immunosuppressive therapy
  • Arthritis
  • Advanced respiratory disease

87

The concerns during Period of Oliguria

  • Hypo- or Hypernatremia
  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia
  • Acidosis
  • Fluid Volume Excess