renal failure and dialysis

Question 1

True or false

Acute renal failure has a slow reduction in urine output

Answer 1

false

rapid

Question 2

True or False

Acute renal failure is irreversible

Answer 2

False

usually reverisble

Question 3

In acute renal failure, there is tubular cell ____ and _____

Answer 3

dseath and regeneration

Question 4

S/S of ARF?

Answer 4

Decrease urine output (70%)

Edema, esp. lower extremity

Mental changes

Heart failure

Nausea, vomiting

Pruritus

Anemia

Tachypenia

Cool, pale, moist skin

Question 5

in ARF, urine output is decreased by ______%

Answer 5

70%

Question 6

what is pruritus

Answer 6

itching of the skin

Question 7

what are the three ways ARF can occur?

Answer 7

pre-renal
intrinsic
post-renal

Question 8

Pre-renal reasons of ARF include?

Answer 8

Vomiting
Diarrhea
poor fluid intake
Fever
use of diuretics
heart failure 
liver dysfunction
septic shock

Question 9

Intrinsic reasons for ARF include?

Answer 9

Interstitial nephritis
acute glomerulonephritis
tubular necrosis
Ischemia
toxins

Question 10

Post-renal reasons for ARF include?

Answer 10

prostatic hypertrophy
retroperitoneal disorders
neurogenic bladder
bilateral renal calculi

Question 11

Pre-renal makes up ____% of ARF

Answer 11

55%

Question 12

Intrinsic or renal parenchymal makes up _____% of ARF

Answer 12

40%

Question 13

Post-renal makes up ____-___% of ARF

Answer 13

5-15%

Question 14

what phase of ARF is when urine output is <400 ml in 24 hours?

Answer 14

oliguric/anuric phase

Question 15

what phase of ARF is when the time of urine output at <400 ml in 24 hours to the time BUN stops rising?

Answer 15

Diuretic phase

Question 16

what is the convalescent phase of the diuretic phase?

Answer 16

urine output and BUN are WNL

Question 17

ARF can lead to hyperkalemia. What are the S/S?

Answer 17

Weakness

Lethargy

Muscle cramps

Paresthesias

Hypoactive DTRs

Dysrhythmias

Question 18

describe the EKG of a person with hyperkalemia

Answer 18

K > 5.5 -6
Tall, peaked T’s
Wide QRS
Prolong PR
Diminished P
Prolonged QT
QRS-T merge – sine wave

Question 19

True or False

Hyperkalemia can cause cardiac arrest?

Answer 19

True

Question 20

In chronic renal failure, _____% of function can be lost before its noticeable

Answer 20

75

Question 21

True or False

Chronic renal failure is non reversible, progressive with nephron loss.

Answer 21

True

Question 22

what is the mortality of chronic renal failure?

Answer 22

20%

Question 23

Chronic renal failure and ESRD affect more then ___ out of 1,000 people in the US

Answer 23

2

Question 24

chronic renal failure causes?

Answer 24

Diabetic Nephropathy

Hypertension

Glomerulonephritis

HIV nephropathy

Polycystic kidney disease

Kidney infections & obstructions

Question 25

CRF S/S

Answer 25

``` Malaise Weakness Fatigue Neuropathy CHF Anorexia Nausea Vomiting Seizure Constipation Peptic ulceration Diverticulosis Anemia Pruritus Jaundice Abnormal hemostasis ```

Question 26

what are some problems related to ESRD?

Answer 26

Metabolic – K/Ca/Na Volume overload Anemia, platelet disorder, GI bleed HTN, pericarditis Peripheral neuropathy, dialysis dementia Abnormal immune function

Question 27

what does dialysis do?

Answer 27

Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body

Question 28

what are the two types of dialysis?

Answer 28

hemodialsys | peritoneal dialysis

Question 29

hemodialysis takes around ____ hours and pt must go ____-___ times a week

Answer 29

4 | 2-4

Question 30

in hemodialysis, three types of access include?

Answer 30

temporary site AV fistula AV graft

Question 31

what is an AV fistula?

Answer 31

Surgeon constructs by combining an artery and a vein | 3 to 6 months to mature

Question 32

what is an AV graft?

Answer 32

Man-made tube inserted by a surgeon to connect artery and vein 2 to 6 weeks to mature

Question 33

PT implications for pts on dialysis include?

Answer 33

No BP on same arm as fistula Protect arm from injury Control obvious hemorrhage Bleeding will be arterial Maintain direct pressure

Question 34

In peritoneal dialysis, an _____ _____ filters the blood

Answer 34

abdominal lining

Question 35

what is Continuous Renal Replacement Therapy

Answer 35

Slowly remove fluid, electrolytes, solutes; used mainly in ICU

Question 36

what are the two types of Continuous Renal Replacement Therapy ?

Answer 36

Continuous arteriovenous hemofiltration | Continuous venovenous hemofiltration

Question 37

what is Continuous arteriovenous hemofiltration

Answer 37

Uses arterial system to drive blood flow | Usually connects femoral artery & vein with oncotic pressures driving process

Question 38

what is Continuous venovenous hemofiltration

Answer 38

Requires pump because lack arterial system to drive blood flow

Question 39

what are some dialysis related problems?

Answer 39

Lightheaded –give fluids Hypotension Dysrhythmias Disequilibration Syndrome

Question 40

what is Disequilibration Syndrome?

Answer 40

At end of early sessions Confusion, tremor, seizure Due to cerebral edema

Question 41

what are the PT implications for pts on dialysis?

Answer 41

Blood levels are optimum after dialysis but fatigue is high Best time for exercise varies from Pt to Pt Pt may have low BP after dialysis