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Nurs 2255 Renal, Urinary, Endocrine > Renal Failure PP > Flashcards

Renal Failure PP Flashcards

1
Q

____ Can result from prerenal (decreased blood flow), intrarenal (direct kidney damage), or postrenal (obstruction) causes

A

Acute Kidney Injury (AKI)

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2
Q

______ is a progressive, Irreversible decline in kidney function over months or years

Leading to the accumulation of waste products, fluid imbalances, and electrolyte disturbances.

It is classified into five stages based on glomerular filtration rate (GFR), with end-stage renal disease (ESRD) requiring dialysis or a kidney transplant

A

Chronic Kidney Disease (CKD)

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3
Q

Common causes of CKD include….. (3)

Management focuses on controlling underlying conditions, slowing progression, and preventing complications like anemia, bone disease, and cardiovascular issues.

A

diabetes, hypertension, and glomerulonephritis

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4
Q

Hemodialysis is a medical procedure used to remove waste, excess fluids, and toxins from the blood in which type of patients

A

kidney failure (CKD stage 5 or acute kidney injury)

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5
Q

Haemodialysis typically occurs ____ times per week.

Nursing care includes monitoring vital signs, assessing for complications….. (3)

And ensuring vascular access patency (AV fistula or catheter).

A

3–4

hypotension, infection, electrolyte imbalances

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6
Q

______ is a kidney replacement therapy that uses the peritoneal membrane in the abdomen as a natural filter to remove waste, excess fluids, and toxins from the blood.

A _____ solution is introduced into the peritoneal cavity via a catheter, where it absorbs waste before being drained out.

A

Peritoneal dialysis (PD)

dialysate

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7
Q

Describe 2 types of peritoneal dialysis…

A

Continuous Ambulatory Peritoneal Dialysis (CAPD): Manual fluid exchanges 3–5 times daily.

Automated Peritoneal Dialysis (APD): Uses a machine (cycler) to perform exchanges, usually at night.

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8
Q

Monitor for infection in Peritoneal Dialysis, how…

A

Cloudy dialysate, abdominal pain, fever

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9
Q

Cardiorenal Syndrome (CRS) is…

A

a condition in which heart and kidney dysfunction are interconnected, where dysfunction in one organ negatively affects the other

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10
Q

Cardiorenal syndrome happens due to…

A

Hemodynamic changes

Decreased Cardiac Output → Reduced renal perfusion, leading to prerenal acute kidney injury (AKI).

Increased Central Venous Pressure (CVP) → Congestion in the kidneys, impairing glomerular filtration rate (GFR).

Left Ventricular Failure → Reduced systemic perfusion, causing renal ischemia.

Neurohormonal activation

Renin-Angiotensin-Aldosterone System (RAAS) Activation → Vasoconstriction and sodium retention, worsening both hypertension and fluid overload.

Sympathetic Nervous System (SNS)
Overactivity → Increased heart rate and vasoconstriction, leading to increased cardiac workload and renal hypoperfusion.

Arginine Vasopressin (AVP) Secretion → Promotes water retention, causing hyponatremia and further volume overload.

Fluid overload

Excessive Sodium & Water Retention → Worsening pulmonary congestion and peripheral edema.

Cardiorenal Syndrome Type 1 → Acute decompensated heart failure leading to rapid decline in kidney function.

Right Heart Failure → Hepatorenal congestion, reducing kidney filtration efficiency.

leading to worsening heart failure and kidney failure.

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11
Q

_____ is a specially formulated fluid used in dialysis to help remove waste, toxins, and excess fluids from the blood while maintaining electrolyte and acid-base balance.

Used in (hemodialysis / peritoneal) dialysis but differs in composition depending on the patient’s needs

A

Dialysate

Dialysate is used in both dialysis

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12
Q

Characterized by rapid, deep breathing without pauses between breaths.

Called what…

What is the purpose in renal cases….

A

Kussmaul

To rid the body of Acid.

Acidosis occurs in renal issues and due to not voiding out the H ions

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13
Q

Describe Patho of Renal Osteodystrophy….

A

Kidney failure → Reduced phosphorus excretion → Hyperphosphatemia.

Low kidney function → Decreased vitamin D activation → Hypocalcemia.

Hypocalcemia & Hyperphosphatemia → Increased parathyroid hormone (PTH) secretion → Bone resorption (secondary hyperparathyroidism).

Bone weakening → Osteomalacia, osteoporosis, fractures, and skeletal deformities.

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14
Q

SS

Neurological: Lethargy, confusion, seizures, coma

Cardiovascular: Hypertension, pericarditis, fluid overload

Gastrointestinal: Nausea, vomiting, anorexia, metallic taste

Hematologic: Anemia, bleeding tendencies (due to platelet dysfunction)

Skin: Pruritus, uremic frost (white, crystallized urea on the skin)

PROBLEM…

Treatment….

Meds….

Diet..

A

Uremic Syndrome

Severe complication of acute or chronic kidney failure

Accumulation of uremic toxins in the blood due to the kidneys’ inability to filter waste

Treatment:

Hemodialysis
Peritoneal Dialysis
CRRT

Phosphate Binders (Sevelamer, Calcium Acetate) → Reduce phosphate buildup.

Erythropoietin (EPO) Therapy → Treats anemia from uremic suppression of RBC production.

Diuretics (if some kidney function remains) → Helps control fluid overload and mild toxin removal

Low-protein diet → Reduces urea production (except in dialysis patients, who need adequate protein intake).

Restricted sodium, potassium, and phosphorus intake → Prevents electrolyte imbalances.

Increased caloric intake → Prevents muscle wasting.

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16
Q

Gradual decline

Sudden decline

AKI / CKD

A

Gradual decline: CKD

Sudden decline: AKI

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17
Q

Norms

BUN

Serum Creatinine level

BUN/ Creatinine ratio

A

BUN: 10 - 20

Serum Creatinine level

Males 0.6 - 1.2
Females 0.5 - 1.1

BUN/ Creatinine ratio 6 -25

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20
Q

HTN/ hypotension
Shock claro
Cardiac Surgery
Sepsis
Prolonged mechanical ventilation
DM
CKD
Liver disease
Elderly

All risk factors for….

A

AKI

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21
Q

Type of AKI Postrenal

Causes

Examples

Key Features

Reversible?

A

(Obstruction-Related)

Cause: Blockage of urine flow, leading to kidney damage from increased pressure.

Examples: Kidney stones, enlarged prostate (BPH), bladder cancer, neurogenic bladder.

Key Features: Fluctuating urine output, hydronephrosis on ultrasound.

Reversible if obstruction is removed early.

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22
Q

Impaires perfusion:

Cardiac Failure
Sepsis
Blood loss
Dehydration
Vascular Occlusion

This type of AKI…

A

Pre-renal

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23
Q

Glomerulonephritis
Small vessel vasculitis

Acute tubular necrosis
Drugs
Toxins
Prolonged hypotension

Interstitial nephritis
Drugs
Toxins
Inflammatory disease
Infection

Lead to this AKI

A

Intrinsic (Intrarenal) - inside the kidney

Renal Cortex / Medulla

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24
Q

Urinary calculi
Retro peritoneal fibrosis
BPH
Prostate/Cervical Cancer
Urethral strictures
Metal stenosis

This type of AKI

A

Postrenal

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25
Q

Anything that reduces blood flow to the kindeys

Renal vasoconstriction: NSAIDS lead to this AKI

A

Prerenal

Also

Hypovolemia
Hypotension

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26
Q

Patho of Prerenal AKI

Afferent Arteriole

What is the response to decrease in renal blood flow…. ( What makes more blood flow into kidneys)

What Inhibits this increase in blood flow…

Efferent Arteriole

Flow perfusion to kidneys actives the RAAS to increase BP. Which medication stop this…

A

Prostaglandins Vasodilate to incesse blood flow. However, NSAIDS inhibt Prostaglandins production.

ACE / ARB

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27
Q

Most common causes of this AKI include

Blood clots in renal vessel
Pyelonephritis
Lupus
Contrast dye
Antibiotics, NSIADS, Chemotherapy
Tumors

A

Intrarenal

Acute tubular necrosis

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28
Intrarenal AKI Tubular epithelial cells have high metabolic rate Most vulnerable to this type of injury...
Ischemic
29
Signs & interventions for AKI
Signs Low urine <30 ml/hr Low systolic BP, decreased pulse pressure, orthostatic Thirst RISING BLOOD OSMOLALITY Interventions Oral & IV fluids Monitor lab I&O Daily weight Report oliguria prompt
30
Why many AKI are elderly (3)
Dehydration Polypharmacy Complications of Surgery
31
4 stages of AKI
Onset Oliguric Diuretic Recovery
32
Oliguric phase of AKI Urine output... Begins ____ after injury Last.... Clinical Manifestions BUN, Cr, GFR Fluid (Decrease / Increase) HTN? K / Na This metabolic condición
Urine output <400 mL Begins 1 - 7 days after injury Last 10 - 14 days (can be months) Clinical Manifestions BUN >20, Cr >1.5 , GFR <60 Fluid Increase & Weight Gain HTN Yes K Increases >5 / Na <135 Metabolic Acidosis
33
Oliguric phase Manage HTN.... Correct electrolyte Na.... K... Fluid overload Fluid restriction....(How) Diuretics
ACE /ARB & Fluid restriction Na (Low) Fluid Restriction K (High) Kayexalate, lokelma Insulin & D50 Fluid restriction (Yesterday output + 500mL)
34
AKI diuretic phase Urine production increases 1 - 3 L up to 5L daily Electrolyte improves Clinical Manifestions... Treatment....
Hypotension Hypovolemia Hyponatremia Hypokalemia Weight loss NEUROLOGICAL SYMPTOMS Manage hypotension/ Replace electrolyte
35
Recovery phase of AKI Describe
Kidney regain ability to manage metabolic waste BUN & Cr return to normal but may stay elevated 4 life Some progress to CKD & need life long management
36
Immune mediated AKI Describe....
Acute glomerulonephritis From Flu, Cold, Gastroenteritis
37
AKI Assessment Map value.... Tachycardia Threads pulse Lowered cognition... Why SPO² <88
Map <65 Lowered cognition due to hyponatremia due to Hypervolemia
38
Describe Phosphorus & Calcium levels with AKI...
Phosphorus High 2.5 - 4.5 norm Calcium Lowered 8.5 – 10.5 mg/dL
39
Fluid challenge for AKI Describe...
If hypovolemia/ Hypotension Adminster 500 - 1000 Ml NS over 1 hr and assess for improvement
40
This type of diet on dialysis...
Protein, Sodium, Potassium restriction
41
What is the fluid restriction for dialysis....
Yesterday urine volume + 500mL
42
CRRT is a slow, continuous form of dialysis used for critically ill patients with ______ who are hemodynamically unstable and cannot tolerate traditional hemodialysis. It removes waste, fluids, and electrolytes gradually over 24 hours or longer to prevent sudden shifts in fluid balance
Continious Renal Replacement Therapy Acute kidney injury
43
Hemodialysis Peritoneal Dialysis CRRT Indicated for...
Systemic uremia (Pericarditis, neuropathy, decreased cognition) Severe metabolic acidosis <7.1 Rapidly rising K >6.5 Fluid overload reducing tissue Perfusion
44
Progressive, irreversible disorder lasting >3 months Gradual loss of functioning nephrons
CKD
45
_____ is a genetic disorder characterized by the growth of multiple fluid-filled cysts in the kidneys, leading to progressive kidney enlargement, damage, and eventual kidney failure
Polycystic Kidney Disease (PKD) PKD
46
Which stage of CKD do you implement renal replacement therapy or kidney transplant...
Stage 5
47
CKD Describe Na K Ca Phosphate Basic / acid
Na Hypo (Early) Hyper (Later) K hyper Ca hypo Phosphate Hyper Acidosis
48
ECG Changes for Hyperkalemia 6.8 - 8 .... >8.....
6.8 - 8 Tall peaked T waves Loss of P Widening QRS ST Elevation Prolongation of PR Interval >8 Loss of R wave amplitude ST Depression Sine wave Ventricular fibrillation Asystole
49
Sodium zirconium cyclosilicate (Lokelma) Sodium polystyrene sulfonate (Kayexalate) Use...
Lower Hyperkalemia
50
Treatment for severe Hyperkalemia.... >6.5
10 u Regular insulin Humulin R Novolin R Velosulin R With 25 g D50 IV GIVEN 15 - 30 Minutes Also IV Calcium Gluconate Sodium Bicarbonate
51
CKD induced Hypocalcemia causes....
Renal osteodystrophy
52
Use of Calcium acetate & sevelamer carbonate in CKD...
Phosphate binders Lowers Phosphate to increase Calcium
53
Kidney dysfunction Effects on phosphate.... Effects in calcium... Decreased serum calcium has this affect....
Phosphate retention Binding of Phosphate with calcium Reduced calcium Effects on calcium Decreased production of vitamin D Decreased absorption of calcium from GI tracts Decreased serum calcium Decreased serum calcium releases PTH Which releases calcium stored in the bones (Demineraliztion & lowered bone density) Which then increases calcium levels causing more binding with phosphate and more boneloss
54
Patho on why Acidosis occurs with CKD...
Hydrogen ions need bicarbonate to move to the urine Bicarbonate can't be reabsorbed by the kidneys Build up H & decreased bicarb
55
Sodium bicarbonate tabs can help with Acidosis...
True
56
CKD Cardio / Pulmonary changes. HTN Pericarditis Dysrhythmias Pulmonary edema Hyperlipidemia CHF
Ok
57
Why anemia with CKD...
Decreased Erythropoietin Iron & folic acid deficiency
58
Why bruising and bleeding in CKD...
Impaired platelet function from uremia
59
Aranesp Epogen Mircera Used for...
Increasing RBC Erythropoiesis Stimulating Agent
60
Why give Gabapentin Pregabalin Duloxetine Amitriptyline For CKD....
Neurological changes Tremors , Asterixis Neuropathy RLS Lethargy Cog dysfunction
61
Integumentary changes in CKD
Dry skin Pruritus Uremic Frost Ecchymosis Decreased tumor Soft-Tissue calcification
62
Manifestions of kidney disease Acute, Chronic, End-Stage Neurological
Confusion Lethargy Seizures Asterixs
63
Manifestions of kidney disease Acute, Chronic, End-Stage Respiratory
SOB Crackles Tachypnea Kussmaul
64
Manifestions of kidney disease Acute, Chronic, End-Stage Cardiac
S3 HTN Edema HF JVD Dysrhythmias
65
Manifestions of kidney disease Acute, Chronic, End-Stage Hematologic
Anemia Bruising / Bleeding
66
Manifestions of kidney disease Acute, Chronic, End-Stage GI
NV Anorexia Change in taste Constipation
67
Manifestions of kidney disease Acute, Chronic, End-Stage Urinary
An,oli,Polyuria Protein uria
68
Manifestions of kidney disease Acute, Chronic, End-Stage Skin
Pruritis Purpura Uremic frost Yellow gray color Purpura is a condition characterized by purple or red discolorations on the skin or mucous membranes due to bleeding under the skin from small blood vessels (capillaries). These spots do not blanch when pressed. Causes of Purpura: Platelet disorders (e.g., thrombocytopenia, ITP) Vasculitis (e.g., Henoch-Schönlein purpura) Clotting disorders (e.g., DIC, hemophilia) Infections (e.g., meningococcal sepsis) Medication-induced (e.g., anticoagulants, steroids) Chronic diseases (e.g., CKD, liver disease, leukemia)
69
Manifestions of kidney disease Acute, Chronic, End-Stage Musculoskeletal
Cramps Bine pain Renal osteodystrophy
70
Manifestions of kidney disease Acute, Chronic, End-Stage Reproductive
Decreased fertiliy Libido Sexual Dysfunction/ impotence
71
Any pt can be considered for hemodialysis Typically started when...
False Patients Who Can Be Considered for Hemodialysis: ✔ End-Stage Renal Disease (ESRD) – When kidney function is ≤10-15% of normal. ✔ Acute Kidney Injury (AKI) – Severe, reversible kidney failure requiring temporary dialysis. ✔ Severe Electrolyte Imbalances – Life-threatening hyperkalemia, acidosis, or fluid overload. ✔ Poisoning or Drug Overdose – When dialysis can remove toxins (e.g., lithium, methanol). Uremic symptoms are present
72
Hemodialysis For acute and chronic kidney failure ___ transfer of toxins by diffusion Blood flows one way, ____ flows the other way Movement across ______
Passive transfer of toxins by diffusion Blood flows one way, dialysate flows the other way Movement across semi-permeable membrane
73
Before hemodialysis can happen this procedure must occur...
Forming a fistula (Artery/ Vein fused together) Graft a tube attaching Artery & Vein
74
Medications, heprin, bicarbonate, and erythropoietin can be given to a pt through a dialysis machine...
True
75
Length & frequency of hemodialysis
4 hrs 3x weekly
76
Risk with hemodialysis
Blood infection Thrombosis Internal bleeding
77
Temporary access for dialysis uses this..
CVC Central Venous Cath
78
Caution with Access site for dialysis...
No IV or BP on this side
79
_______ is a complication that can occur after the creation of an arteriovenous fistula (AVF) for dialysis access. It refers to the impaired blood flow to the distal tissues (such as the hand or fingers) due to shunting of blood from the artery into the vein through the fistula, effectively "stealing" blood that would normally nourish the surrounding tissues
Steal syndrome
80
Before dialysis (4)
Consult dialysis nurse for meds to hold Assess pt, access site, vs Lab values Weigh pt
81
Dialysis Disequilibrium Syndrome (DDS) is a rare but serious complication that can occur during hemodialysis, primarily in these types of patients __________. It results from a rapid shift of toxins, especially urea, from the blood into the dialysis machine, causing a fluid imbalance that can lead to _______ Symptoms include headache, nausea, vomiting, confusion, seizures, and, in severe cases, coma. DDS can be prevented by slowing the dialysis rate and gradually adjusting fluid and solute removal to avoid rapid shifts, with treatment focused on supportive care and adjusting dialysis parameters.
Severe uremia or those who are new to dialysis cerebral edema (brain swelling).
82
Nursing considerations during dialysis
Hypotension Dialysis Disequilibrium Syndrome Mental status change/ seizure/coma Cardiac events Reaction to dialyzer Hemorrhage Clots Air embolism
83
After dialysis monitor fir...
HA dizzy NV Decreased LOC VS Orthostatic Hypotension Site Cramps Weight pt
84
Continous ambulatory peritoneal dialysis process of diffusion & osmosis Pt. Selection Type of stability of patient... For pt. who can't tolerate _____ (meds) Used while graft/fistula matures
Stable / Unstable pts Anticoagulants
85
Peritoneal dialysis 1- 2 L Warmed dialysate infused by gravity Fluid dwells in abdominal cavity for a specific time then drained Why warm the dialysate.... Weight pt....
Prevent cramps Weight before and after
86
Which is quicker hemodialysis or peritoneal.... More efficient....
Hemo is quicker and more efficient But peritoneal can be done for longer and be as effective
87
______is a form of peritoneal dialysis (PD) that uses an automated machine to perform multiple exchanges of dialysis solution overnight while the patient sleeps. The process involves filling the peritoneal cavity with dialysate fluid, allowing it to dwell for a set period, and then draining it. This cycle is repeated several times during the night, typically over 8-10 hours, and the patient remains free from dialysis during the day.
Continuous Cycling Peritoneal Dialysis (CCPD)
88
While a kidney transplant is the best treatment option for many ESRD patients, it is a treatment, not a permanent cure T or F
T
89
GFR to be considered for a renal transplant...
<20 Medically stable, reasonable life expecancy
90
Absolutel contradictions for kidney transplant
Active cancer Current infection Psy illness Substance abuse Non compliant with meds or dialysis
91
To recieve a kidney one must match ____ with the donor.
Blood & tissue type
92
________ refers to a group of proteins found on the surface of cells that play a crucial role in the immune system's ability to distinguish self from non-self.
Human Leukocyte Antigen (HLA)
93
Dialysis with in ____ of renal transplantation.
24 hrs
94
Donat3d Kidney are put in this part of the body.... What happens if a kidney does work when implanted...
R or L anterior iliac fossa Failed kidneys left in place (unless infected or painful)
95
Races that don't handle organ transplants & have graft failures...
Black Hispanic Indians
96
Organ rejection Hyperacute with in (Time Frame) SS.... (3) TX:
Within 48 hrs Increase Temp, BP, Pain Tx: immediate remove & dialysis
97
Organ rejection Acute.... (Time frame) SS (5).... TX.....
1 week to anytime after sx (Surgery) Oliguria/ anuria, >100 temp, increase BP, tender kidney, increase renal function Tx: Increase Immunosupressuves
98
Organ rejection Chronic Time frame.... SS..... TX.....
Gradual months to years SS Gradual declining renal function, fluid retention, fatigue, electrolyte imbalances TX: Dialysis is required
99
Is AKI associated with hypovolemia or Hypervolemia...
Both Hypovolemia (Fluid Deficit) Cause: AKI can result from conditions like dehydration, hemorrhage, or severe fluid losses (e.g., diarrhea, vomiting, or burns) Pathophysiology: In this case, reduced fluid volume leads to decreased renal perfusion, causing the kidneys to fail to filter waste effectively Hypervolemia (Fluid Overload) Cause: AKI can also be caused by conditions like heart failure, cirrhosis, or kidney damage (e.g., nephrotoxins), where the kidneys are unable to eliminate excess fluid. Pathophysiology: In this situation, kidneys cannot excrete sufficient urine, leading to fluid retention. This results in edema (swelling), pulmonary edema, and hypertension due to excess fluid in the body
100
One of the biggest causes of AKI is...
Hypotension
101
Which types of precautions should be done for severe hyponatremia...
Seizure Precautions – Padded bed rails, oxygen, suction setup
102
Post kidney biopsy monitor for hypertension or hypotension...
Both Plus any sign / lab for bleeding
103
Which supplemnts will a CKD patient tske to help with RBC creation... Which medication...
Iron & Folic Acid Meds taken Epoetin Alfa (Epogen, Procrit) Darbepoetin (Aranesp) Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)
104
Hemodialysis cather will access this vessel...
Subclavian
105
While waiting for a fistula to mature a pt will have acess for dialysis via catheters A short term catheter is callled... And a permacath is a longer lasting catheter
Quinton
106
What to do if you find bruit and/or thrill in a fistula for dialysis...
Nothing this is normal. Abnormal is to not find them
107
Encourage ROM in a newly placed graft patient...
True
108
Contraction for peritoneal dialysis...
Previous ab surgery with SCARS & ADHESIONS
109
Type of technique is peritoneal dialysis...
Sterlie
110
SS Severe abdominal pain (worse with movement) ⚠ Rigid, board-like abdomen ⚠ Fever & chills ⚠ Nausea, vomiting, and loss of appetite ⚠ Decreased bowel sounds or paralytic ileus ⚠ Tachycardia, hypotension (shock in severe cases) SS for...
Peritonitis
111
NSAIDS cause this type of AKI...
Prerenal due to vasoconstriction Or Intrarenal Meds cause intrarenal damage: Antibiotics, NSAIDS, Chemo
112
Calcium carbonate used...
Vitamin D analog Treats Hypocalcemia
113
Calcitriol use...
Vitamin D analog Increases calcium levels
114
Calcium Acetate use...
Phosphate Binders Lowers Phosphate level
115
Sevelamer Carbonate use....
Phosphate Binders Lowers Phosphate levels
116
AKI Intrinsic (Intrarenal) Causes.... Exampels... Key Features... Dialysis?
Intrarenal (Intrinsic) AKI (Kidney Tissue Damage) Cause: Direct injury to the kidney tissues, affecting filtration and reabsorption. Examples: Acute tubular necrosis (ATN), glomerulonephritis, nephrotoxic drugs (NSAIDs, aminoglycosides), infections, contrast dyes. Key Features: Normal or low BUN/Creatinine ratio (<15:1), muddy brown urine casts (ATN), proteinuria, oliguria or non-oliguria. May require dialysis if severe.
117
Types of AKI Pre renal.... Causes.... Examples... Key Features... Reversible?
Prerenal AKI (Perfusion-Related) Cause: Reduced blood flow to the kidneys, leading to decreased filtration. Examples: Dehydration, heart failure, hemorrhage, shock, severe hypotension. Key Features: High BUN/Creatinine ratio (>20:1), low urine output, concentrated urine. Reversible if treated early (fluids, blood pressure support).
118
AKI definition Increase of serum Cr..... (48 hrs) Or Increase serum Cr...(over 7 days) Or Urine volume....
Serum Cr Incresse 0.3 mg/dl within 48 hrs Serum Cr Increase from baseline of 1.5 times 7 days or more <0.5 ml/kg/hr for 6 hrs

Nurs 2255 Renal, Urinary, Endocrine (12 decks)

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