Flashcards in Renal/Heme Deck (90)
The dominant form of PKD is also associated with
intracranial aneurysms and mitral valve prolapse
___% of ESRD patients have DM
___% of ESRD patients have HTN
Patients going for surgery with ARF will always have an ASA designation of
Two types of dialysis
Continuous peritoneal dialysis
Wide spread systemic manifestations are seen from uremia when the GFR decreases below
Patients with a GFR < ____ rely on dialysis for survival
Continuous peritoneal dialysis involves _____ and may be better for those who _______
1) Diffusive solute transport across the peritoneal membrane
2) Those who do not tolerate rapid fluid shifts and those with poor vascular access
Dialysis is required in these conditions
Hyperkalemia (can cause fatal arrhythmia)
Severe acidosis (will inhibit proper enzyme activity)
Pericarditis (will help reduce the fluid around the heart)0
Refractory GI symptoms
An AV fistula involves the anastamosis of
The radial artery and cephalic vein
Emergency vascular access for dialysis can be obtained from
Femoral vein or internal jugular vein
Basic purpose of hemodialysis
Diffusion of solutes between the blood and the dialysis solution remove metabolic wastes and restore buffers to the blood
A weight gain of __-__% of body mass in 2 days is appropriate between dialysis treatments
These types of drugs are readily cleared by dialysis
Low-molecular weight, water soluble, non protein bound drugs
(Best to give scheduled drugs after dialysis)
S/S of uremic encephalopathy
What is disequilibrium syndrome?
Transient CNS disturbance after rapid decrease in ECF osmolality compared with ICF osmolality --> this is due to dialysis
Patients with a GFR < __ will generally have anemia
(Unless the patient is on aggressive EPO replacement therapy. Most ESRD patients will be on EPO to increase their hematocrit to 36-40%)
Why do ESRD patients usually tolerate their anemia well
Because they have acidosis and increased 2,3-DPG, both of which shift the hgb-oxygen disassociation curve to the right (facilitates the unloading of O2)
Why are most patients with ESRD anemic?
1) Decreased EPO (decreases RBC production)
2) Decreased RBC life-span
3) GI blood loss, hemodilution, bone marrow suppression
4) Excess PTH replaces bone marrow with fibrous tissue
When should you transfuse for someone with ESRD?
Transfuse only when absolutely indicated <6-7g/dL or significant intra-operative blood loss
What is an important cause of coagulation issues in someone with ESRD?
release of defective von Willebrand factor
What is autonomic neuropathy?
Autonomic neuropathy is a nerve disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion.
It isn't a specific disease. Autonomic neuropathy refers to damage to the autonomic nerves. This damage disrupts signals between the brain and portions of the autonomic nervous system, such as the heart, blood vessels and sweat glands. This can cause decreased or abnormal performance of one or more involuntary body functions.
Autonomic neuropathy can be a complication of a number of diseases and conditions. And some medications can cause autonomic neuropathy as a side effect. Signs, symptoms and treatment of autonomic neuropathy vary depending on the cause, and on which nerves are affected.
May have dizziness and fainting, urinary problems, sexual difficulties, gastroparesis, sluggish pupils, or exercise intolerance.
Avoidance of high protein foods can be a subtle sign of
renal disease (contributing to azotemia)
Can an AV fistula revision be given class E status?
Yes, because E is necessary to save LIFE OR LIMB
Someone who can't tolerate large fluid shifts is more likely to be on (HD/peritoneal dialysis)
Continuous peritoneal dialysis
If someone's ESRD is progressing towards dialysis, we should place IVs on their (dominant/non-dominant arm)
Dominant, because if they have an AV fistula placed, this will be on their non-dominant.
When should someone have dialysis before surgery?
The day before or the morning of
Considerations for the patient who JUST had HD
May have low K+ (but remember, that their body is still equilibrating)
May be dry--BP can plummet
Neuro considerations in the renal patient
1) Peripheral neuropathies
2) Autonomic neuropathy
3) Uremic encephalopathy