Week 3 (exam 2)

Question 1

Functions of the kidney

Answer 1

Acid-Base balance
Water removal
Erythropoiesis
Toxin removal
Blood pressure (ADH)(Vasopressin)
Electrolyte balance
Vi D activation

Question 2

Chronic Kidney Disease

Answer 2

Umbrella term that describes decrease in kidney function lasting 3 or more months. Untreated leads to ESKD (end stage kidney disease)

Question 3

Stages 1-5 of chronic kidney disease

Answer 3

Stage 1: GFR > 90
Stage 2: GFR 60 – 89
Stage 3: GFR 30 – 59
Stage 4: GFR 15 – 29
Stage 5: GFR < 15

Question 4

Clinical manifestations of CKD

Answer 4

Increased creatinine levels
Anemia
Metabolic Acidosis
Fluid retention
Edema
Heart failure
Abnormal calcium and phosphorus levels.

Question 5

Management of CKD

Answer 5

• Treat underlying cause
• Monitor labs (GFR), Creatinine clearance, BP and Weight
• Dialysis or early referral to RRT

Question 6

Acute Kidney Injury

Answer 6

a rapid loss of renal function due to damage to the kidneys

if treated it can be reversed

Question 7

Clinical manifestations of AKI

Answer 7

• critically ill and lethargic
• drowsiness
• headache
• muscle twitching
• seizures
• elevated BUN and creatine
• decline in GFR
• may have hematuria
• elevated Phos and potassium and Low Ca
• progressive metabolic acidosis

Question 8

Underlying causes of AKI

Answer 8

-hypovolemia
-hypotension
-Reduced cardiac output and HF
-obstruction

Question 9

Assessments and diagnostics of AKI

Answer 9

• BUN levels
• Creatine
• GFR
• US
• Non contrast CT

Question 10

Prevention of AKI

Answer 10

• Monitor kidney function when giving nephrotoxic medications
• Contrast induced nephropathy (use mucomyst)
• Fluids
• Catheter care

Question 11

Tx of AKI

Answer 11

• blood flow is restored to the kidneys with the use of IV fluids albumin and blood products
• maintaining fluid balance
• dialysis or RRT
• sodium bicarbonate to elevate PH levels
• Phosphate binding agents
• Kayexelate to reduce K+ levels
• IV dextrose 50%, insulin and Ca replacement to those who are hemodynamically unstable
• high carbohydrate feedings

Question 12

Medical management of AKI

Answer 12

• monitor for hyperkalemia
• if the pt is experiencing EKG changes give 50% dextrose and insulin
• Medication dosages should be reduced
• monitor ABGs
• Weigh pt daily (if the pt gains or does not loose weight then fluid retention should be suspected)

Question 13

Nutritional therapy CKD

Answer 13

low sodium, low potassium low phosphorus, moderate protein intake

Question 14

End Stage Kidney Disease

Answer 14

5th stage of CKD, pt will require permanent renal replacement therapy

Question 15

Complications of ESKD

Answer 15

Anemia
Bone disease
Hyperkalemia
HTN
Pericarditis
Pericardial effusion/tamponade

Question 16

Vascular access device

Answer 16

Temporary dialysis catheter in the Subclavian vein, IntraJugular, or Femoral

the main type of vascular access devices for dialysis are
- arteriovenous fistulas
- arteriovenous grafts
- central venous catheters (there is cuffed vs non cuffed and cuffed has reduced chance of infection)

Question 17

Renal function tests

Answer 17

• 24 Hour Urine/creatinine clearance (keep in dark container on ice)
• Creatinine level
• BUN
• GFR (should be >125)

Question 18

Risk factors of chronic kidney disease

Answer 18

• cardiovascular disease
• diabetes
• hypertension
• obesity

Question 19

Epogen

Answer 19

erythropoiesis-stimulating agent that is used to treat anemia in CKD

Question 20

Periactin

Question 21

Hemodialysis pre procedure

Answer 21

pt will need a patent vascular access point such as, an intra jugular CVC or an AV fistula
auscultate for bruit and palpate for a thrill
obtain vital signs, weight and labs prior to dialysis

Question 22

Hemodialysis during and after the procedure

Answer 22

monitor for adverse effects such as hypotension, N/V, bleeding

after take pts weight and vitals (a decrease in weight and BP is expected) compare weight to estimate the amt of fluid removed

Question 23

Peritoneal dialysis

Answer 23

instill hypertonic dialysate solution into the pts peritoneal cavity and allow it to dwell, then drain with the excess fluid and waste products

Question 24

Peritoneal dialysis pre procedure

Answer 24

• warm dialysate solution
• assess pts weight
• sterile technique when accessing the catheter insertion site

Question 25

Peritoneal dialysis post procedure

Answer 25

- when draining we want to make sure we are keeping the outflow lower that the patients abdomen - monitor the color of the out flow (should be clear or yellow)

Question 26

disequilibrium syndrome

Answer 26

a hemodialysis complication with neurologic deterioration that is associated with an increased in ICP S&S - N/V - confusion - decreased LOC - can cause seizures coma and death slow the rate or stop if symptoms become more severe

Question 27

Peritonitis signs and symptoms

Answer 27

a complication associated with peritoneal dialysis infection of the peritoneal S&S - fever - cloudy outflow - abdominal pain - abdominal tenderness - N/V

Question 28

During hemodialysis pts may experience

Answer 28

- SOB- due to the extra fluid between dialysis treatments - Hypotension - Painful muscle cramping (electrolytes rapidly leaving ECF) - Arrhythmias

Question 29

Continuous cyclic PD (CCPD)

Answer 29

programmed to deliver an established amount of PD solution that will dwell in the peritoneal cavity for a programmed period of time This process is done every night while they sleep to achieve the effects of dialysis required. CCPD has a lower infection rate than other forms of PD

Question 30

Continuous Renal Replacement Therapy (CRRT)

Answer 30

may be indicated for patients with acute or chronic kidney disease who are too clinically unstable for traditional HD Some forms of CRRT may not require dialysis machines or dialysis personnel

Question 31

Continuous Venovenous Hemofiltration

Answer 31

a type of CRRT - often used to manage AKI - requires a dual lumen venous catheter - CVVH provides ultrafiltration (continuous slow fluid removal so hemodynamics effects are more tolerable)

Question 32

Continuous Venovenous Hemodialysis

Answer 32

a form of CRRT - requires a dual lumen venous catheter - Provides ultrafiltration - uses a concentration gradient to facilitate the removal of uremic toxins and fluid by adding a dialysate solution into the jacket of the dialyzer

Question 33

Prerenal AKI

Answer 33

occurs in 60% to 70% of cases, is the result of impaired blood flow that leads to hypoperfusion of the kidney commonly caused by volume depletion - burns - hemorrhage - GI losses - hypotension - sepsis - shock - obstruction of renal vessels

Question 34

Intrarenal or intrinsic AKI

Answer 34

the result of actual parenchymal damage to the glomeruli or kidney tubules - Rhabdomyolysis (muscle tissue breaks down, releasing harmful substances into the bloodstream) - Contrast - NSAIDs - Myosin antibiotics

Question 35

Postrenal AKI

Answer 35

results from obstruction distal to the kidney by conditions such as - renal calculi - strictures - blood clots - benign prostatic hyperplasia - malignancies - pregnancy

Question 36

Phases of AKI

Answer 36

1. Initiation period- whatever harms the kidney to the start of oliguria 2. Oliguria period- elctrolytes become abnormal, metabolic acidosis, elevated BUN and creatine 3. Diuresis period- marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover 4. Recovery period- signals the improvement of renal function and may take 3 to 12 months

Question 37

What is an indication that potassium is high

Answer 37

a Peaked T-wave and PVCs