acute renal failure 2
Terms
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- What is acute renal failure?
- The sudden, rapid deterioration in kidney function
- What is acute renal failure characterized by?
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* accumulation of nitrogenous waste products
ex. creatinine and urea
* decreased urine output -
What laboratory values are monitored for acute renal failure?
Which one is the best indicator? -
1) BUN and Creatinine
2) Best indicator- Creatinine - What is Azotemia?
- The accumulation of BUN and creatinine
- Three types of renal failure and what is their etiology?
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1) Prerenal- decreased blood flow to the kidneys
2) Postrenal- obstruction of flow below kidneys
3) Intrarenal- direct damage to nephrons and kidney parenchyma from disease or nephrotoxic substances - What are the two most common causes of prerenal failure?
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Hypovolemia (ex. hemorrhage, burn patient)
Heart failure - What is produced as the body's natural response to hypovolemia?
- Angiotensin II- powerful vasoconstrictor
- Are NSAIDS and ACE inhibitors dangerous for those who have renal problems?
- YES
- What lab value is important to know before a test procedure that uses contrast dye?
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Creatine b/c contrast dye can cause renal failure, esp. in diabetes.
The kidneys have to work extra hard to get the dye out. - What is used prophylactically before procedures that use contrast dye?
- Mucomyst
- What is chronic renal failure?
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It is a progressive, irrreversible deterioration in kidney function leading to:
1) the inablility to eliminate waste
2) inability to maintain F&E blalance - What are the two main causes of Chronic Renal Failure in the US?
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* Diabetes Mellitus
* Hypertension - What are some clincal cardiac manifestations of CRF?
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Cardiac
*HTN (b/c fluid overload)
*hyperkalemia (changes in EKG)
*Pericarditis
- Cardiac Tamponade - What is the triad symptoms of pericarditis?
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1) JVD
2) muffled heart sounds
3) narrowing pulse presssure
[difference between diastolic and systolic gets closer] - What are the pulmonary manifestations of CRF?
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*Pulmonary edema
*Pleural effusions - Acute renal failure is generally recognized by what clincal observations?
- AnsweR: Fall urinary output and increase in BUN and.or creatinine; oliguria is common
- Acute renal failure follows three phases, what are they?
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1) Initiation phase: begins with the onset of the event causing tubular necrosis; this phase ends when tubular injury occurs.
2) Maintenance phase: Begins w/i hours of the initiation phase and typically lasts 1-2 weeks; characterized by persistent reduction in GFR and tubular necrosis.
3) Recovery phase: Begins when GFR and tubular fx have recovered and there is not further elevation of the BUN and creatinine; renal fx. improves rapidly the 1st 5-25 days and continues up 1 year. - What should be included in the nursing assessment when caring for a pt. with acute renal failure?
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Answer:
1) Wight
2) VS -- watch for orthostatic hypotension due to diuretics)
3) hydration status
4) I&O
5)pain status and eefect of meds. - What are the common signs and symptoms of renal failure?
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1) Skin- yellow,edema, ecchymosis, uremic frost
2) ENT- urinous brath
3) Pul- crackles, effusion, tachypnea
4) CV- HTN, S3 or S4, dysrhythmia
5) GI- bleeding
6) Neuro- changes in LOC
7) Neuromusc- tremors, hyperreflexia. -
What would the diagnostic tests show in acute renal failure?
1) Electrolytes
2) BUN and Creatinine
3) ABGS
4) CBC
5) UA -
Answer:
1) Electrolytes (hyperkalemia, hyponatremia, hyperphosphatemia)
2) BUN and Creatinine (both elevated)
3) ABGS (metabolic acidosis)
4) CBC (anemia)
5) UA (fixed specific gravity, protein, casts) - Why is Creatinine a more accurate test than BUN when assessing renal fx,?
- Answer: Creatinine is more accurate than BUN because it is not affected by proteins in the diet or fluid status; the BUN to creatinine ratio should be 10:1; the cratinine does not increase unless one-quarter of nephrons ar enot fx.
- When should you weigh an ARF patient?
- Answer: At the same time each day to document fluid volume status. Restrict fluids as ordered.
- What position should you put an ARF in to enhance cardiac and respiratory fx?
- Answer: Semi-folwer's position
- Why is it important to monitor the skin status of an ARF pt.?
- Answer: It is important to monitor the skin status because increased edema can decrease tissue perfusion and increase the risk for skin breakdown.
- What are the most common causes of chronic renal failure?
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Answers:
*Diabetic neuropathy
*HTN
* glomerulonephritis
*cystic kidney disease
* urologic disease - Describe the treatment that would be given to a renal failure patient for hyperkalemia.
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Answer:
1) Sodium polystyrene sulfonate (Kayexalate); works w/i 1-4 hours and binds with K+ in the bowel and is excreted in the feces. Calcium gluconate is used to prevent cardiac disfx but does not lower K+
2) Insulin in DSW forces K+ back in to cells because potassium follows insulin into cells
3) NaHCO3 (sodium bicarb) is infused to promote excretion of K+ in urine. Controls metabolic acidosis. - What are the three types of dialysis?
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Answer:
1) Hemodialysis
2) Continuous renal replacement therapies
3) Peritoneal dialysis - For hemodialysis, how soon do the AV fistulas or AV grafts take to be used for dialysis after surgery?
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Answer:
1) AV fistula is anatomic (join artery and vein together)-- can't be used for 1-3 m/o after surgery
2) AV grafts are synthetic-- an can't be used for 2-4 weeks after surgery.
Note: In the mean time...have to use a temporary access point: Subclavian, IJ, femoral caths. - What is an important teaching for those who have a AV graft or fistula?
- Answer: Do not wear constrictive clothing on limb w/ access device. do not sleep on or carry anything heavy on area of access device.
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How do you know if the AV graft or fistula is working?
(2 ways) -
Answer:
1) Palpate "thrill"
2) Auscultate bruit - Where do you draw blood and place BP cuff on a dialysis pt?
- Answer: On limb that does not have the access device.