Term
describes any condition that decreases the kidney's ability to funtion normally |
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Definition
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Term
hallmark sign of renal failure |
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Definition
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Term
kidney failure is classified as _ based on onset and reversibility |
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Definition
acute kidney injury or chronic kidney disease |
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Term
has a rapid onset (1 to 7 days) and may be reversible |
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Definition
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Term
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Definition
prerenal, intrarenal or postrenal |
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Term
ruslts from decreased blood flow to the glomeruli |
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Definition
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Term
a systolic BP of _ ore greater is necessary to sustan glomerular filtration |
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Definition
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Term
intrarenal fialure may be caused by |
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Definition
nephrotoxic drugs, kidney infections, occlusion of intrarenal arteris, hypertension, diabetes mellitus, direct trauma to the kidnesy |
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Term
things that may be toxic to the kidneys (intrarenal failure) |
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Definition
antibiotices("mycins'), heavy metals (lead and mercury), cleaning compounds, pesticides, poisonus mushrooms |
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Term
examples of kidney conditions that may lead to kidney failure |
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Definition
pyelonephritis, glomerulonephritis, renal tuberculosis, polycystic kidney diseas |
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Term
_ may also be intrarenal causes of failure |
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Definition
trauma from motorvehichle accidents, contact sports injuries, and other direct blows |
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Term
postrenal causes of AKI are _ beyond the kidneys causing the urin to back up into the _ resulting in _ |
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Definition
obstructions, renal pelvis, hydronephrosis |
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Term
most common causes of postrenal aki |
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Definition
ureteral calculi, benign prostatic hypertrophy, prostate cancer and trauma |
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Term
pts at risk for AKI include thos having |
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Definition
major surgery, experiencing major trauma, or receiving large doses of nephrotoxi drugs |
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Term
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Definition
onset, oliguric, diuretic, revcovery |
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Term
initial phase of AKI is short with a duration between |
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Definition
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Term
inital pase is characterized by increasing _ with normal to decreased _ |
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Definition
BUN and serum creatinin, urine output |
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Term
primary treatment goal of the inital phase of AKI is _ to prevent further damage |
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Definition
reversal of failing renal function |
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Term
during the oliguric phase the urin output decreases to _ per day or less |
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Definition
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Term
in the oliguric phas the serum values for _ increase, serum _ decrease |
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Definition
BUN, creatinine, potassium and phsophorus calcium and bicarb |
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Term
the oligurc phase follows the initial stage and continues between |
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Definition
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Term
in the oliguric phase urin specific gravity becomes fixed at _ indicating the inability of the tubules to concetrate urine |
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Definition
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Term
normal urine specific gravity |
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Definition
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Term
during the oliguric phase the pt becomes |
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Definition
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Term
in the oliguric phase urin osmolality _ and serum osmolality _ as wast products are retained |
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Definition
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Term
the diuretic phase begins when |
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Definition
the cause of AKI is corrected |
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Term
in the diuretic phase urin output exceeds _ and may rise above _ |
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Definition
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Term
towards the end of the diuretic stage the kidneys begin to excreate and retain _ which is an indication of return of kidney function |
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Definition
BUN creatinine, potassium and phosporus calcium and bicarbonate |
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Term
if complete recovery from AKI does not occur _ may develop |
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Definition
renal insuffiency or chronic renal failure |
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Term
renal insufficiency is indicated by loss of approx _ of function |
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Definition
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Term
the primary goal of AKI is to |
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Definition
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Term
for prerenal AKI _ must be restroed |
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Definition
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Term
Treatment of intreinsic aki is based on efforts to stimulate urin production with |
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Definition
iv fluids and dopamine, furosemide or both |
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Term
postrenal AKI is treated by |
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Definition
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Term
oliguria is treated with diuretics, most often an osmotic diuretic such as _ or a loop diuretic such as _ or _ |
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Definition
mannitol, furosemid, ethacrynic acid (edecrin) |
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Term
_ typically accompanies oliguria |
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Definition
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Term
drigs givven IV to lower serum potassium included |
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Definition
hypertonic glucose and insulin, sodium bicarbonat, calcium gluconate |
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Term
_ given orally or rectally also lowers serum potassium |
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Definition
sodium polystyrene sulfonate (kayexalate) |
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Term
_ can lead to acute kidney injury |
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Definition
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Term
hemodialysis may be required if other conservative measures fail to treate |
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Definition
hyperkalemia, sever metabolic acidosis, pulmonary edeam and rising BUN |
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Term
for hemodialysis a temporary cannula can be placed in the |
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Definition
jugular, femoral or subclavian vein |
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Term
disadvatages of a femoral cannula include: |
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Definition
pt must be immmobil between dialysis treatments and risk for infection increases |
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Term
a subclavian cannula can be left in place between treamtnts but can cause |
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Definition
thrombosis, stenosis, pneumothorax, hemothorax and brachial nerve damage |
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Term
because eventually the heart may fail with AKI it is important to monitor for |
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Definition
cardiac dysrhythmias, change in BP, shortness of breath |
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Term
characterized by progressive destruction of the nephrons of both kidneys |
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Definition
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Term
the final stage of kidney disease |
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Definition
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Term
important measure of renal function |
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Definition
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Term
when creatinin clearance falls below _ dialysis or transplantation becomes necessary |
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Definition
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Term
increased nitrogenous wast products in the blood |
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Definition
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Term
chronic kidney diseas is charactrized by |
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Definition
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Term
the term used for the symptoms that develop when the condition advances to the point of ESRD |
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Definition
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Term
uremic symptoms may influde |
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Definition
nausea, vomiting, anorexia, peripheral neuropathy, central nervous system abnormalities |
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Term
_ may predispose the pat to progressive renal failure |
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Definition
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Term
the most common cause of prgressive rena failure |
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Definition
htn, diabetes mellitus and atherosclerosis |
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Term
first function lost in chronic kidney disease is |
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Definition
the ability to concentrate urin |
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Term
approximate estimate of the GFR |
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Definition
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Term
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Definition
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Term
when BUN reaches or exceeds _ dialysis is needed to reduce it |
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Definition
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Term
a wast product of skeletal msucle breachdown |
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Definition
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Term
more reliable measure of kidney function tahn bun |
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Definition
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Term
creatinine is not affected by |
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Definition
diet, hdration, hepatic funciton or metabolism |
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Term
normal serum creatinein is _ in female pt and _ in male pt |
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Definition
0.5 to 1.1 mg/dL, 0.6 to 1.2 mg/dL |
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Term
a serum creatinine level that is twice the normal level reflects a _ loss of funtion, when the value reaches or exceeds 10 times normal, _ of function ahs been lost |
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Definition
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Term
the best indicator of renal function(a urine test) |
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Definition
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Term
creatinine clearance requires collection of all urin in a |
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Definition
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Term
normal creatinin clearance is _ in males and _ in females |
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Definition
107-139 mL/min, 87 to 107 mL/min |
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Term
in renal failure, cells become resinant to the action of |
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Definition
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Term
hyperinsulemia stimulates the liver to produce |
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Definition
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Term
pts with chronic kidney disease have high severl lelves of |
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Definition
very low density lipoproteins (VLDLs) |
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Term
the primary means of potassium excretion is through the |
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Definition
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Term
the most life threatening effect of renal failrue |
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Definition
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Term
elevated serum potassium interferes with _ causing _ |
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Definition
normal cardiac function, cardiac dysrhythmias |
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Term
in hyperkalemia the pt becomes |
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Definition
apathetic, confused and may ahve nausea, abdominal cramps, muscle weakness and numbness of the extremities |
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Term
serum potassium greater than _ requires cardiac monitoring |
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Definition
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Term
if serum potassium is not reduced, _ may develop |
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Definition
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Term
hyperkalemia is treated with |
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Definition
iv glucose or insulin or intravenous 10% calcium gluconate (drives K+ back into the cells) |
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Term
the method used most often to reduce elevated serum potassium is |
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Definition
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Term
diseased kidney tissue lacks the enzyme that activates |
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Definition
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Term
the normal total serum calcium level is |
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Definition
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Term
the normal ionized calcium |
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Definition
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Term
pts with hypocalcemia exeriecne |
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Definition
tingling sensations, muscle twitches, irritability and tetany |
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Term
sustained painful muscle contraction |
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Definition
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Term
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Definition
calcium supplements, active vitamin d and phosphate binders |
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Term
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Definition
calcium carbonate,c alcium acetat, sevelamer (renagel) |
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Term
seide effects of phosphate binders include |
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Definition
hypophosphatemia and constipation |
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Term
antacids with _ should be avoided for pt with hypocalcemia |
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Definition
aluminum or magnesium, such as milk of magnesia, magnesium carbonate, magnesium oxide, and magnesium trisilicate |
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Term
failure of the renal tubules to exrete acid ions and acid waste products causes the body's acid level to |
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Definition
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Term
decreased bicarb reabsorption renders the body unable to |
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Definition
neutralize the excess acid |
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Term
symptoms associate with metabolic acidosis include |
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Definition
headache, lethargy and delirium |
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Term
most pat with chronci kidney disease retain _ causing _ |
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Definition
sodium and water, hypernatremia and hypervolemia |
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Term
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Definition
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Term
prevention and treament hypervolemia include |
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Definition
fluid restriction, diuretics and dialysis if necessary |
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Term
kidneys of pts with chronic kidney disease produce less _ a hormone necessary for rbc production |
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Definition
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Term
transfusions may be required if the hct drops belos _ |
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Definition
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Term
normal hct values are _ for women and _ for men |
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Definition
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Term
this product improves RBC fromation and has revered anemia and the need for transfusions in some patients with chronic kidney disease |
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Definition
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Term
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Definition
moist breath sounds, bounding pulse, dependent edema and dyspnea |
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Term
dyrhthmias may be caused by |
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Definition
hyperkalemia or hypocalcemia |
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Term
neurologic effects of chronic kidney disease are |
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Definition
mental status changes and peripheral neuropathy |
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Term
peripheral neuropath may be evident initially as a _ and later as _ |
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Definition
restless feeling foot drop, loss of feeling in the legs or paralysis of the legs |
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Term
may occur with hemodialyis |
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Definition
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Term
the rapid remvoal of urea from the blood with dialisy leaves an increased concentration of solutes in the |
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Definition
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Term
_ r/t disequilibrium may progress to coma or seizures if not treated |
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Definition
confusion, lethargy, headache, nausea, and vomiting |
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Term
disequilibrium is corrected with the administration of |
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Definition
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Term
calcium phosphate crystals and urea r/t kidney failure accumulate in the skin causing _ |
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Definition
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Term
the temr used when whitich crystals composed of urea and other salts precipitate on the skin and around the mouth |
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Definition
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Term
a breakdown product of urea |
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Definition
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Term
when ammonia accumulates in the GI tract it causes |
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Definition
irritation, nausea, vomiting a metallic tast in the mouth and bleeding |
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Term
a diet high in _ and low in _ is prescribed to reduce the accumulation of _ |
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Definition
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Term
other common gi disturbances with chronic kidney diseases include |
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Definition
stomatitis, anorexia, nausea, vomiting, constipation, diarrhea |
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Term
renal osteodystropy, the skeletal changes characteristic of hcronic kidney disease |
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Definition
metastatic calcification, bone demineralization, osteitis fibrosa |
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Term
deposition of calcium phosphate complexes in blood vessesls and in joints, lungs, muscles and eyes |
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Definition
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Term
depositis in blood vessels can impair blood flow so severly that fingers and toes may become |
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Definition
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Term
bone deminerilization is directly r/t |
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Definition
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Term
when calcium is lost form bones, it is replaced with fibrous tissue, a condition konw as |
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Definition
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Term
pt with chronic kidney diseas usually appear |
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Definition
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Term
hyperparathryroidism occurs in response ot the chronically low _ and high _ |
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Definition
serum calcium, serum phosphates |
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Term
when kidney failure cna no longer be managed conservatively _ is required to sustain life |
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Definition
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Term
the passage of molecules through a semipermeable membrane into a special solution called dialysat solution |
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Definition
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Term
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Definition
remove the end products of protein matabolims form the blood maintian safe ocncentrations of serum electrolytes, correct acidosis and replenish the body's bicarb buffer system remove excess fluid from the blood |
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Term
two priamry means of dialyssi |
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Definition
hemodialysis, peritoneal dialysis |
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Term
a process by which blood is removed from the body and circulated through an artificial kidney for removal of electrolytes and wasts |
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Definition
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Term
_ catehters can be used for temp acces for dialysi during AKI while a _ or for a pt on _ who need immediate access for hemodialysis |
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Definition
subclavian or femoral, graft or fistual matures, peritoneal dialysis |
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Term
an internal connection between the pt's artery and vein |
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Definition
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Term
a fistula requries approx _ wks to mature and may be used for up to _ |
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Definition
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Term
occurs when too much arterial blodo is diverted from the extremity by the access device |
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Definition
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Term
disadvantages for hemodialysis |
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Definition
need for vascular access, use of an anitcoagulant and the potential for hemorrhage, anemia, rapid fluid, and electrlolyte shifts, muscle cramps, n/v, and air emboli |
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Term
complications of hemodialysis |
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Definition
atherosclerotic cardiovascular disease, anemia, gastric ulcers, disturbed calcium metabolism, hepatits, |
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Term
uses the patients on peritoneum as a semipermeable dialzing membrain |
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Definition
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Term
advantages of peritoneal dialysis over hemodialysis included |
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Definition
less anemia, reduced cost of equipment, fewer dieteary fluid restrictions, independence, closer esemblance to normal kidney funtion |
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Term
disadvantages of peritoneal dialysis |
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Definition
peritonitis, catheter site infection, hyperglycemia, elevated serum lipis, body image disturbance |
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Term
peritoneal dialysis has three phases |
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Definition
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Term
during inflow phase of peri dialysis fluid is allowed to drian into the _ cavity through an an established catheter over about _ |
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Definition
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Term
during dweel time fluid remains in the cavity for a specified period of time while _ occur |
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Definition
ultrafiltratin,osmosis and diffusion |
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Term
allows the pt freedom form a machine and the independence to perform dialysis alone |
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Definition
continuous ambulatory peritoneal dialysis |
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Term
the most seroius complication of peritoneal dialysis |
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Definition
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Term
evidnce of infection r/t peritoneal dialysis |
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Definition
cloudiness, and particles in the fluid in the outflow ocntainer |
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Term
other complications of peri dialysis |
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Definition
bleeding, abodminal pain, hernias, low back pain, resp distressm decreased serum ablumin |
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Term
a condition in which a thick membrane dvelops around the bowel |
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Definition
encapsulating sclerosing peritonitis |
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Term
cerebral edema and elevated metabolic wastes in the blood can cause |
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Definition
confusion, slwoed thought processes, lethargy and loss of consciousness |
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