Term
|
Definition
accumulation of nitrogenous waste products
increased BUN and Creatinine |
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|
Term
|
Definition
|
|
Term
|
Definition
| a reduction in renal function to the extent that it interferes with biological homeotasis |
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|
Term
| characterisitcs of ACUTE renal failure |
|
Definition
*sudden onset (6-8 hours)
*rapid deteriorating (days)
*USUALLY REVERSIBLE with treatment
*return to normal renal function is possible (atleast close to baseline)
*chronic kidney diseae may develop if not treated or no response to treatment
*UOP < 400 mL/day but can vary |
|
|
Term
| characteristics of CHRONIC kidney disease |
|
Definition
*slow insidious onset (months to years)
*progressive nature (get sick slowly)
*progressive from insufficiency to ESRD
*IRREVERSIBLE only gets worse
now considered a manageable chronic illness
*Dialysis or transplant need for survival in ESRD |
|
|
Term
| Causes of acute renal failure |
|
Definition
Pre-renal causes
Intra renal causes
Post renal causes |
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|
Term
| Pre renal causes result from... |
|
Definition
| result from decreased blow flow to the kidneys |
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|
Term
| Pre Renal causes. Effects of decreased blow flow... |
|
Definition
Decreased CO, Blood isn't filtered because it is not perfusing the nephrons which can lead to DAMAGED NEPHRONS which can cause intra renal disease
*QUICK TREATMENT CAN SAVE NEPHRONS |
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|
Term
| Examples of pre renal causes of acute renal failure |
|
Definition
*Anything that interrupts blod flow to kidneys
*See text for examples |
|
|
Term
| Intra renal causes result from.. |
|
Definition
| direct damage to the renal tissue causes nephrons to malfunction |
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|
Term
| Most common cause of intra renal failure |
|
Definition
| Acute tubular necrosis (membranes break up and travel thru tubules...epithelium is present in urine) |
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|
Term
| Acute Tubular Necrosis (ATN) is caused by: |
|
Definition
1. ischemia from pre renal problems
2. nephrotoxins that damage tubular epithelium or obstruct structers (meds, contrast, ibuprofen) |
|
|
Term
| Examples of intra renal causes |
|
Definition
|
|
Term
|
Definition
| Yes, if the tubular epithelium regenerates and the basement membrane is not destroyed |
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Term
|
Definition
| any med detoxified or excreted by the kidney can cause ATN. tubular cells slough off and plug up tubules |
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Term
| Post renal causes of acute renal failure result from.. |
|
Definition
| obstruction to urine outflow. |
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|
Term
| What happens when urine outflow is obstructed (as is the case with post renal acute renal failure) |
|
Definition
obstruction blocks lower urinary tract
urine collects in renal pelvis
Pressure increases on renal cells
Circulation decreases
Ischemia, necrosis |
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|
Term
| Examples of Post renal acute renal failure |
|
Definition
| See text (calculi, BPH, prostate/bladder CA, trauma) |
|
|
Term
| Will pts with ACR caused by post renal always have a UOP? |
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Definition
|
|
Term
|
Definition
| onset, oliguric, diuretic, recovery/convalescent |
|
|
Term
|
Definition
initial injury
hours or days before symptomatic
RNs must be aware of risk factors to prevent damage to nephron
Major surgery, massive trauma, burns, cardiac failure, shock, sepsis, hypovolemia |
|
|
Term
| What is specific gravity of urine in ARF |
|
Definition
| it is the same specific gravity of the plasma |
|
|
Term
Oliguric phase of ARF
Include S/S |
|
Definition
*GFR drops and UOP drops to <400 mL/da
**Post renal ARF can be anuric
S/S:hypervolemic,hypertensive,hyperkalemic,high phosphorus levels |
|
|
Term
| as GFR decreases, what happens to fluid? and nursing diagnosis??? |
|
Definition
| backs up in the system; FVE, Decreased Co |
|
|
Term
| Diuretic phase (OPPOSITE OF OLIGURIC PHASE) |
|
Definition
*can't concentrate
*UOP increases, more and more each day
*kidneys can excrete wastes but can't concentrate
*osmotic diuresis results
*Hypovolemic, hypotenive, hypokalemic
*LOW SPECIFIC GRAVITY |
|
|
Term
|
Definition
creatinine and BUN stabilize as nephrons begin to heal
*May take months to get back to near baseline
*Some patients have residual deficitis |
|
|
Term
|
Definition
*treat underlying cause quickly to preserve renal fx
*interventions for FVE or FVD fluid restrictions
*Interventions for Ca and Phosphorous H
*Interventions for uremic syndrome (toxins in system, edema
*Daily weights L of fl = 1kg=2.2lbs
*24 hour output + 500 or 600=next day's fluid replacement |
|
|
Term
| How to determine next days fluid replacement in ARF |
|
Definition
| 24 HR OUTPUT + 500/600 = next day's fluid replacement |
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|
Term
| Nutritional therapy for ARF |
|
Definition
*Prevent body protein catabolism (bc kidneys cant handle protein)-->this increases toxins (urea, K phosphate)
*CARBS & FATS for energy
*Restrict NA to prevent CHF, edema, HTN
*fats 30-40% of daily calories
*enteral nutrtion, intralipds (white bag), rental TPN
*****RESTRICT K AND PHOSPHORUS******** |
|
|
Term
|
Definition
| bananas, greens, hot dogs |
|
|
Term
|
Definition
| seeds, fish, cheese, nuts, bens, lentil |
|
|
Term
| Summarize nutritional therapy for ARF |
|
Definition
| Low protein, Low Na, High fat, High carbs |
|
|
Term
| Therapies for hyperkalemia |
|
Definition
*regular insulin IV with glucose
*Socium bicarb
*Ca gluconate IV pull into cells
Dialysis
Kayexalate (PO,enemas, ostomies)
Dietary restrictions |
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|
Term
|
Definition
|
|
Term
|
Definition
"MURDER"
Muscle weakness
Urine (oliguria, anuria)
Respiratory distres
Decreased cardiac contractility
EKG changes
Reflexes (hyperreflexia or areflexia=flaccid) |
|
|
Term
|
Definition
| bananas, fruits, vegetables, corn, asparagus |
|
|
Term
| Many foods high in protein are high in potassium as well...example |
|
Definition
|
|
Term
| salt substitutes contain... |
|
Definition
|
|
Term
| When do ARF pts require dialysis?? |
|
Definition
*volume overload with CHF/pulmonary edema=lungsounds
*extremely high K with EKG changes = +6
*BUN >120
*drastic changes in mental status
*metabolic acidosis
*pericarditis=irritation
*PERICARDIAL EFFUSION=fluid fills up, causes..
*CARDIAC TAMPONADE=irregular heartbeat |
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|
Term
| Which dialysis works faster in an emergency? |
|
Definition
|
|
Term
| Characteritics of chronic kidney disease |
|
Definition
*slow, insidious onset=mo to yrs
*progressive=get sick slowly; insuffiency to ESRD
*IRREVERSIBLE=get worse
*considered manageable chronic illness
*dialysis or transplant needed for survival |
|
|
Term
| causes of Chronic Kidney disease |
|
Definition
Diabetes
HTN
unresolved ARF
hereditary congenital disorders (PKD=polycystic kidney disease)
Cancers (renal or metastasized)
pyelonephritis, glomerulonephritis, nephrotic syndrome
Lupus |
|
|
Term
| What happens in chronic kidney disease? |
|
Definition
The nephrons slowly lose their ability to concentrate urine, eliminate wastes, and perform other functions
*Stages in ESRD determined by GFR |
|
|
Term
| ESRD is what stage of renal disease? |
|
Definition
| final stage when patients need dialysis or transplants to survive |
|
|
Term
| EARLY s/s of chronic kidney diseae |
|
Definition
*polyuria->can't concentrate urine
*nocturia-toxins
*headaches-toxins
*nausea-toxins
*fatigue-toxins |
|
|
Term
| What happens to UOP as chronic kidney disease progresses? |
|
Definition
|
|
Term
| What will final urine specific gravity be? |
|
Definition
|
|
Term
| Diabetes and CKD (3 things) |
|
Definition
1. Diabetics require less insulin bc it stays on board
2. liver makes more triglycerides bc of the high levels of insulin
3. hyperlipidemia further complicates atherosclerosis seen in patients with diabetes |
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|
Term
|
Definition
Need sufficient calories to provide energy and prevent catabolism HIGH CARbS, HIGH FAT
*if insufficient calories, they break down protein for energy leading to negative nitrogen balance and increased toxins.
Watch proteins!
BAD=brown sugar, molasses, chocolate, corn greens
low sodium, FL RESTRICTIONS |
|
|
Term
| Know FOODS that are good/bad for CKD |
|
Definition
|
|
Term
|
Definition
low biological value proteins better (Fresh meats) than high bioligcal value (protein shakes)
Lower protein decreases toxins, headaches, nausea
**protein needs change with peritoneal dialysis |
|
|
Term
| protein supplements for CKD |
|
Definition
|
|
Term
|
Definition
1-4 GRAMS
*AVOID HIGH SODIUM FOODS
AVOID SALT SUBSTITUTES
AVOID CANNED FOODS
I&o
DAILY WEIEGHTS |
|
|
Term
|
Definition
| cured meat and fish, cheese, pickles, soups, |
|
|
Term
| fluid restrictions for CKD |
|
Definition
*use formula for daily allowance
*give meds with meals
space fl throughout day |
|
|
Term
| Catabolic states break down cells and release ___________ which leads to ___________ |
|
Definition
|
|
Term
| in CKD, as GFR drops, _________________is retained |
|
Definition
|
|
Term
| phosphorus binds with ionized _________, decreasing ____________levels which makes patients more prone to... |
|
Definition
| Calcium; prone to heart problems and fractures |
|
|
Term
| When calcium levels decreased, PTH is released which... |
|
Definition
| releases Ca from the bone AND more phosphorus is released decreasing calcium and incresing phosphate levels super high!!!! |
|
|
Term
| CALCIUM PHOSPHATE CRYSTALS AFFECT |
|
Definition
*joints=decrease ROM
*brain=personality changes
*heart=conduction problems, arrest
*eyes=uremic red eye,blindness
*kidney=calculi
*muscles
*arterial deposit=gangrene in fingers and toes |
|
|
Term
|
Definition
bones are brittle=osteomalacia
assess for bone pain, fractures, increased alkaline phosphatase
***treat with meds and diet |
|
|
Term
| Must correct ______before correcting low_______ |
|
Definition
|
|
Term
| Treatment for high phosphorus |
|
Definition
Low phosphorus diet
Take meds with meals that bind with phosphorus |
|
|
Term
|
Definition
| AVOID SOFT DRINKS, NUTS, PROCESSED FOODS |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| increases parathyroid sensitivity |
|
|
Term
|
Definition
|
|
Term
| Why does anemia occur in Chronic Kidney Disease (CKD)? |
|
Definition
decreased RBC production s/t decreased erythropoietin->made in kidneys
*decreased RBC surival |
|
|
Term
| Treatment for anemia in CKD? |
|
Definition
administer erythropoietin IV or Subcut
folic acid
iron supplements->binds with phosphate binders
Ferrlecit |
|
|
Term
| Risk for injury: bleeding...WHY? |
|
Definition
defective platelet function s/t uremia
uremic toxins ar irritating to GI tract
Assess for bruising,hemorrhage
Gi bleed can be life threatening |
|
|
Term
| Risk for infection in CKD...WHY? |
|
Definition
uremic toxins reduce inflammatory, cellular, and humoral responses
*trauma from catheters, blood draws, vascular access devices |
|
|
Term
| What cardiovascular problem is an emergency in CKD? |
|
Definition
| cardiac tamponade=slow, rapid compression of heart d/t fluid |
|
|
Term
cardiovascular problems in CKD..LIST
WHAT CAUSES? |
|
Definition
fluids, sodium, triglycerides, atherosclerosis
HTN
MI
CVA
CHF
Pericarditis
Pericardial effusion |
|
|
Term
|
Definition
| interstitial edema in the lungs |
|
|
Term
| respiratory complication of CKD that get easily |
|
Definition
| pneumonia-->decreased protection against infection, wet lngs, secretions |
|
|
Term
| respiratory complications of ckd |
|
Definition
*uremic lung
*cough reflex depressed
*thick tenacious sputum
*pulmoary edema from CHF
*uremic pleuritis, pleural pain, pleural rub
*pleural effusions
*pneumonia |
|
|
Term
|
Definition
stomatitis=inflammation of mouth and lips
*uremic fetor=urine breath
n/v anorexia
diarrhea
constipation
gastritis, gastric ulcers, GI bleeds |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| why is diarrhea a gi complication of ckd? |
|
Definition
| increased potassium, altered calcium |
|
|
Term
| Why is constipation a GI complication of CKD? |
|
Definition
| fluid restrictions, diet restrictions, FE supplements, phosphate binders |
|
|
Term
| What could you give for taste and dry mouth? |
|
Definition
| hard candy, gum lollipops |
|
|
Term
| if diabetic, what kind of candy? |
|
Definition
|
|
Term
| intervention for alterred nutrition |
|
Definition
| assess likes/dislikes to give some control |
|
|
Term
| intervention for GI complications for stomatitis |
|
Definition
| frequent mouth care for mucous membranes and bad breath |
|
|
Term
| Interventions for diarrhea |
|
Definition
monitor consistency/frequency of stools
electrolyte levels
peri care
i&o
determine cause |
|
|
Term
| interventions for constipation |
|
Definition
**can be diff. to treat bc of phosphate binders and fluid restrictions
ambulation
activity
avoid OTC laxatives that have mag--can not be excreted |
|
|
Term
| Why do you not use laxatives that have magnesium as an intervention for constipation?? |
|
Definition
|
|
Term
|
Definition
lethargy, apathy, decreased concentration
lose recent recall
confusion, stupor
seizures, coma with rapid increase in BUN->encephalopathy
depression, psychosis |
|
|
Term
| altered mental status often leads to... |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fooddrop, muscle weakness, twitching, cramps, restless leg, burning feet, asterixis |
|
|
Term
|
Definition
| flapping tremor of bird, sign of peripheral neuropathy in ckd |
|
|
Term
| what does skin look like in ckd? |
|
Definition
yellow gray bronze=waste retention
pale=anemia
very dry=decrease oil and sweat gland activity
pruritus=dry skin, toxins, ca phosphate crytals
uremic frost |
|
|
Term
|
Definition
| skin change in ckd; pale yellow crstallized frost on skin |
|
|
Term
|
Definition
| grease em up! oils, lotions, antihistamines, antipruritics, short nails |
|
|
Term
| children with ckd.... (reproductive) |
|
Definition
| do not grow or develop secondary sex characteristics |
|
|
Term
| adults with ckd (reproductive)... |
|
Definition
general=decreased libido
women-=amenorrhea, cessation of ovulation
men=impotence, infertility |
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