Term
| CRF is progressive and ______ destruction of the _____ ______ |
|
Definition
IRREVERSIBLE,
bilateral nephrons |
|
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Term
| GRF, ______ _____ _____, is the measurement of _____ ______. Specifically, it's the amount of _____ ____ through the _____ per/___ |
|
Definition
Glomerular filtration rate.
Measurement of kidney function. Specifically the amount of plasma filtered through the glomeruli per minute. |
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Term
| Normal GFR is ____/min. Renal insufficiency occurs when the GFR is approximately ____ ml/min, where as ESRD is when the GFR is <____ml/min. |
|
Definition
125
Renal insufficiency: 90 ml/min
ESRD: <30 ml/min. |
|
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Term
There are 5 stages of renal disease.
1: ____ kidney damage with _____ or _____ filtration. Greater than or equal to ___ml/min
2: _____ decrease in kidney function. __-___ ml/in
3: ______ decrease in kidney function. ___-___ml/min
4: _______ decrease in kidney function. ___-__ml min
5: _____ or _____. < ___ml/min |
|
Definition
1: Slight. Greater than or equal to 90 ml/min
2: Mild. 60-89 ml/min
3: Moderate. 30-59 ml/min.
4: Severe. 15-29 ml/min.
5: Transplant or dialysis. , 15 ml/min |
|
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Term
| When a person has diminished renal reserve, the serum levels are ____. The BUN is __-___, Cr is __-__. There symptoms are ___. |
|
Definition
Serum levels are normal
BUN 10-20
Cr 0.5-1.2
Symptoms are absent |
|
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Term
Symptoms of kidney failure occur when the GFR is approximately ___, AKA _____ _____. The common symptoms are ____ and ____. As the disease progresses: h/a, ______, ______, ___uria and ___uria.
The BUN and Cr are ____. So the BUN is >___, but <___. Cr is >__. |
|
Definition
| Symptoms appear when GFR is aprx. 90ml/min. Renal insufficiency. Common symptoms are fatigue and weakness. As the disease progresses, H/A, nausea, pruritis, nocturia & polyuria (kidney's have lost their ability to concentrate urine.) |
|
|
Term
| ESRD, AKA _____ or ______ occurs when the GFR is <___ml/min. The BUN is ____-____. Cr Cl is <__-__ml/min. |
|
Definition
ESRD aka uremia or azotemia occurs when the GFR <30ml/min
BUN is 100-200
Cr Cl <5-10ml/min |
|
|
Term
| The best indicator of CRF is increased ____ _____ and decreased ______ ______. _____ builds up in the blood, and will be >___. |
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Definition
| The best indicator of CRF is increased serum creatinine and decreased Cr Cl. Creatinine builds up in the blood and is >2 |
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Term
| Leading cause of CRF in the US is ______&______ |
|
Definition
| Diabetes and hypertension |
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Term
|
Definition
| Build up of urea and other junk (Cr, phenols, hormones, electrolytes, chemicals, etc) in the blood. Manifestation of CRF. |
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Term
| Altered _______ metabolism is a clinical manifestation of CRF. The kidney's can't excrete the breakdown of _____ and the ___ becomes abnormally high, as a result, increased ____ levels occur. This ________ stimulates the ______ production of ______. Almost all patients with _____ develop ________, a risk factor for _____. |
|
Definition
Altered carbohydrate metabolism.
Kidney's can't excrete breakdown of protein.
BS becomes abnormally high causing increased insulin.
Hyperlipidemia stimulates hepatic production of triglycerides. Almost all patients with uremia develop hyperlipidema, a risk factor for atherosclerosis. |
|
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Term
| The most serious electrolyte imbalance that can occur with CRF is _______, due to decreased ______. S/S include cardiac _____, muscle ____, and cardiac _____. The ____ ___ _____ is one of the first signs!! |
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Definition
| Hyperkalemia due to decreased excretion. S/S include cardiac arrhythmias, muscle weakness, cardiac arrest. Peak T wave is one of the first signs!!! |
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|
Term
Hypo_____ & hyper_____ (_____ relationship between ____ and ______). The low serum _____ levels triggers the _____ to secrete ________ hormone.
This would be present in a calcium level <___ and a phosphorous level > 4.5. |
|
Definition
Hypocalcemia & hyperphosphatemia (inverse relationship between calcium and phosphorous)
Low serum calcium (kidney's fail to produce vitamin D), causes parathyroid gland to secrete parathyroid hormone.
Calcium <9 and phosphorous > 4.5 |
|
|
Term
Tap facial nerve to stimulate twitch due to ______: _______.
Arm twitching: _______ |
|
Definition
Hypocalcemia
Chovstek's sign
Arm twitching= Trousseau's sign. |
|
|
Term
| Normal serum sodium levels |
|
Definition
|
|
Term
| Acid base balance associated with CRF |
|
Definition
Metabolic acidosis
PH <7.35
PaCO2: 35-45 (normal)
HCO3<22 (normal 22-26) |
|
|
Term
| With CRF, the kidney's produce less of the hormone erythropoieten, which stimulates the _____ to produce ____. This leads to _____. |
|
Definition
Stimulates the bones to produce RBC's
Leads to Anemia |
|
|
Term
|
Definition
| Increased bleeding due to uremia interfering with platelet aggrigation |
|
|
Term
|
Definition
| Increased infection due to changes in leukocyte and altered immune response |
|
|
Term
Types of cancer found associated with CRF
(6) |
|
Definition
| Lung, breast, uterus, colon, prostate, skin |
|
|
Term
| The most common cardiovascular manifestation of CRF is ______, which makes sense due to _______. |
|
Definition
| Hypertension- atherosclerosis |
|
|
Term
| In addition to _____ edema, dyspnea, pneumonia, and a _____ cough, ________ respirations may be noted in CRF. These are _______, regular, _______ respirations) |
|
Definition
| Pulmonary edema, dyspnea, pneumonia, depressed cough, kussmaul's respirations. T |
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|
Term
| GI manifestation of CRF: Inflammation, ____itis, ______ taste in the mouth, ______, nausea, GI ______, _____ ulcer, ____itis |
|
Definition
Inflammation
Stomatitis
Metallica taste in the mouth
Anorexia
Nausea
GI bleeding
Peptic ulcer
Gastritis |
|
|
Term
Neurological manifestations of CRF
Changes in ___ due to increased ____ ____ and altered _____
Fatigue, __/__, ___disturbances, ____ irritability, ______, confusion, ____, ______neuropathy, paresthesia, ____ weakness, muscle _____ |
|
Definition
Changes in LOC due to increased waste products, altered electrolytes
Fatigue, headace, sleep disturbances, lethargy, mescular irritability, seizures, confusion, coma, peripheral neuropathy, paresthesia, motor weakness, muscle twitching |
|
|
Term
Skin color on a person with CRF may be _____/______/______
Or they may have _____ ____, a ____ color. In this condition, ______ _______ on the skin. It is seen when ____ levels are extremely high.
The skin may also have ____, ___itis, and there may be _____/______ due to increased bleeding. The skin may also be dry and _____. |
|
Definition
Yellow/grey/bonze
Or they may have uremic frost, a silvery color seen when uremia crystallizes on the skin (sweating urea)
Pallor, pruritis, there may be ecchymosis and petechiae due to increased bleeding. Dry, scaly skin. |
|
|
Term
| Reproductive manifestations of CRF: |
|
Definition
| Infetility, decreased libido, amenorrhea |
|
|
Term
| Endocrine disorders associated with CRF |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 types of renal osteodystrophy |
|
Definition
| Osteomalacia, osteritis, fibrosa, matastatic calcification |
|
|
Term
|
Definition
|
|
Term
|
Definition
| bone demineralization> porous bones due to the pulling out of calcium |
|
|
Term
|
Definition
Worst form of osteodystrophy.
Body isn't responding to PTH anymore. Calcium and phosphorous are pulled out of the bone into the bloodstream, causing calcification, depositing into blood vessels, joints, lungs, heart and eyes |
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|
Term
Conservative therapy includes ____, ______, and ____ care.
**_____ lifestyle will make kidneys last longer |
|
Definition
Pharmacological
Nutritional
Supportive care
Helathy lifestyle |
|
|
Term
Pharmacological therapy for hyperkalemia
IV ___% glucose/ ____ _____
IV ______ ______/______ ______ (inactivates K+)
______ bicarbonate: _____ K+ into the ____
Dietary restrictions: avoid _____
_____ enema or PO: exchanges ___ for ___ in the _____ and excess __ is expelled in the stool
______ |
|
Definition
IV: 50% glucose/regular insuline
IV: Calcium gluconate/calcium chloride (inactivates K+)
Sodium bicarbonate pushes K+ into the cell
Avoid high K+ foods
Kayexalate enema or po, exchanges Na for K ions and K is expelled in the stool
Dialysis |
|
|
Term
|
Definition
Sodium and fluid restriction
Antihypertensive meds: ACES, Angiotensin inhibitors, calcium channel blockers, central-acting agents (clonidine) |
|
|
Term
| those with renal osteodystorphy should be on _____ restriction (<_____mg/dl). This means avoiding ___-rich foods: |
|
Definition
Phosphate intake rsetriction <1000ml/dl
Avoid phosphate rich foods: eggs, nuts, whole grains, meat, fish, poultry, milk&milk products |
|
|
Term
|
Definition
| Hyperphosphatemia and hypocalcemia are treated with meds that bind phosphorous in the gi tract. These meds enable excess phosphate to be extreted in the stool |
|
|
Term
| Renal osteodystrophy tx: eliminate the use of ____-based _____/_____ |
|
Definition
| eliminate phosphorous-based laxatives/enemas |
|
|
Term
| Osteodystrophy med tx progression |
|
Definition
Calcium-based phosphate binders to lower phosphate levels and increase calcium
Once phosphate is lowered, then calcium lelvel can increase with administration of Vit D & calcium
**Watch for hypercalcemia |
|
|
Term
| Examples of calcium-based phosphate binders |
|
Definition
| Oscal, tums, calcium acetate (Phoslo), renagel |
|
|
Term
| _____ and ______ are aluminum hydroxide gels/antacids. They're rarely used due to ____ problems and dementia |
|
Definition
Amphogel and alu-cap
Bone problems and dementia |
|
|
Term
| Those with osteodystrophy should avoid the use of _____-containing antacids |
|
Definition
|
|
Term
| All phosphorus-binding agents must be administered with ______ to be _____ |
|
Definition
| with food to be effective |
|
|
Term
| _____ and _____ are given for osteodystrophy to prevent hyperparathyroidism, to prevent _____ from being released from the bone |
|
Definition
Calcitrol (Rocaltrol)
Paricalcitrol (Zemplar)
Prevents calcium from being released from the bone |
|
|
Term
| If renal osteodystrophy remains severe: |
|
Definition
| Subtotal/total parathyroidectomy |
|
|
Term
| Hemiatinic meds increase ________. These are _____ ___ (____), ferrous ______ (______), and folic acid. These should NEVER be given at the same time as ______ _____. |
|
Definition
increase hemoglobin
ferrous sulfate (Feosol)
ferrous fumarate (Chromagen)
folic acid
never given at the same time as phosphate binders (os-cal, tums, phoslo) |
|
|
Term
| _____ is used to estimate renal function to adjust dosages of medications. If only serum creatinine is available, use ____ to _____ Crcl |
|
Definition
CrCl
Use calculation to estimate CrCl |
|
|
Term
| Protein restriction with CRF |
|
Definition
|
|
Term
| CRF needs to restrict sodium as well as ______ |
|
Definition
|
|
Term
| Patient's with CRF should be on ____ products, or _____ acid supplements. They need to be taken ______, NOT _____ meals. They CANNOT take _____. |
|
Definition
| nepro products, keto acid supplements (essential amino acids). Specific for CRF. Take BETWEEN, NOT WITH MEALS. Cannot take ensure or other "normal" people supplements. |
|
|
Term
| Water intake depends on ___ ____. Intake should be +____-_____ml. |
|
Definition
urine output. intake should be +500-600ml output.
(output 500, fluid restriction is 1,000) |
|
|
Term
| High sodium foods to avoid |
|
Definition
| Cured meats, pickled foods, canned soups, cold cuts, soy sauce, salad dressings, salt substitutes (contains k+) |
|
|
Term
| High potassium foods to avoid |
|
Definition
| Dried fruits, legumes, oranges, banans, melons, strawberries, deep green & yellow veggies, beans and peas |
|
|
Term
| 3 renal replacement therapies |
|
Definition
Peritoneal dialysis
Hemodialysis
Continuous renal replacement therapy |
|
|
Term
| 3 general principals of dialysis |
|
Definition
| Diffusion, osmosis, ultrafiltration |
|
|
Term
|
Definition
| movement of solutes from an area of greater to lesser |
|
|
Term
|
Definition
| Movement of fluid to an area of lesser to greater concentration of solutes |
|
|
Term
|
Definition
| Solution moves by pressure gradient |
|
|
Term
| Hemodialysis works based on the principal of |
|
Definition
|
|
Term
| Peritoneal dialysis utilizes these general principals of dialysis: ____ and ____. |
|
Definition
|
|
Term
| Dialysis is started when the patient's _____ state can no longer be managed conservatively. It is used to correct ____ and ____ imbalances and remove ____ products in renal failure |
|
Definition
Uremic
Correct fluid and electrolyte imbalances and remove waste products |
|
|
Term
| PD consists of an _____ _____ catheter such as _____ _____, the _____ which pulls waste products/urea out of the body and an ____ ____ _____ to perform the procedure |
|
Definition
indwelling peritoneal catheter like a Tenckhoff Catheter
Diasylate: pulls wasted products/urea from the body
Administration set to perform the procedure |
|
|
Term
| Because risk for infection is a big problem with PD _____ _____ care is important. _______ using sterile technique, change ____ _____, and examine the site for ___ of _____ |
|
Definition
| Daily catheter care: cleanse using sterile technique, change the DSD daily, examine site for signs and symptoms of infection |
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|
Term
____ is the dialysis solution. It is a _____ dextrose concentration (not always, depends on the nephrologist. The ____ the concentration, the ____ the osmotic effect and ____ water is removed. The diasylate may be ___%, __%, ___%
It is usually ______ |
|
Definition
Diasylate, hypertonic dextrose concentration
Higher dextrose concentration, greater osmotic effect, more water is removed
1.5%, 2.5%, 4.5% |
|
|
Term
The three phases of the dialysis cycle
1: ___ (___,___)
2: ____ (___min-__hrs)
3: _____ (__-___ min)
The completion of all three phases is called ______. |
|
Definition
1. Influx (fill, inflow)
2. Dwell (20 min- 8 hrs)
3. Drain (15-30 minutes)
Completion: Exchange |
|
|
Term
| Best method to avoid peritonitis |
|
Definition
|
|
Term
|
Definition
| Motivated, support system, able to perform at home, unable to have hemodyalisis, waiting for kidney transplant |
|
|
Term
|
Definition
| Multiple abdominal surgeries, diverticulitis, abdominal hernias, obesity, back problems (can't handle the influx of fluid), COPD (fluid puts pressure on diaphragm) |
|
|
Term
| Deep breathing is important during PD to prevent _____ |
|
Definition
|
|
Term
| Who has more dietary restrictions, someone on dialysis or not? |
|
Definition
| The person who has CRF and is not on dialysis has more dietary restrictions |
|
|
Term
| Hemodyalisis treatments last __-__ hours. |
|
Definition
| 3-6 hours, very time consuming |
|
|
Term
| HD uses circulating _____ ____ through a ______ _____ that is surrounded by diasylate solution, which, is in a machine (____ ____). |
|
Definition
| Client's blood through a semipermeable membrane that is surrounded by a diasylate solution, which is in an artificial kidney. |
|
|
Term
| ___ are rarely used for HD anymore, can be used as ____ access. ____ implanted in ____ ___ and into ____ ___. Forms a ___-shape rubber tubing that's ___/ |
|
Definition
Shunts
Temporary access
Cannula implanted into radial artery & into adjacent vein, forms u-shaped rubber tubing that's external |
|
|
Term
Most common vascular access site
RN should check for ___&___
No ___, __'s or ___ draws on affected extremity and no ___ ___. Complications include ____, ____, ____ |
|
Definition
Internal arteriovenous fistuals and grafts
Check for bruit & thrill
No BP's, IV's or blood draws on the affected extremity, no constrictive clothing either
Complications include thrombosis, aneurysm, infection |
|
|
Term
| Palpate for ____, auscultate for ____ |
|
Definition
|
|
Term
| A dialyzer is a cartridge that contains thousands of ___ and ___, which are the ____ ____. Blood is pumped into the ____ of the cartridge and ____ to all the fibers. _____ is pumped into the cartridge and bathes the outside of the fibers. _____ takes place. |
|
Definition
| Thousands of tubes and fibers, which are semipermeable. Blood is pumped into the top of the cartridge and dispersed to all the fibers. Dialysate is pumped into the cartridge and bathes the outside of the fibers with dialysis fluid. Exchange takes place. |
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|
Term
A patient receiving their first treatment of dialysis experiences N/V, confusion, restlessness, H/A, twitching, jerking, seizures, muscle cramps, hypotension.
What might be going on and what is the underlying physiology? |
|
Definition
Disequilibrium syndrome.
Urea, Na & other solutes are removed from teh blood more rapidly than the CSF/brain. This causes and osmotic gradient in the brain resulting in shift of fluid into the brain.
Disequilibrium syndrome |
|
|
Term
|
Definition
Volume and electrolyte balance
BUN less than 100 (40-80)
Cr less than 8 |
|
|
Term
| Pt with CRF who is already fluid overloaded may be a candidate for _____ ____ ____ ____, which removes solutes and fluids more slowly and continuously. |
|
Definition
| Continuous Renal Replacement Therapy |
|
|
Term
| _____ disease, ____ _____, severe ____ ____, chronic ____ _____, extensive ______ disease, chronic ____ are considered high risk for renal transplant |
|
Definition
| cardiovascular disease, DM, severe cardiac failure, chronic respiratory failure, extensive vascular disease, chronic infections |
|
|
Term
| Urine output following transplant may be as high as ___/hr. Fluid replacement should be ____ urine output. Sudden ______ in urine output warrants concern. Average length of stay in hospital is ___ days. ____ ____ may have a delayed function. |
|
Definition
1/L hr.
Fluid replacement should equal output.
Sudden decrease in urine output warrens concern |
|
|
Term
| Immunosuppressive agents given to prevent rejection |
|
Definition
| Cyclosporine, cellcept, antithymocote globulin |
|
|
Term
| The most common complications following transplant occurs during the _____ phase, __ days to ___months after surgery. S/S are increased ___ and ___, high __, fever, weight ___, ____ urine output, tenderness over ___ ____. These episodes can be _____ with additional _______ _______. |
|
Definition
Acute phase 4 days to 4 months
s/S increased BUN and Cr, BP, fever, weight gain, decreased UO, tenderness over transplanted kidney. Episodes can be reversed with additional immunosuppressive therapy. |
|
|
Term
| ____ rejection occurs over months to years after a kidneys transplant. The prognosis is poor. |
|
Definition
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|
