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Kidney - CCRN
CCRN review course
81
Nursing
Professional
04/09/2018

Additional Nursing Flashcards

 


 

Cards

Term
Approximately ___% of cardiac output goes to the kidneys?
Definition
20%
Term
If you decrease the blood flow to the kidneys they will...
Definition
conserve Na+ and H2O
Term
Main Kidney functions
Definition
1. Filtration
2. Reabsorption
3. Secretion
4. Acid/Base balance
5. BP regulation
6. Erythropoietin
Term
What is the Glomerulus?
Definition
Network of capillaries that filters blood
Term
What is the main function of the proximal convoluted tubule?
Definition
To reabsorb H2O, Na, amino acids and glucose
Term
What is the main function of the Loop of Henle?
Definition
Reabsorbs Na, water and concentrates urine
Term
What is the main function of the Distal Convoluted Tubule?
Definition
It is the fine tuner

Regulates pH, K, Na, and Ca
Term
Primary job of the Collecting duct?
Definition
Collects urine from the nephrons
Term
Purpose of Aldosterone?

If you increase ___ it triggers release of Aldosterone.
Definition
1. Fluid balance

2. K+
Term
Renin Angiotensin Aldosterone System (RAAS) when activated....
Definition
Causes constriction. Kidneys hold onto Na and H2O
Term
Spironolactone
Definition
Aldosterone Antagonist
Term
Normal urine output
Definition
.5ml/kg/hr
Term
Anuria
Definition
less than 100ml/day
Term
Oliguria
Definition
100-400 ml/day
Term
Polyuria
Definition
more than 2500 ml/day
Term
What is Cr?
Definition
The breakdown of muscle

-has a 12 hour lag time
-Urine output is better indicator of injury
Term
Acute Kidney Injury
Definition
-abrupt decrease in glomerular filtration rate
-results in retention of metabolic waster
-causes increase in K, Mg, P, acidosis
-Decrease Ca
-fluid overload
Term
Causes of AKI
Definition
1. low perfusion
2. medications
3. parenchymal disease
4. sepsis
5. HF
6. trauma

*reversible if prompt treatment
Term
Protein and albumin in urine indicates...
Definition
Tubular damage
Term
Casts present in urine indicates
Definition
tubular cell death
Term
Normal Na in urine
Definition
40 mEq
Term
Most accurate way to estimate GFR is by assessing...
Definition
Cr Clearance
Term
Normal GFR
Definition
80-120 ml/min
Term
Post Renal AKI:

Causes
Examples
Definition
Caused by disruption of urine flow

Examples: urethral obstruction, prostatic disease, infection, neurogenic problems, stones
Term
Post Renal AKI Bun:Cr ratio
Definition
10:1
Term
Acute Tubular Necrosis (intrarenal injury)
Definition
Injury occurs at nephron
Causes structural damage
Term
Acute Tubular Necrosis (Intrarenal Injury) BUN:Cr Ration
Definition
10:1 both elevated
Term
Two types of acute tubular necrosis
Definition
1. Toxic ATN
2. Ischemic ATN
Term
Toxic ATN:

-caused by
-UA?
-Treatment
Definition
-caused by drugs of bacteria
-Recovery more rapid (less than 8 days)
-UA: cast present, protein and albumin
-Tx: take away cause and hydrate

*reversible
Term
Ischemic ATN
Definition
-irregular damage along tubular membranes
-tubular cell death and cast formation
-no perfusion to kidneys
-recovery long (greater than 8 days)
Term
Three phases of ATN:
Definition
1. Oliguric
2. Diuretic
3. Recovery
Term
Oliguric phase of ATN
Definition
-inability of excrete fluids and metabolic wastes
-sig. increase in BUN and Cr
-fluid overload, acidosis
-electrolyte imbalance
-Urine Na < 10 b/c conserving Na
-Urine specific gravity > 1.1010
-often requires dialysis
Term
General Treatment Goals for AKI
Definition
-hemodynamic stability
-improve renal perfusion
-correct chemistry
-electrolyte imbalances
-adequate hydration
Term
Monitor drug levels in what drugs?
Definition
Vanco
Gentamycin
Digoxin
Dilantin
Term
Chronic Kidney Disease:

What is it?
GFR
Definition
Slow progression of deterioration of renal function

GFR < 60ml/min and/or albuminuria
Term
Lab findings for CKD
Definition
1. Anemia
2. Increase BUN, Cr, PO4
3. Decrease Ca, HCO3, protein

*spill a lot of albumin
Term
Main risk factors for CKD
Definition
Diabetes
Hypertension
Term
How is CKD staged?
Definition
GFR
Term
Dialysis Disequilibrium Syndrome
Definition
-can occur after dialysis
-LOC changes
-increase amount of BUN on one side of BBB than the other
-monitor, no active intervention
Term
Treatment of an air embolus
Definition
1. Turn patient on left side (isolates air embolism in R ventricle)
2. Trendelenburg position
3. 100% Fi02 (accelerates removal of nitrogen)
Term
When do we use CRRT instead of HD?
Definition
hemodynamic instability
Term
What would it mean if you saw blood in CRRT effluent (waste) bag and what would you do?
Definition
membrane rupture

stop treatment and disconnect circuit
Term
Complications of peritoneal dialysis
Definition
1. Peritonitis (glucose breads bacteria)
2. Hyperglycemia
3. Diaphragmatic pressure/Resp. complications
4. Pleural effusion - third spacing
5. Visceral herniation or perforation
Term
Contraindications of Peritoneal Dialysis
Definition
-recent abdominal surgery
-abdominal adhesions
-need for emergent dialysis
Term
Hypernatremia
Definition
>145 mEq/L
Term
Causes of Hypernatremia
Definition
1. dehydration
2. excess NaCl or NaHCO3
3. Hypertonic enteral feedings
Term
Treatment of hypernatremia
Definition
1. fluid hydration
2. free H2O
3. Diuretics
Term
Hyponatremia
Definition
Na < 136
Cl <98
Term
Causes of hyponatremia
Definition
1. NG tube suction
2. SIADH
3. Diarrhea
4. Intestinal surgery
5. Heart failure
6. diuretics
7. liver or renal disease
Term
Treatment of hyponatremia
Definition
***slow correction or could cause demyelination syndrome if correct to fast

1. Na+ Phos
2. Hypertonic Saline
3. Na+ tabs
Term
Diuretic Phase of ATN
Definition
-lasts 7-14 days
-UO 2-5L/day
-kidneys can often clear volume, but not solute or waste
-waste electrolytes (K,Na)
-Urine specific gravity < 1.010
-Urine Osmo < 350
-Urine Na > 20-40
Term
Contrast induced Nephropathy:

Treatment
Prevention
Definition
Treatment: hydration

Prevention: N - acetylcysteine
Term
Indications for Dialysis

AEIOU
Definition
A- Acid/base imbalance

E- electrolyte imbalance

I- Intoxication (ODs/toxins)

O- Overload (fluid)

U- uremic symptoms
Term
Lab profile associated with renal failure
Definition
- decrease Ca
- increase K
- increase Cr
Term
Pre Renal AKI:

What is it?
Examples?
Urine Na?
Definition
-injury occurs before blood reaches the kidney
-hypoperfusion
-no structural damage if reversed

Examples: sepsis, HR, trauma, hypovolemia

Urine Na < 10 mEq/L b/c kidneys conserve Na and H2O
Term
Pre-Renal AKI BUN:Cr Ratio
Definition
BUN:Cr ratio 25:1
Term
Normal Potassium
Definition
3.5 - 5.0 mEq/L
Term
Development of a "u" wave on the ECG indicates..

May also see ST segment depression
Definition
hypokalemia
Term
Hypokalemia
Definition
< 3.5 mEq/L
Term
Causes of Hypokalemia
Definition
1. increases loss (GI: vomiting, suctioning, diarrhea, fistula, ileostomy)
2. excessive urinary loss
3. Inadequate intake (anorexia, ETOH, mag depletion)
4. Intracellular shift (pH and K have inverse relationship, insulin)
Term
Tall peaked T waves can indicate...
Definition
hyperkalemia
Term
Hyperkalemia
Definition
> 5.5 mEq
Term
Causes of hyperkalemia
Definition
1. renal failure
2. acidosis (DKA)
3. decrease cardiac output
4. Elderly taking K+ sparing diuretics
5. Severe trauma and burns (muscle damage causes K to be released into serum)
6. infection
7. Addison's disease
8. Increased consumption of substitute table salt of antacids
Term
Hyperkalemia Symptoms:

K+ and Mg go together

Hint: If high- Mag drag
Definition
-N/V
-diarrhea
-tingling skin
-numbness in hands and feet
-flaccid paralysis
-cardiac signs
-apathy
-confusion
Term
Cardiac changes in Hyperkalemia
Definition
-tall tented P waves
-Widened QRS
-Prolonged PR
-Widened P wave
-P waves disappear, QRS merges with T to form Sine wave (Looks like monomorphic VT)
Term
Hyperkalemia Treatment

Move then remove
Definition
Emergency
1. Move potassium:
-Regular insulin
2. Calcium Gluconate: stabilizes action potential membrane but no effect of K levels)
3. NaHCO3
4. Nebulized Albuterol - speeds up Na/K pump

Remove K
-dialysis
-loop diuretics
-kayexalate
Term
What electrolyte is commonly deficient with chronic alcoholism and can lead to what dysrhythmia?
Definition
Magnesium, Torsades De Pointes
Term
Hypomagnesemia
Definition
<1.3 mEq/L
Term
Causes of hypomagnesemia
Definition
1. Increased excretion
-NG suctioning, diarrhea, fistulas
-diuretics
-osmotic diuresis
-antibiotics
-hypercalcemia
2. decreased intake
3. chronic alcoholism
4. malabsorption
5. acute pancreatitis
Term
Hypomagnesemia Symptoms:
Definition
-Prolonged QT
-PACs/PVCs
-hypotension
-Twitching, cramps, tremors
-mentation changes, seizures
-hypokalemia
Term
What happens if you correct Mg too quickly?
Definition
flushed and hypotensive because causes dilation
Term
Hypermagnesemia
Definition
> 2.5 mEq/L
Term
Hypermagnesemia: extremely rare

Patient pop.?
Clinical presentation?
Treatment?
Definition
Population: renal failure, OB patients, DKA

Clinical presentation: vasadilation, hypotensive, flushed, drowsy, lethargy

Treat: increase excretion, fluids and diuretics
Term
Hypocalcemia
Definition
< 8.5
Term
Hypocalcemia:

Follow which lab value?
Causes?
Definition
-Follow ionized (active) Ca++
-normal 1.1-1.35 mmol/L

-Causes: diarrhea, diuretics, malabsorption, chronic renal failure, alkalosis
Term
Ca++ and PO4 have an ____ relationship
Definition
inverse
Term
Ca++ and alkalosis
Definition
decreased calcium
Term
Ca++ and a acidosis
Definition
increased calcium
Term
Trousseau's sign
Definition
arm and hand muscles spasm

-Ca low
-PO4 high
Term
Chvostek's sign
Definition
facial twitch
Term
Electrolytes and acid/base
Definition
Acidosis- hyper

Alkalosis-hypo
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