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
|
|
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 |
|
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 |
|
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
|
Definition
| moist breath sounds, bounding pulse, dependent edema and dyspnea |
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Term
| dyrhthmias may be caused by |
|
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 _ |
|
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 |
|
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
|
|
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
|
|
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 |
|
Definition
|
|
Term
|
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 |
|
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 |
|
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
|
|
Term
| disadvantages for hemodialysis |
|
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 |
|
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 |
|
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
|
|
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
|
|
Term
| during dweel time fluid remains in the cavity for a specified period of time while _ occur |
|
Definition
| ultrafiltratin,osmosis and diffusion |
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|
Term
| allows the pt freedom form a machine and the independence to perform dialysis alone |
|
Definition
| continuous ambulatory peritoneal dialysis |
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|
Term
| the most seroius complication of peritoneal dialysis |
|
Definition
|
|
Term
| evidnce of infection r/t peritoneal dialysis |
|
Definition
| cloudiness, and particles in the fluid in the outflow ocntainer |
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|
Term
| other complications of peri dialysis |
|
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 |
|
Definition
| encapsulating sclerosing peritonitis |
|
|
Term
| cerebral edema and elevated metabolic wastes in the blood can cause |
|
Definition
| confusion, slwoed thought processes, lethargy and loss of consciousness |
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