Term
|
Definition
| Acute weight loss, loss of skin turgor, oligurea, concentrated urine, weak rapid pulse, capillary filling time prolonged, low CVP, hypotension, flattened neck veins, dizziness, weakness, thirst and confusion, rapid pulse, muscle cramps, sunken eyes |
|
|
Term
|
Definition
| Acute weight gain, peripheral edema and ascites, distended jugular veins, crackles, elevated CVP, shortness of breath, hypertension, bounding pulse and cough, increased respiratory rate |
|
|
Term
|
Definition
| Anorexia, nausea and vomiting, headache, lethargy, dizziness, confusion, muscle cramps and weakness, muscular twitching, seizures, papilledema, dry skin, increased pulse, decreased BP, weight gain, edema |
|
|
Term
|
Definition
| Thirst, elevated body temperature, swollen dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, focal or grand mal seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, increased pulse and BP |
|
|
Term
|
Definition
| Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, decreased BP, ileus, abdominal distention, hypoactive reflexes, |
|
|
Term
|
Definition
| Muscle weakness, tachycardia ---> bradycardia, dysrhythmias, flaccid paralysis, paresthesias, intestinal colic, cramps, abdominal distention, irritability, anxiety |
|
|
Term
|
Definition
| Numbness, tingling of fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, decreased BP, |
|
|
Term
|
Definition
| Muscular weakness, constipation, anorexia, nausea and vomiting, polyuria and polydipsia, dehydration, hypoactive deep tendon reflexes, lethargy, deep bone pain, pathologic fractures, flank pain, calcium stones, hypertension |
|
|
Term
|
Definition
| Neuromuscular irritability, positive Trousseau's and Chvostek's signs, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, and increased BP |
|
|
Term
|
Definition
| Flushing, hypotension, muscle weakness, drowsiness, hypoactive reflexes, depressed respirations, cardiac arrest and coma, diaphoresis |
|
|
Term
|
Definition
| Paresthesias, muscle weakness, bone pain and tenderness, chest pain, confusion, cardiomyopathy, respiratory failure, seizures, tissue hypoxia, and increased susceptibility to infection, nystagmus |
|
|
Term
|
Definition
| Tetany, tachycardia, anorexia, nausea and vomiting, muscle weakness, signs and symptoms of hypocalcemia; hyperactive reflexes, soft tissue calcifications in lungs, heart, kidneys, and cornea |
|
|
Term
|
Definition
| Agitation, irritability, tremors, muscle cramps, hyperactive deep tendon reflexes, hypertoncity, tetany, slow shallow respirations, seizures, dyrhythmias, coma |
|
|
Term
|
Definition
| Tachypnea, lethargy, weakness, deep rapid respirations, decline in cognitive status, decreased cardiac output, dyspnea, tachycardia, pitting edema, dysrhythmias, coma |
|
|
Term
|
Definition
| Sudden and rapid deterioration of kidney function that is sometimes reversible |
|
|
Term
|
Definition
| Total urine output less than 50 mL in 24 hours |
|
|
Term
|
Definition
| Type of vascular access for dialysis; created by surgically connecting an artery to a vein |
|
|
Term
|
Definition
| Type of surgically created vascular access for dialysis by which a piece of biologic,semibiologic, or synthetic graft material connects the patient's artery to a vein. |
|
|
Term
|
Definition
| Abnormal concentration of nitrogenous wastes in the blood |
|
|
Term
|
Definition
| Chronic progressive and irreversible diseases of the kidneys |
|
|
Term
|
Definition
| Solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis |
|
|
Term
|
Definition
| Movement of solutes (waste products) from an area of higher concentration to an area of lower concentration |
|
|
Term
|
Definition
| Term used to describe the drained fluid from a peritoneal dialysis exchange |
|
|
Term
|
Definition
| Final stage of renal failure that results in retention of uremic waste products and the need for renal replacement therapies |
|
|
Term
|
Definition
| Inflammation of the glomerular capillaries |
|
|
Term
|
Definition
| Type of renal failure with increased glomerular permeability and massive proteinuria |
|
|
Term
|
Definition
| Any substance, medication, or action that destroys kidney tissue |
|
|
Term
|
Definition
| Movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration |
|
|
Term
|
Definition
| An excess of urea and other nitrogenous wastes in the blood |
|
|
Term
|
Definition
•Proteins secreted by damaged kidney tubules
•Casts in the urine look like a cell but it is kinda oblong or funny shape cell in the urine, this will sometimes help to diagnose if it's glomerular nephritis or it it's a hereditary disease |
|
|
Term
| Chronic renal failure or ESRD (End Stage Renal Disease) |
|
Definition
| A progressive, irreversible deterioration in renal function, The body is unable to maintain metabolic and fluid and electrolyte balance resulting in uremia or azotemia |
|
|
Term
| CKD (Chronic Kidney Disease) |
|
Definition
| An umbrella term that describes kidney damage or a decrease in the glomerular filtration rage (GFR) for 3 or more months. CKD is associated with decreased quality of life, increased health care expenditures, and premature death. If left untreated CKD can result in ESRD and necessitate renal replacement therapy (dialysis or kidney transplant). |
|
|
Term
| What lab values will be elevated with renal failure? |
|
Definition
| Elevated serum creatinine levels indicate underlying kidney disease; as the creatinine level increases, symptoms of CKD begin. |
|
|
Term
|
Definition
| Anemia is caused because the kidney produces less erythropoietin |
|
|
Term
| Major functions of the kidney |
|
Definition
•Rid body of excess waste products
•Rid body of excess fluids
•Regulate fluid and chemicals in the body
•Regulate blood pressure
•Stimulates the production of RBC's
•Regulation of acid base balance
•Metabolism of Vit D
•Synthesis of prostaglandin |
|
|
Term
|
Definition
•Diabetes mellitus (leading cause)
•Hypertension
•Chronic glomerulonephritis
•Pyelonephritis
•Obstruction of the urinary tract
•Hereditary disorders (polycystic kidney disease and Alports syndrome)
•Vascular disorders
•Infections
•Medications
•Toxic agents
•Environmental and occupational agents |
|
|
Term
| The rate of decline in renal function and progression of disease is related to what? (In CRF) |
|
Definition
| Underlying disorder, urinary excretion of protein, and presence of hypertension |
|
|
Term
| CRF progresses faster in patients with what? |
|
Definition
| The disease tends to progress more rapidly in patients who excrete significant amounts of protein or have elevated blood pressure than in those without these conditions. |
|
|
Term
|
Definition
•As renal function declines, end products of protein metabolism accumulate in the blood
•Uremia develops affecting body systems
•The greater the build op of waste products the greater the symptoms |
|
|
Term
| What are the three stages of chronic renal disease |
|
Definition
•Reduced renal reserve- 40-75% loss of nephron function
•Renal insufficiency- occurs when 75-90% of nephron function is lost
•End stage renal disease (ESRD)- the final stage of CRF, occurs when there is less then 10% nephron function remaining |
|
|
Term
| S/S of Uremia (A clinical manifestation of ESRD) |
|
Definition
•Swelling of hands and face
•Fatigue
•Nausea and vomiting
•Loss of appetite
•Headache
•Blurred vision
•Pruritus
•Shortness of breath |
|
|
Term
|
Definition
|
|
Term
| Neurological symptoms with clinical manifestations of CRF |
|
Definition
•Weakness and fatigue
•Confusion and inability to concentrate
•Disorientation
•Twitching and tremors
•Seizures
•Restlessness of legs
•Burning of soles of feet
•Behavior changes |
|
|
Term
| Cardiovascular symptoms in clinical manifestations of CRF |
|
Definition
•Hypertension
•Pitting edema
•Periorbital edema
•Pericardial friction rub
•Engorged neck veins
•Pericarditis
•Pericardial effusion
•Pericardial tamponade
•Hyperkalemia
•Hyperlipidemia |
|
|
Term
| Pulmonary symptoms in clinical manifestations of CRF |
|
Definition
•Crackles
•Thick, tenacious sputum
•Pleuritic pain
•Shortness of breath
•Tachypnea
•Kussmal type respirations
•Uremic pneumonitis (Uremic lung)
•Pulmonary edema |
|
|
Term
| GI symptoms in clinical manifestations of CRF |
|
Definition
•Ammonia odor to breath (Uremic fetor)
•Metallic taste in mouth
•Mouth ulcerations and bleeding
•Nausea, vomiting, and anorexia
•Hiccups
•Constipation or diarrhea
•Gastrointestinal bleeding |
|
|
Term
| Hematological Symptoms in clinical manifestations of CRF |
|
Definition
|
|
Term
| Reproductive symptoms in clinical manifestations of CRF |
|
Definition
•Amenorrhea
•Testicular atrophy
•Infertility
•Decreased libido |
|
|
Term
| Musculoskeletal symptoms in clinical manifestations of CRF |
|
Definition
•Muscle cramps
•Loss of muscle strength
•Renal osteodystrophy
•Bone pain
•Bone fractures
•Foot drop
•Carpal tunnel syndrome |
|
|
Term
| Integumentary symptoms in clinical manifestations of CRF |
|
Definition
•Changes in skin color
•Dry, flaky skin
•Pruritus
•Uremic frost
•Ecchymosis
•Purpura
•Thin, brittle nails
•Coarse, thinning hair |
|
|
Term
|
Definition
•24 hour urine for creatinine clearance
•BUN
•Creatinine |
|
|
Term
| What will be elevated in Azotemia |
|
Definition
| Elevation of both BUN and Cr |
|
|
Term
| Non-renal reasons for BUN to be elevated |
|
Definition
•Increased protein intake
•Corticosteroids
•Dehydration
•Blood in the GI tract
•Fever
•Starvation and catabolism |
|
|
Term
| Environmental and Occupational agents that can contribute to ESRD |
|
Definition
| Lead, cadmium, mercury, and chromium |
|
|
Term
|
Definition
| Patient usually does not have symptoms because the remaining nephrons are able to carry out the normal functions of the kidney. No symptoms at this point |
|
|
Term
|
Definition
| Serum creatinine and blood urea nitrogen rise, the kidney loses its ability to concentrate urine and anemia develops. Patient may report polyuria and nocturia. |
|
|
Term
|
Definition
| All of the normal regulatory, excretory, and hormonal functions of the kidney are severely impaired. ESRD is evidenced by elevated creatinine and blood urea nitrogen levels as well as electrolyte imbalances. Once patient reaches this point the patient will show S/S of uremia and dialysis is usually indicates. Many of the symptoms of uremia are reversible with dialysis. |
|
|
Term
| Urinalysis studies for assessment and diagnostic findings |
|
Definition
•24 hour urine for creatinine clearance
•Protein
•Urea, albumin, Na, Cl, K
•RBC's
•Casts |
|
|
Term
| When is acute dialysis needed |
|
Definition
| With high and increasing levels of serum potassium, fluid overload, impending pulmonary edema, or increasing acidosis |
|
|
Term
| What is the treatment for metabolic acidosis in a CRF patient |
|
Definition
| No treatment, In a CRF patient there are usually no symptoms and so therefor no treatment is needed |
|
|
Term
| Assessment and diagnostic findings during sodium and water retention in patient with ESRD |
|
Definition
•The kidney cannot concentrate or dilute urine normally
•Appropriate responses by the kidney to changes in daily intake of water and electrolytes do not occur
•In some patients retention of sodium and water result in: edema, heart failure, hypertension
•Some patients may have a tendency to lose salt resulting in: hypotension and hypovolemia |
|
|
Term
| What causes metabolic acidosis in pt's with ESRD |
|
Definition
•Metabolic acidosis occurs because the kidney cannot excrete increased loads of acid
•Decrease acid secretion primarily results from inability of the kidney tubule to excrete ammonia and to reabsorb sodium bicarbonate |
|
|
Term
| What are the causes of Anemia in pt's with ESRD |
|
Definition
•Inadequate production of erythropoietin
•Shortened life span of RBC's
•Nutritional deficiencies
•High risk for bleeding |
|
|
Term
| S/S of profound anemia in pt's with ESRD |
|
Definition
•Fatigue
•SOB
•Angina
•H&H values |
|
|
Term
| What electrolyte imbalances are common in pt with ESRD |
|
Definition
•Hyperphosphatemia and Hypocalcemia (Remember that serum calcium and phosphate levels have a reciprocal relationship in the body: as one rises the other decreases)
•Also watch Potassium and Sodium level's as they will change as well
•Hyperkalemia due to decrease excretion, metabolic acidosis, catabolism, and excessive intake (diet, medications, fluids)
•If pt is renal and codes then be sure to check most recent K levels because the reason that the pt coded could be that they are hyperkalemic |
|
|
Term
| How would Hyperphosphatemia and hypocalcemia be treated in a pt with ESRD |
|
Definition
| Hyperphosphatemia and hypocalcemia are treated with aluminum based antacids that bind dietary phosphorus in the GI tract. Also binds dietary phosphorus in the intestinal tract and permits use of smaller doses of antacids. Must be administered with food to be effective |
|
|
Term
| Which type of medications need to be withheld during dialysis?? |
|
Definition
| Water soluble medications need to be held as these will be removed from the blood during dialysis so the patient will not benefit from these so hold prior to dialysis |
|
|
Term
| What type of things will be held or increased in patient with ESRD (Nutritional therapy) |
|
Definition
Restrict:
•Protein
•Sodium
•Potassium
•Phosphorous
•Fluids (500 to 600 ml more than the previous day's 24 hour output)
Increase:
•Calories (unless diabetic)
(60 gram protein, 2 gram sodium, 3 gram potassium, low phosphorus, 2000 calorie diet) |
|
|
Term
| Conditions that patients with CRF will always have |
|
Definition
•Anemia, because the kidney's are responsible for production of RBC's and when the kidney's fail production goes down
•Hypocalcemia because the synthesis of vitamin D is impaired |
|
|
Term
| What are the two things that cause CRF that are hereditary |
|
Definition
Polycystic kidney disease and Alports syndrome
These are the only two causes that have been proven to be hereditary |
|
|
Term
| What are the common traits and views about Alports syndrome |
|
Definition
| Patients with Alports syndrome are hearing impaired, the connection is that the kidney's and the ears develop at the same time in utero and for some reason they both stop developing at the same time |
|
|
Term
| What is a common sickness that can lead to kidney failure |
|
Definition
| Strep, This is the most common infection that can lead to kidney disease, if a pt has strep all the time and it is not treated or the antibiotics are not completed so it is not gone completely then it can spread to the kidney's and destroy them |
|
|
Term
| What is the highest priority when you have a patient with renal failure |
|
Definition
| Finding the cause, when the cause if found then you can treat that and slow the progression |
|
|
Term
| Lab value to qualify as thrombocytopenia |
|
Definition
| Platelet count less than 100,000 qualifies as thrombocytopenia, if count is around 20,000 this is a major risk, bleeding out is a major risk as well |
|
|
Term
| What causes carpal tunnel in a patient with CRF |
|
Definition
| Carpal tunnel from build up of amyloid, a paraprotein deposition around the medial nerve causing compression |
|
|
Term
| What are ecchymosis and purpura |
|
Definition
| Bleeding in the skin (kinda of like petechia only bigger) |
|
|
Term
|
Definition
|
|
Term
| What is one of the most important things to remember with a 24 hour urine |
|
Definition
| Discard the first void and collect from that point forward for 24 hours, keep the collection on ice, if pt has a Foley then keep Foley bad on ice |
|
|
Term
| BUN/Cr ratio in a patient with CRF |
|
Definition
| The BUN/Cr ratio will usually be normal in a patient with CRF because both lab values will be elevated and they usually elevate at about the same rate so the ratio will stay normal as both levels rise. Look at levels though because even though the ratio is normal the levels will be elevated |
|
|
Term
| Common tests done to determine cause for renal failure |
|
Definition
| IVP (Intravenous Pilogram: The pt will have a contrast or dye injected into the IV and this will help to look at the size and shape of the kidney and also look at the veins and arteries to see if there is an issue such as the blood not perfusion as well on once side or the other and also to see if one kidney is smaller than the other), CT, Renal angiography, Renal scanning, Renal biopsy (assess for bleeding) |
|
|
Term
| The three steps to hemodialysis |
|
Definition
•Diffusion- movement of particles
•Osmosis- movement of water
•Ultrafiltration- removal of fluid by applying negative pressure on dialysate compartment |
|
|
Term
|
Definition
| Clearance is the removal of waste products from the blood in a given unit of time |
|
|
Term
| What is the most important additive in dialysate? |
|
Definition
| Glucose- it is important because it is what causes increased osmotic pressure |
|
|
Term
| What are things you need to watch for if a patient has a fistula for dialysis |
|
Definition
| Should be able to feel the blood flowing when you touch it, can use stethescope to hear the blood flowing, make sure that it is not clotted off because patient will need to go back to surgery if this happens, also need to watch and make sure that it does not become dislodged, Infection is also a risk so keep area clean to prevent infection, teach patient not to sleep or lay on the side that has the fistula and also no needle sticks or BP are to be taken on that arm |
|
|
Term
| What are some possible complications during dialysis |
|
Definition
| Hypertension, cramps, bleeding/clotting, dialyzer reaction, hemolysis, dysrhythmias, infections |
|
|
Term
| What is the cause of hypertension during dialysis |
|
Definition
| With dialysis blood is being pulled out of the patient to be cleaned so the blood volume goes down so the heart is having to work harder |
|
|
Term
| What is the cause of hypertension during dialysis |
|
Definition
| With dialysis blood is being pulled out of the patient to be cleaned so the blood volume goes down so the heart is having to work harder |
|
|
Term
| What are some possible complications during dialysis |
|
Definition
•Hypertension
•Cramps
•Bleeding/Clotting
•Dialyzer reaction
•Hemolysis
•Dysrhythmias
•Infections
•Hypoxemia
•Vascular access dysfunction
•Disequilibrium syndrome
•Pyrogen reactions
•Technical mishaps- incorrect dialysate mixture, contaminated dialysate, or air embolism |
|
|
Term
| S/S of disequilibrium syndrome and what causes it |
|
Definition
| Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include headache, nausea, vomiting, restlessness, decreased level of consciousness, and seizures. It is more likely to occur in ate renal failure or when blood urea nitrogen levels are very high (exceeding 150 mg/dL) |
|
|
Term
| The three steps in Peritoneal dialysis |
|
Definition
•Inflow
•Dwell time
•Outflow |
|
|
Term
|
Definition
|
|
