Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
N4117
Exam II Alterations in the Renal System
| Question | Answer |
|---|---|
| The kidney is very...? | Vascular |
| The entire blood volume in an individual is filtered by the kidneys how many times a day? | 60 to 70 times/day |
| Kidney filtration resultls in how many liters of filtrate in a day? | 180 liters |
| What will the kidney do with filtates? | Compress 180 liters of filtrates into 1 - 2 liters so it can be eliminated through urine. |
| Name the functions of the kidney? | Elimination of metabolic wastes. Blood pressure regulation. Erythrocyte (RBC) production. Vitamin D activation. Prostaglandin synthesis. Acid-base balance. |
| What is the better indicator of renal function | Creatinine level |
| Urea and Creatnine are what? | End product of protien metabolism |
| How is urea measured? | BUN |
| BUN results from breakdown of what? | Ammonia |
| What is normally filtered out completely by the kidney? | Ceatinine |
| Name the process through which the kidney break down filtrates fron 180 liters to 1-2 liters? | Glomerular Filtration. Tubular Resorption. Tubular Secretion. |
| The process of Glomerular Filtration, Tubular Resorption, Tubular Secretion, is also known as the process of what? | Urine formation. |
| Efferent arteriole | Exits the Bowman's capsule |
| Affrent arteriole | Enters the Bowman's capsule |
| Each kidneys contains how amny nepherons | Over a million |
| For kidney to perform its job of filtration, what must be present? | Positive pressure |
| If protien, RBC, or other large molecule is seen in the urine, what must be damaged? | Kidney basement membrane lining |
| 3 things needed by the glomerulus to do its job of filtration? | Good glomerular blood flow. Pressure in the Bowman space. Plasma oncotic pressure. |
| Why is it important to look at the workings of the kidney? | To know how a lot of the drugs we give works which works on different parts of the nepherons. |
| Increased pressure in Bowman's space will cause what? | Decreased glomerular filtration |
| What could cause too much pressure in the Bowman's capsule? | UTI, Cellular death which causes debris that buils up and create more pressure |
| What will prevent damage to the nepherons | Constant MAP Between 80 and 180 |
| If MAP is low, what happens in the nephrons? | Afferent arteriole will dilate to maintain Pressure. |
| Normal value for glomerular filtration? | 125 ml/min |
| Creatinine clearance < 90 ml/min is indicative of what? | Insufficient renal function |
| Creatinine clearance < 20 ml/min is indicative of what? | Renal failure |
| GFR is measure over what period | 24 hrs |
| What can lead to a low oncotic pressure | Low albumin |
| If MAP is high? | The Afferent arteriole will constrict to maintain pressure |
| Tubular resorption is the ...? | Movement of a substance from the tubular lumen to the peritubular capillaries. |
| Tubular resorption requires what kind of transport? | Active and passive |
| Passive transport requires what and uses what? | Diffusion and Osmosis but requires no effort or energy |
| Active transport reqiures what & uses what? | Requires energy and uses Adenosine triphosphate (ATP). Glucose, amino acids, calcium, potassium, sodium. |
| Explain threshold concentratiion? | A point where the kidney could no longer filter solutes. It will then spill out into urine. E.g., diabetics. |
| Explain tubular secretion? | The transport of substances into the tubules from the peritubular capillaries through Diffusion and Active transport |
| Tubular secretions depends on what? | Body needs |
| What role does tubular secretion play in uring formation? | Lesser role in changinf filtrates into urine |
| What are secreted into tubular secretions? | Potassium, hydrogen, drugs & drug metabolites to decrease their concentration in the body. |
| Kidney is alo involved in what? | Blood pressure regulation |
| In relation to B/P, Kidney failure is equal to what? | HTN |
| What does JGA stand for? | Juxtaglomerular Apparatus |
| Functions of the JGA? | Synthesizes, stores and releases renin |
| How does the Kidney regulate blood pressure? | It maintains circulating blood volume by ensuring Fluid balance via Renin-Angiotensin-Aldosterone System |
| More information on JGA? | Group of cells located around the afferent arteriole where the distal convulated tubule & efferent arteriole make contact. It provides feedback message system from the distal tubule to control blood flow through the afferent arteriole. |
| What does RAAS do? | A powerful vasoconstrictor, maintains circulating volume, increases vascular resistance to maintain hydrostatic pressure within the kidneys |
| Describe how RAAS work to blood pressure? | Low renal blood flow --> decreased pressure in glomerulus --> JGA releasing renin --> renin turn into angiotensin I & II --> aldosteron retains Na & H2O --> increased B/P -- increased renal blood flow -- JGA stop releasing renin. |
| Further describe how RAAS work to blood pressure? | Angiotensin II --> vasoconstricition --> increased vascular resistance --> increases B/P --> increases renal blood flow --> decrease renin |
| What other function of the kikneys? | Kidneys secrete erythopoietin for erythrocyte (RBC) production |
| Hormone that controle RBC production is where? | Bone marrow |
| How does kidney know when to secrete erythopoietin? | When it senses a decrease in the amount of O2 delivered. |
| In relation to blood, Kidney failure will equal what? | Anemia |
| Why are kidney patients anemic | Due to kidney failure, no longer producing erythopoietin. |
| What other function of kidney? | Vitamin D activation |
| How do kidney activate Vit. D? | By converting Vitamin D from food sources into an active form of use by the body. |
| What does active Vit. D do? | Stimulates the absorption of calcium by the intestine and resorption of calcium by the tubules so that calcium is available for use in teeth, bone, metabolism, blodd clottinf functions. |
| In relation to Vit. D, kidney failure is eqaul to what? | Bone disease |
| Prostaglandins PGE1 & PGI2 is what? | A vasoactive substance that dilates arteries, by increasing sodium and water excretion Stimulation of renin release |
| Prostaglandin works locally around where? | Nephrons |
| Prostaglandin PGF2 is what | Vasoconstricts arteries, Bronchoconstriction Vasoconstriction |
| Prostaglandin PGF2 is used in time of what? | Volume depletion. |
| Azotemia is? | An acute rise in the BUN level |
| Uremia is what? | An elevated rise in BUN value |
| In relation pH, the kidney is involved in what? | Acid base balance. |
| Explain how kidney regulates pH? | It Reabsorbs or excretes acids and bases in the kidney tubules. |
| How fast can the kidney resolve pH problem? | Cannot respond rapidly, takes 1 - 2 days to see effect. |
| What is the normal value for creatinine? | 0.9 |
| Fluid compatment: Intracellular has...? | 40% of total body weight |
| Fluid compatment: Extracellular has...? | 20% of total body weight |
| In extracellular: Intravascular has...? | 5% of total body weight |
| In extracellular: Interstitial has...? | 15% of total body weight |
| Percentage of total body weightd varies according to what? | Sex, age, and body fat content |
| How to calculate fluid balance based on body weight? | 0.5 ml/kg/hr |
| What is AKI | Acute Kidney Injury |
| The most common type of kidney disease is known as? | AKI |
| How is AKI defined? | An abrupt decline in the GFR with azotemia |
| GFR is closely related to what? | Creatinine |
| AKI results in what? | Inability to maintain electrolyte and acid base balance |
| Is AKI reversible? | Yes, Usually reversible |
| What does the acronym RIFLE stand for? | Risk. Injury. Failure. Loss. End stage kidney disease. |
| RIFLE is used for what? | To classify or describe level of renal injury |
| Define criteria for renal "Risk" | Increased creatinine x 1.5 or GFR decrease >25%, UOP < 0.5ml/kg/hr x 6hrs |
| AKI is classified by what? | Etiology |
| Define criteris for renal "injury"? | Increased creatinine x 2 or GFR decrease >50%, UOP <0.5ml/kg/hr x 12hrs |
| defines criteria for renal "failure"? | Increased creatinine x 3 or GFR decrease >75%, UOP < 0.3ml/kg/hr x 24hrs or anuria x 12hrs. |
| Define criteria for renal "Loss"? | Persistent ARF = complete loss of kidney functions > 4 weeks. |
| Define criteria for "ESKD"? | End Stage Kidney Disease (loss of function > 3 months) |
| Define prerenal? | A Decrease in renal blood flow. |
| Prerenal is about what? | Volume. be sure there is enough blood flow to the kidney |
| Prerenal etiology? | Decreased circulating volume secondary to dehydration, hypotension, decreased CO, embolism, sepsis. |
| Define Intrarenal? | Primary or Parenchymal damage. Its an Actual nephron damage with decreased glomerular filtration. |
| Intrarenal etiology | Due to disturbances within the glomerulus or renal tubules |
| Other causes of intrarenal? | Acute Glomerulonephritis, Acute Pyelonephritis, Acute Cortical Necrosis, Hypertension, Diabetes, Rhabdomyolysis, Nephrotoxic drugs. |
| Intrarenal is also called what? | Acute tubular necrosis (ATN) |
| Explain what is happening in intrarenal? | A condition that produces an eschemic or toxic insult @ the site of the nephrons |
| In prerenal, whats occuring? | Something is preventing blood flow to the kidney. Any condition that decreases blood flow, BP, or kidney perfussion BEFORE arterial blood reaches the renal artery that supplies the kidney. |
| Post renal is what? | Obstruction to urinary outflow from kidneys. |
| Post renal etiology? | Obstructions such as Stenosis, Renal Calculi, Prostate disease, Bladder Obstruction or Infection. |
| What do you do in post renal? | Palpate bladder to see if bladder full, irrigate foley |
| What do you do prerenal? | Monitor I&O, give fliud, |
| Normal value for BUN | 5 - 25 mg/dl. Not reliable indicator for kidney function. |
| ARF Assessment: Hemodynamics? | Monitor CVP, PAWP, CO, CI b/cos all values will be low (help guide fluid replacement), Increased BP |
| ARF Assessment: Cardiovascular? | Dysrhythmias, Edema, Weight. Electrolyte imbalance. weigh pt dly |
| ARF Assessment: Respiratory? | Increased RR, SOB, Kussmaul respirations (Metabolic Acidosis), pulmonary edema. It is trying to get rid og CO2 |
| ARF Assessment: Neuro? | Confusion, lethargy, decreased LOC (Increased BUN/Cr) |
| ARF Assessment: Integument? | Dry, pruritus, edema, bruising - painful swelling. |
| Normal creatinine value? | 0.5 - 1.5 mg/dl. A better indication for kidney function. |
| Causes of increased BUN | Hypovolemia/Hypotension; Nephrotoxic drugs; Too much protein in diet; Starvation (Poor nutrition in ICU patient); Infection; Surgery; Trauma. |
| BUN/Creatinine ratio of 10:1? | Suspect renal failure |
| Factors affecting creatinine clearance (GFR)? | Age(as person ages, decreased muscle mass & protein). Gender (more muscle mass in male than females). Race (More muscle mass in certain races). Weight or albumin level. Serum creatinine. |
| BUN/Creatinine ratio is to identify what? | Etiology |
| BUN/Creatinine ratio of 20:1 | Suspect extrarenal problem, Dehydration, catabolic state. |
| What is the purpose of looking at specific gravity? | To know amount of material in urine and compare it to water. The closer it is to 1.0, the more water it is - more dilute it is. |
| Normal specific gravity? | More water/dilute <--1.005 - 1.030--> more concentrated |
| Increased value of specific gravity indicate what? | Volume deficit, prerenal ARF (>1.020). Give fluid |
| Decreased value of specific gravity | Volume overload, intrarenal AKI. Restrict fluid. |
| Normal urine osmolality is ? | 50 - 1400 mOsm/kg |
| Increased osmolality value means? | Volume deficit. Dehydrated. Prerenal AKI (Urine > serum osmolality). Give fluid/volume. |
| Decreased osmolality value means? | Volume excess. Intrarenal AKI (urine < serum osmolality). Restrict fluid. |
| Urine osmolality more accurately pinpoints what? | Fluid balance |
| FENa (%) is what? | Fractional excretion of sodium |
| Decreased FENa of < 1% is indicative of what? | Suggests pre-renal problem. Give fluid. |
| Increased FENa > 2 - 3% is indicative of what? | Suggests intra-renal (Kidney damage) |
| Normal urine sodium? | 40-220 mEq/24hr |
| Decreased urin sodium values is indicative of what? | Prerenal AKI |
| Normal or Increased values of urine sodium indicates what? | Intrarenal AKI |
| What is hemodialysis? | Separating nitrogenous waists from blood. |
| Purpose of hemodialysis? | To replace kidney function that Remove excess fluid, electrolytes, and toxins from the blood. |
| What are the ndications of hemodialysis? | BUN > 90 mg/dl. Serum creatinine > 9 mg/dl. Hyperkalemia. Metabolic acidosis. Fluid overload (intravascular/extravascular). Uremia. Pericarditis. GI bleeding. Mental changes. |
| Hemodialysis contraindications? | Hemodynamic instability. Inability to coagulate. Lack of access. |
| Complications of hemodialysis? | Hypotension. Thrombus. Infection (very common & the biggest thing). Bleeding. Skin erosion. Vascular steal syndrome. Disequilibrium Syndrome. Hemodynamic Instability. Hepatitis. |
| What is a vascular steal syndrome? | Diversion of arterial blood during dialysis |
| What does vascular steal syndrome do? | Robs distal extremity of perfusion |
| S/S of vascular steal syndrome? | Cold. Pale. Painful. |
| Nursing intervention for pt with graft on the right arm? | No blood draw, no B/P taken, no puting of IV fluid on that arm. Only assess for patency by feeling the thrill & bruit. The arm is protected. |
| What to monitor durinf dialysis? | blood loss. air embolus. vascular access collapse. Hemodynamic instability. |
| Hemodialysis: Management goals? | Acute management: daily hemodialysis. Chronic management: 3 times/week. Maintain hemodynamic stability. Reduce BUN: should decrease at least 60% or to 30 mg/dl . Prevent infection. Maintain graft patency. |
| Hemodialysis: Nursing interventions? | Verify subclavian VAS cath access with x-ray. Monitor femoral access for excessive bleeding. Collaborate with Dialysis nurse and MD regarding medications to be held during procedure. Monitor s/s infection. |
| Further nursin intervention for hemodialysis? | Assess patency: Palpate thrill. Auscultate bruit. Ensure hemostasis following needle withdrawal. Apply firm pressure after needle withdrawn. Avoid taking BP or IV sticks in arm with fistula. |
| What is CRRT? | Continuous renal replacement therapy. This is different from dialysis because it is slower and continuous. |
| CRRT works by? | Diffusion. Convection. Absorption. Ultrafiltrate volume. Replacement fluid. |
| Indications for CRRT? | Hemodynamically unstable Pts. Large amount of volume removal is needed. Unresponsive to diuretic therapy. MODS. |
| Contraindications for CRRT? | Hct >45%. Why? Because this pt has a higher chances of clotting as the blood is removed. |
| Name types of CRRT in use? | SCUF, CVVH/CAVH, CVVHD/CAVHD, CVVHDF. The more letter, the more stuffs it does. |
| SCUF stands for what? | Slow continuous ultrafiltration |
| SCUF indications? | For fluid removal only. |
| CVVH/CAVH stands for what? | Continuous venovenous/veno-arterial hemofiltration. |
| CVVH/CAVH indications? | Fluid removal, moderate solute removal |
| CVVHD/CAVHD stand for what? | Continuous venovenous/venoarterial hemodialysis |
| CVVHD/CAVHD indications? | Fluid removal, maximum solute removal |
| SCUF is a treatment of choice for what kind of patients? | Acute heart failure, decreased renal perfusion, unresponsiveness to diuretics. |
| CVVHDF stands for what? | Continuous venovenous hemodiafiltration. |
| CVVHDF indications? | Maximum fluid removal, maximum solute removal. |
| Nursing Management of CRRT Complications? | Decreased ultrafiltration rate. Hypotension. Inadequate blood flow thru filter. Filter clotting. Fluid and electrolyte changes. Bleeding. Access dislodgement or infection. Dehydration. Acid-base abnormalities. Hypothermia. Hyperglycemia. |
| Kidney Transplantation indications? | Treatment for end stage renal disease. |
| Contraindications for Kidney Transplantation? | Active disease: Infections (HIV, TB). Glomerulonephritis. Social Drug user. Noncompliance with meds. Mental incompetence. Advanced cardiopulmonary Disease. cancer Malignancy. Positive T-cell lympho-cytotoxic crossmatch. |
| Kidney Transplantation Management Goals? | Maintain optimal renal perfusion. Elevated CVP and BP. Electrolyte balance. |
| Kidney Transplantation; Medical Management? | Posttransplant medical management and nursing care Fluid status. Electrolytes. Post-operative complications. Immunosuppression. Infection risk. Kidney graft non-function. Patient education. |
| Kidney Transplantation Nursing Interventions? | Monitor I and O. Daily weights. Monitor VS. Monitor hemodynamics. Assess for dehydration. Monitor for signs hemorrhage at operative sight (flank bruising). |
| Kidney Transplantation Infection surveillance? | Monitor increased temp, WBC, chills, Obtain cultures. |
| How should the nurse Prevent Organ Rejection? | Suppress T cell activity by using immuno-suppressive drugs. Begins at time of transplant, IV drugs. Continues with oral medications when patient can take PO. |
| Immunocompromised Pts are susceptible to what? | infection such as Candida, Epstein-Barr virus, Cytomegalovirus, herpes simplex |
| Name of the antirejection meds? | Cyclosporin - Inhibition of cytotoxic T cells. Corticosteroids - Steroids to reduce immune response. Azathioprine - Impairs antibody production Prevents activation and rapid proliferation of T cells. |
| Further Name of the antirejection meds? | Orthoclone - Monoclonial antibody Targets specific T cells Makes them less able to recognize foreign antigen. |
| PAtient teaching on Kidney transplant? | Self medication program in hospital. Medication side effects. Financial - Medication costs. Insurance will not continue to cover drug cost for life. |
| Teach Pts what about medication side effects | Incr. body hair, Acne, Mood Swings, Insomnia. Risk for Infection, Diabetes, Impaired wound healing. HTN, Wt. Gain, Moon Face. (Watch pt. may not take meds because of side effects). |
| Kidney Transplantation Rejection surveillance? | Tenderness at graft site. Decreased UOP. Sudden increase in weight. Edema. Tachycardia. HTN. Elevated temp. Elevated creatinine. |
| Hyperacute kidney rejection is within? | Thw first 48 hrs |
| Acute kidney rejection is within? | 1 week to 2 years |
| Chronic kidney rejection is? | Gradually over months to years. |
| Nursing Management for Rejection Surveillance? | Assist with obtaining tissue biopsies. Monitor organ function. Lab results (BUN/CR, Electrolytes K+, Ca++). Physiologic responses. |
| Kidney Transplantation Diet? | No protein restriction. Na restriction due to steroids. Low fat. Low cholesterol. |
Created by:
nze
Popular Nursing sets