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General info about acute renal failure (ARF)?
- Rapid decrease in renal function = accumulation of metabolic waste
- Caused by inadequate kidney perfusion
- Prerenal failure: something happened that had nothing to do with the kidney to cause it to fail, ie trauma or toxins introduced to body.
- Intrarenal failure: Stuff happening inside the kidney.
- Postrenal failure: Stuff happening below (after) the kidney to cause it to fail.
- Prognosis
- End-stage renal disease (ESRD)
- Reversible/pre-ARF level of renal function
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What is acute tubular necrosis? (ATN)
- THE one form of recoverable renal failure.
- Causes:
- poisons (NSAIDs)
- hypoperfusion (kidney shock)
- Early SnSs:
- oliguriea (3-7 days), hyperkalemia danger
- later:
- diuresis (up to 2 wks, 4Lt/day), potassium wasting
- Throughout: isosthenuria
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What are some complications associated with end stage renal disease (esrd)
- Progressive, irreversible kidney injury
- Azotemia:^BUN, Crt
- Uremia
- Uremic syndrome: Uremic "frost." Pasty flower on skin.
- Stages?
- Diminished renal reserve
- Renal insufficiency
- End-stage renal disease
- Decreased adrenal fxn-->^cortisol levels-->^BP.
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- Good idea to know this.
- Potassium = acid-->upset acid/base balance.
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What is the biggest problem with peritoneal dialysis?
- Infection. Pt education, education, education.
- Also, speed of infusion can effect pain/cramping.
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SnSs of peritonitis?
- pain, distention, and loss of bowel sounds.
- progressively sicker
- hurts to breath
- symptoms of shock
- pt preferes to lay on back with knees bent.
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Management of peritonitis?
- NPO
- I/O
- TPN fluids
- antibiotics
- NG suctioning
- Pain Rx
- semifowlers
- drains
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Major complications of peritonitis?
- hypovolemic shock
- sepsis
- abscess
- paralytic ileus
- multiple organ failure
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What are the dietary restrictions associated with chronic renal failure?
- Protein restriction
- Sodium restriction
- Potassium restriction
- Phosphorus restriction
- Vitamin supplementation
- Individualization of diet
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What kinds of Rx are used for kidney failure?
- Typical Crt. 28---> give erythropoetin-->^RBC count.
- Iron-->^RBCs (and constipation and black stools).
- Calcium + vit D to avoid demineralizing bones along with parathyroid hormones. Will draw vit D levels.
- Phos and phos binding agents, ie 6 tums with meals.
- Vit replacements, ie NephroVit to help skel muscle cramping.
- Benadryl (secreting toxins through skin)-->depressed personality.
- Antihypertensives.
- Folic acid to correct homocystine levels.
- Statins to correct cholesterol/triglycerides.
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What is EKD and AKI
- ESKD: End Stage Kidney Disease. Same as ESRD.
- AKI: Acute Kidney Injury. Early onset of kidney damage. May precede ATN.
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