NRS 440 exam-Acute Renal Failure

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Author:
AKotwitz
ID:
77177
Filename:
NRS 440 exam-Acute Renal Failure
Updated:
2011-04-04 00:57:53
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ARF
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Description:
acute renal failure & dialysis
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  1. Initiating phase
    • -Begins at time of insult and continues until s+s become apparent. Progressive increase in BUN, Cr, K, with our without oliguria.
    • -Can last hours to days
  2. Oliguric Phase
    • Multiple organ systems-urinary, cardiac, resp, GI, heme, neuro, metabolic.
    • 10-14 days, up to months
    • Reduction in GFR
    • WATCH for pulm edema and ecg changes
  3. Diuretic phase
    • Begins with gradual increase in daily urine output.
    • Persistant s+s, symptoms gradually returning closer to regular function
    • 1-3 weeks
    • Monitor for hyponatremia, hypokalemia, and dehydration
  4. Recovery phase
    • Increase in GFR, causing BUN+Cr to eventually decrease
    • 1-2 weeks for major improvement and up to 12 months for renal function to stabalize
    • Some do NOT recover and go into chronic kidney disease :(
  5. Creatinine: value and relevance to impaired kidney function
    • N=0.5-1.5
    • HIGH bc kidneys filter creatinine through urine and when they are impaired, levels rise
  6. BUN: value and relevance to impaired kidney function
    • N=5-25
    • HIGH bc kidneys can't remove urea
  7. Potassium: value and relevance to impaired kidney function
    • N=3.5-5
    • HIGH bc kidneys can't remove excess K
  8. Calcium: value and relevance to impaired kidney function
    • N=8-10
    • LOW bc phosphate increases, which makes ca drop. Takes ca out of bones, and is lost even more
  9. Hgb & Hct: value and relevance to impaired kidney function
    • Hbg (N=12-18) Hct (N=35-45)
    • LOW bc decrease in kidney function=decrease in EPO=decrease RBC=decrease oxygen
  10. Metabolic acidosis ( LOW: ph, paco2, pa02, HCO3, o2) WHY?
    Functioning nephrons start to decrease, ammonium excretion also drops bc of drop in GFR-now there is not enough functioning nephrons. More common as you age (lose nephrons)
  11. Peritoneal Dialysis: principles involved
    • Catheter through abd wall, "exchanges"- inflow, dwell, drain.
    • Usually 4 exchanges a day at home, portable!
  12. Peritoneal Dialysis: advantages vs disadvantages
    • ADVANTAGES:
    • Heparin not needed
    • Less cardiovascular stress
    • Can be used at home
    • Fewer dietary restrictions
    • DISADVANTAGES:
    • prolonged immobility
    • Peritonitis
    • Dialysate leak
    • Respiratory compromise
    • Contraindicated after abd surgery
    • SLOW/ hyperglycemia
  13. Hemodialyis: principles involved
    • Obtain vascular access, very rapid blood flow required, & AV fistula/graft/shunt.
    • Dual-lumen catheter
    • Heparin required
    • Weekly exchange outpatient 3-4x week
  14. Hemodialysis: advantages vs disadvantages
    • ADVANTAGES:
    • quick & efficient
    • effective potassium removal
    • Can prolong life!
    • useful for OD's poisonings
    • DISADVANTAGES:
    • exchange rate 3-4hrs
    • cardio stress
    • does NOT remove phosphorus
    • access may clot
    • Heparin required
    • diet/fluid restrictions
    • Hypotension
    • Medications lost thru dialysis!

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