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What are the four phases of acute renal failure?

Onset, oliguric phase, diuretic phase, recovery phase

During the onset phase of acute renal failure, gradual accumulation of nitrogenous wastes such as _____ and ____ may be noted.

creatinine and BUN

How long does the onset phase of acute renal failure last?

hours to days, until oliguria develops

How long does the oliguric phase of acute renal failure last?

1-3 weeks

Oliguric phase of ARF is defined as?

urine output of 100-400 ml/24 hours

Oliguric phase of ARF does not respond to...

fluid challenge and administration of diuretics

Diuretic phase of ARF often has a _____ onset within ____ to _____ _____ after the oliguric phase.

sudden, 2-6 weeks

Later in the diuretic phase of ARF, ___ starts to fall and continues to fall until it reaches normal levels

BUN

During the recovery phase of ARF, complete recovery may take...

up to 12 months

When dehydration or renal hypoperfusion exist, the ____ level rises more rapidly than the ____ level

BUN, creatinine

ARF or chronic renal failure? onset is gradual, months to years

chronic renal failure

ARF or chronic renal failure? onset is sudden, hours to days

acute renal failure

ARF or chronic renal failure? percentage of nephron involvement about 50%

acute renal failure

ARF or chronic renal failure? percentage of nephron involvement about 90%-95%

chronic renal failure

ARF or chronic renal failure? duration 2-4 weeks, less than 3 months

acute renal failure

ARF or chronic renal failure? duration is permanent

chronic renal failure

ARF or chronic renal failure? prognosis is good for return of renal function with supportive care, high mortality rate in some cases

acute renal failure

ARF or chronic renal failure? prognosis is ultimately fatal without replacement therapy such as dialysis or transplant

chronic renal failure

What are some of the complications that may occur with dialysis?

hypotension, air embolism, access site infection, hypersensitivity, anemia, bleeding ,muscle cramping, and dialysis disequilibrium

The cause of dialysis disequilibrium syndrome is thought to be d/t...

rapid decrease in fluid volume and BUN during HD

In dialysis disequilibrium syndrome, the change in urea levels can cause...

cerebral edema and increased ICP

In dialysis disequilibrium syndrome, neurologic symptoms can result such as...

h/a, n/v, restlessness, decreased LOC, seizures, coma, and death

Early recognition of dialysis disequilibrium syndrome is crucial. Treatment with _______ may prevent a life-threatening situation

anticonvulsants

What is the major complication of peritoneal dialysis?

peritonitis

The most common cause of peritonitis is...

connection site contamination

In peritoneal dialysis, it may take patients ____ to ____ ____ to tolerate a full 2 liter exchange without leakage around the catheter site.

1-2 weeks

In peritoneal dialysis, leakage occurs more often in ____ or ____ patients, _____ adults, and those on long-term, ______ therapy.

obese or diabetic, older, steroid

______ is a common complication during the first few exchange after a new catheter insertion with peritoneal dialysis.

Bleeding

______ is common in patients undergoing long-term peritoneal dialysis suggesting that the therapy may accelerate atherogenesis

Hypertriglyceridemia

What are major causes of morbidity and mortality in patients undergoing PD and have diabetes and vascular disease?

Increase in BP and fluid volume leading to left ventricular hypertrophy and dyslipidemias

What is the goal of kidney transplant?

to bring the patient's metabolic status to as close to normal as possible

What must the patient be free from preop kidney transplant?

infection

Postop kidney transplant, the survival of the transplanted kidney depends on...

the ability to block the body's immunie response to the transplanted kidney

Postop kidney transplant, the use of _____ is limited because of the long-term side effects

corticosteroids

The postop kidney transplant patient will be requried to take some form of _____ therapy for the entire time that he or she has the transplanted kidney

immunosuppressive

After kidney transplant, the nurse will assess the pt for signs and symptoms of transplant rejection which are:

oliguria, edema, fever, increasing BP, weight gain, abnormal swelling or tenderness over transplanted kidney area

In patients receiving cyclosporine, the only sign of transplant rejection may be...

rise in serum creatinine

More than 20% rise in serum creatinine, post kidney transplant, is considered to be _____ ______

acute rejection

Clinical manifestations of infection in kidney transplant pt include

shaking chills, fever, rapid heart rate and respirations, increase or decrease in WBCs

When does a kidney from a living donor usually begin to function?

immediately after surgery

A kidney from a cadaver donor may undergo ___ ___ ___ and may not function for ____ to ____ ____

acute tubular necrosis, 2-3 weeks.

How often is the foley output monitored in kidney transplant pt?

every hour

What are 4 important factors in management of ARF?

dialysis, monitor electrolyte abnormalities, reduce medication dosages, limit dietary protein and potassium

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