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Acute and Chronic Renal Disease
Trinity College of Nursing Powerpoint Notes
Terms in this set (58)
What is a normal BUN level?
What is a normal creatinine level
What is urea nitrogen?
BUN - the end product of protein metabolism.
What is serum creatinine?
creatinine: nitrogen waste product of muscle metabolism.
What does it mean when the BUN is elevated, but creatinine is normal?
What is the purpose of the kidneys?
urinary elimination, maintaining proper fluid volume, blood pressure, electrolytes, vitamin D activation, wastes and acid-base balance.
What body systems does chronic renal failure affect?
All body systems.
urine output of less than 400 mL per day.
urine output of less than 100 mL per day.
What is a normal specific gravity level?
What is acute renal failure? (ARF)
sudden decrease or cessation of renal function
What is chronic renal failure? (CRF)
a progressive destruction of renal structures over time
What is end stage renal disease? (ESRD)
kidneys permanently fail and their function must be taken over by dialysis or transplant - kidneys are often shrunken and filled with scar tissue.
What is the onset of acute renal failure?
sudden (hours to days)
What is the onset of chronic kidney disease?
gradual (months to years)
What is the percentage of nephrons involved in acute renal failure?
What is the percentage of nephrons involved in chronic kidney disease?
What is the duration of acute renal failure?
2-4 weeks; less than 3 months.
What is the duration of chronic kidney disease?
What is the prognosis for acute renal failure?
good for return of renal function with supportive care; high mortality in some situations.
what is the prognosis for chronic kidney disease?
fatal without replacement therapy such as dialysis or transplantation.
What is the most common cause of ARF?
What are common causes of ARF?
uncontrolled diabetes, hypertension, glumerial nephritis.
What are the types of acute renal failure?
prerenal failure, intrarental/intrinisic renal failure, postrenal failure.
What is prerenal failure?
A type of acute renal failure caused by reduced blood flow to the kidneys.
what is intrarenal/intrinsic renal failure?
A type of acute renal failure caused by damage to the glomeruli, interstitial tissue, or tubules.
What is postrenal failure?
A type of acute renal failure caused by an obstruction of urine flow.
What is the most common sign of acute renal failure?
decreased urine output.
What are common conditions associated with prerenal acute renal failure?
sepsis, heart failure, dehydration, hemorrhage, shock, pulmonary embolism, cardiac tamponade, use of diuretics, anaphylaxis.
What are common conditions associated with intrarenal failure?
acute intersitial nephritis, exposure to nephrotoxins, acute glomerular nephritis, vasculitis, acute tubular necrosis, renal artery or vein stenosis, renal artery or vein thrombosis, formation of crystals or precipitates in the nephron tubules.
What are conditions which may cause postrenal acute renal failure?
ureter/bladder/urethral cancer, kidney/ureter/bladder stones, bladder atony, prostatic hyperplasia or cancer, urethral stricture, cervical cancer.
the retention and build-up of nitrogenous wastes in the blood.
What are the phases of acute renal failure?
onset phase, oliguric phase, diuretic phase, recovery phase.
Describe the onset phase of acute renal failure.
Begins with the precipitating event and continues until oliguria develops.
How long goes the onset phase of acute renal failure last?
Describe the oliguric phase of acute renal failure.
Urine output of 100-400mL/24hr that does not change in response to fluid challenges or diuretics.
How long does the oliguric phase of acute renal failure last?
Describe the diuretic phase of acute renal failure.
Often has a sudden onset within 2-6 weeks after oliguric stage. Urine flow increases rapidly over a period of several days. Diuresis can occur of up at 10L per day.
Describe the recovery phase of acute renal failure.
The patient begins to return to normal levels of activity.
How long does the recovery phase of acute renal failure last?
Up to 12 months.
What characteristics are common during the onset phase of acute renal failure?
gradual accumulation of nitrgenous wastes (serum creatinine and BUN).
What characteristics are common during the oliguric phase of acute renal failure?
increasing serum and BUN levels. hyperkalemia, bicarb deficit (metabolic acidosis), hyperphosphatemia, hypocalcemia, hypermagnesiua. Sodium retention occurs.
What characteristics are common during the diuretic phase of acute renal failure?
electolyte loss. later in the phase, BUN levels fall and contine tu fall until normal. Renal tubular function is reestablished.
What are common characteristics associated with the recovery phase of acute renal failure?
the patient functions at a lower stamina level than before the illness. Residual renal insufficiency may be noted through regular monitoring of renal function. Renal function may never go back to pre-illness levels.
What are symptoms associated with the oliguric phase of acute renal failure?
peripheral or pulmonary edema, CHF, hypertension, Kussmaul respirations, EKG changes, nausea and vomitting, drowsiness, confusion, coma.
What nursing interventions are important during the diuretic phase of acute renal failure?
daily weights, I&0, labs 2x daily, monitor electrolytes, watch for signs and symptoms of tachycardia and postural hypotension.
What type of food is important to limit in a patient with acute renal failure?
proteins -- which limited metabolic wastes.
Will a patient be high or low in potassium with acute renal failure?
Will a patient be high or low in calcium with acute renal failure.
Should NSAIDS and nephrotoxic drugs be given together?
NO! They are fatal!
Will a patient suffering from acute renal failure by high or low in sodium?
hyponatremic due to extra fluid.
Define: uremia syndrome.
annorexic all the time, often nauseous and vomitting, chronic angina, SOB, insomnia, loss of labido, appear slightly ill.
What fluid intake is appropriate for a patient with acute renal failure?
Common causes of CRF.
Diabetes (leading cause), uncontrolled hypertension, chronic glomerulonephritis, pyelonephritis, polycystic kidney disease, obstruction of urinary tract, gout, drugs and toxins.
What will the lab values show for a patient who has CRF?
elevated BUN and creatinine all the time.
What is common in chronic renal failure due to reduced renal reserve?
high normal BUN and creatinine with an abscence of symptoms.
What are signs and symptoms of CRF due to renal insufficiency?
headaches, nocturia, polyuria, increased BUN and creatinine, GFR 25% of normal, mild anemia, weakness and fatigue.
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