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43 terms

Renal Failure

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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