4100 Exam 1 Study Guide
Unit 1: Complex Elimination (Renal)
Relevant Labs for Exam 1:
• Hemoglobin: Male: 14-18 Female: 12-16
• Hematocrit: Male: 42-52% Female: 37-47%
• Prothrombin Time (PT): 11-12.5 seconds
• INR: 0.9-1.2 seconds
• PTT: 20-30 seconds
• Bilirubin: 0.3-1 mg/dL
• Ammonia: 15-110 mcg/dL
• Albumin 3.5-5 g/dL
• Protein: 6.4-8.3 g/dL
• Amylase: 56-190 IU/L
• Lipase: 0-110 IU/L
• Alkaline Phosphatase (ALP): 30-120 IU/L
• Aspartate aminotransferase (AST): 0-35 IU/L
• Alanine aminotransferase (ALT): 4-36 IU/L
• Bicarbonate HCO3: 22-28 mEq/L
• BUN: 10-20 mg/dL
• Creatinine: Males: 0.6-1.2 Females: 0.5-1.1
End Stage Renal Failure CRRT
, • Indicated in acute or chronic kidney disease
ESR patients: for patients who are too unstable for
• Permanent dialysis requirement traditional hemodialysis
• Increase nitrogenous wastes → uremia and • This is b/c their BP is already low, and
will affect every system in the body and hemodialysis can cause a large BP
decrease function drop
• Uremia is a syndrome with anorexia, metallic • Mild hemodynamic effects
taste in the mouth and metabolic • All use hemofilter
abnormalities • CRRT in ICU; 1 to 1; 24 hr duration
• Uremia is a syndrome marked by elevated urea • Focus is toxins not necessarily fluid so no
in the blood associated w/ fluid, and metabolic drop really
abnormalities
• Can lead to peripheral neuropathy Continuous Venovenous Hemofiltration (CVVH)
peripheral arterial disease
• Vomiting and diarrhea make uremic state worse • No dialysate
Kidney functions: • Removes larger volumes of fluid via
• Regulation of inorganic ions convection Replacement fluid added
• Regulation of water balance and osmolality
• Excretion of nitrogenous wastes • Effective for removal of large molecules
• Excretion of foreign chemicals
• Regulation of pH and HCO3 Continuous Venovenous Hemodialysis (CVVHD)
• Glucogenesis
Etiology: • Dialysate
• Presence of HTN speeds progression ESRD (HTN
is #1 cause!) • Replacement fluid
• Nephrons are working overtime and after a
certain point the body cannot help and • Combines diffusion and convection for
uncontrolled HTN causes arteries around the solute removal
kidneys to narrow, weaken and harden →
damage (not able to deliver enough blood to
the kidney tissue)
Signs and Symptoms:
• Metabolic acidosis
• azotemia/uremia
• Fluid and electrolyte abnormalities (K+, Na,
Mg, Phosphorus, Bicarb, Ca)
• Low Ca and High Phosphorus
• Osteodystrophy r/t Ca and
Phosphorus imbalance
• Burning feet and restless leg syndrome
• Anemia r/t decreased erythropoietin
production shortened lifespan of RBS’s
• Neurologic: imbalance, altered mental status,
, seizures, tremors, slurred speech
• Integumentary: uremic frost, dry and flaky,
itchy, thin brittle nails, bronze skin, edematous
• Cardiovascular: K will increase HTN, chest
tightness, pericarditis, hypervolemic,
distended neck veins, periorbital edema,
pitting edema, pericardial tamponade,
pericarditis, imbalance ion electrolyte.
• Pulmonary: atelectasis, increase for infection
in the lungs.
• GI: Metallic taste in mouth and ammonia odor
of the breath
• Reproductive: imbalance hormones, irregular
periods, difficulty getting pregnant,
hormones can affect sperm count and ability
to have children, erectile dysfunction
• Musculoskeletal
Diagnosis:
• Decreased GFR - less than 15mL/min (normal is
90-120)
• Pt will have high potassium, always check
patient first before acting on lab result alone
• Low calcium and High phosphorus
Nursing Care:
• Fluid status: weigh every morning
• Nutrition, education, dietary restrictions
• No sodium
• Teach about what kind of fluids to drink,
ensure the RN is speaking in language the
patient will understand
• Do not have more than what you usually eat
on potassium foods
• Low potassium b/c patient is at risk for
hyperkalemia. Don’t eat milk, bananas, and
cantaloupe (high in K+)
• CRRT
• Emotional support
• Pts cannot digest Mg well, so Pepcid is good for
indigestion
• Maintain kidney function and homeostasis
• Regulate protein consumption and do not need
as much (protein becomes nitrogenous waste
in
, the body)
• Protein intake: 0.6-0.8 g/kg/day
• Fluid intake - how much u are having, and
how much are coming out
• High biological value proteins
• Complete proteins with amino acids (Ex: eggs,
non-high fat meats, certain dairy products)
• Dialysis
• Transplant
Common Meds:
• Ca and Phosphorus Binders - Ca acetate
(monitor for hypercalcemia)
• Inotropic Agents: Heart is wearing out from
the constant adjustment of renal issues so the
purpose of these meds to help the heart pump
stronger and harder
• Kayexalate (Remove potassium via the bowel)
• Cardiac glycosides (digoxin)
• Beta receptor agonist (dobutamine)
• Anticonvulsants - Benzodiazepine (diazepam)
and Hydantoin (phenytoin)
• Erythropoietin (Epoetin Alfa) doesn’t work right
away, overtime (2 to 6 weeks) (given IV or SubQ
3 times a week)
Geriatric Considerations:
• DM, HTN, chronic glomerulonephritis, interstitial
nephritis, and urinary tract obstruction can
cause ESRD S/S are often non-specific and can be
masked by symptoms of other diseases (heart
failure, dementia, etc.)
• Dialysis (HD and PD) is common treatment
• Transplant is less common due to
comorbidities; CAD, PVD, etc.
• Patients aged 65 and up are not likely to be
placed on transplant list
Unit 1: Complex Elimination (Renal)
Relevant Labs for Exam 1:
• Hemoglobin: Male: 14-18 Female: 12-16
• Hematocrit: Male: 42-52% Female: 37-47%
• Prothrombin Time (PT): 11-12.5 seconds
• INR: 0.9-1.2 seconds
• PTT: 20-30 seconds
• Bilirubin: 0.3-1 mg/dL
• Ammonia: 15-110 mcg/dL
• Albumin 3.5-5 g/dL
• Protein: 6.4-8.3 g/dL
• Amylase: 56-190 IU/L
• Lipase: 0-110 IU/L
• Alkaline Phosphatase (ALP): 30-120 IU/L
• Aspartate aminotransferase (AST): 0-35 IU/L
• Alanine aminotransferase (ALT): 4-36 IU/L
• Bicarbonate HCO3: 22-28 mEq/L
• BUN: 10-20 mg/dL
• Creatinine: Males: 0.6-1.2 Females: 0.5-1.1
End Stage Renal Failure CRRT
, • Indicated in acute or chronic kidney disease
ESR patients: for patients who are too unstable for
• Permanent dialysis requirement traditional hemodialysis
• Increase nitrogenous wastes → uremia and • This is b/c their BP is already low, and
will affect every system in the body and hemodialysis can cause a large BP
decrease function drop
• Uremia is a syndrome with anorexia, metallic • Mild hemodynamic effects
taste in the mouth and metabolic • All use hemofilter
abnormalities • CRRT in ICU; 1 to 1; 24 hr duration
• Uremia is a syndrome marked by elevated urea • Focus is toxins not necessarily fluid so no
in the blood associated w/ fluid, and metabolic drop really
abnormalities
• Can lead to peripheral neuropathy Continuous Venovenous Hemofiltration (CVVH)
peripheral arterial disease
• Vomiting and diarrhea make uremic state worse • No dialysate
Kidney functions: • Removes larger volumes of fluid via
• Regulation of inorganic ions convection Replacement fluid added
• Regulation of water balance and osmolality
• Excretion of nitrogenous wastes • Effective for removal of large molecules
• Excretion of foreign chemicals
• Regulation of pH and HCO3 Continuous Venovenous Hemodialysis (CVVHD)
• Glucogenesis
Etiology: • Dialysate
• Presence of HTN speeds progression ESRD (HTN
is #1 cause!) • Replacement fluid
• Nephrons are working overtime and after a
certain point the body cannot help and • Combines diffusion and convection for
uncontrolled HTN causes arteries around the solute removal
kidneys to narrow, weaken and harden →
damage (not able to deliver enough blood to
the kidney tissue)
Signs and Symptoms:
• Metabolic acidosis
• azotemia/uremia
• Fluid and electrolyte abnormalities (K+, Na,
Mg, Phosphorus, Bicarb, Ca)
• Low Ca and High Phosphorus
• Osteodystrophy r/t Ca and
Phosphorus imbalance
• Burning feet and restless leg syndrome
• Anemia r/t decreased erythropoietin
production shortened lifespan of RBS’s
• Neurologic: imbalance, altered mental status,
, seizures, tremors, slurred speech
• Integumentary: uremic frost, dry and flaky,
itchy, thin brittle nails, bronze skin, edematous
• Cardiovascular: K will increase HTN, chest
tightness, pericarditis, hypervolemic,
distended neck veins, periorbital edema,
pitting edema, pericardial tamponade,
pericarditis, imbalance ion electrolyte.
• Pulmonary: atelectasis, increase for infection
in the lungs.
• GI: Metallic taste in mouth and ammonia odor
of the breath
• Reproductive: imbalance hormones, irregular
periods, difficulty getting pregnant,
hormones can affect sperm count and ability
to have children, erectile dysfunction
• Musculoskeletal
Diagnosis:
• Decreased GFR - less than 15mL/min (normal is
90-120)
• Pt will have high potassium, always check
patient first before acting on lab result alone
• Low calcium and High phosphorus
Nursing Care:
• Fluid status: weigh every morning
• Nutrition, education, dietary restrictions
• No sodium
• Teach about what kind of fluids to drink,
ensure the RN is speaking in language the
patient will understand
• Do not have more than what you usually eat
on potassium foods
• Low potassium b/c patient is at risk for
hyperkalemia. Don’t eat milk, bananas, and
cantaloupe (high in K+)
• CRRT
• Emotional support
• Pts cannot digest Mg well, so Pepcid is good for
indigestion
• Maintain kidney function and homeostasis
• Regulate protein consumption and do not need
as much (protein becomes nitrogenous waste
in
, the body)
• Protein intake: 0.6-0.8 g/kg/day
• Fluid intake - how much u are having, and
how much are coming out
• High biological value proteins
• Complete proteins with amino acids (Ex: eggs,
non-high fat meats, certain dairy products)
• Dialysis
• Transplant
Common Meds:
• Ca and Phosphorus Binders - Ca acetate
(monitor for hypercalcemia)
• Inotropic Agents: Heart is wearing out from
the constant adjustment of renal issues so the
purpose of these meds to help the heart pump
stronger and harder
• Kayexalate (Remove potassium via the bowel)
• Cardiac glycosides (digoxin)
• Beta receptor agonist (dobutamine)
• Anticonvulsants - Benzodiazepine (diazepam)
and Hydantoin (phenytoin)
• Erythropoietin (Epoetin Alfa) doesn’t work right
away, overtime (2 to 6 weeks) (given IV or SubQ
3 times a week)
Geriatric Considerations:
• DM, HTN, chronic glomerulonephritis, interstitial
nephritis, and urinary tract obstruction can
cause ESRD S/S are often non-specific and can be
masked by symptoms of other diseases (heart
failure, dementia, etc.)
• Dialysis (HD and PD) is common treatment
• Transplant is less common due to
comorbidities; CAD, PVD, etc.
• Patients aged 65 and up are not likely to be
placed on transplant list
