Question:
Normal Urine output
Answer:
.5-1 mL/kg/hr
Question:
Pre causes of Acute Renal Failure
Answer:
decreased vascular volume, big surgeries, CABG, hemorrhage, burns, prolonged V/D,
excessive diuresis, CHF, MI, cardiac dysrhthmias, renal artery stenosis, septic shock,
anaphylaxis, decreased albumin, liver failure
Question:
What do we want to keep MAP at to keep up perfusion to the kidneys?
Answer:
60 or greater
Question:
What do we want to keep systolic BP at to keep up perfusion to the kidneys?
Answer:
greater than 90
Question:
What are intra causes of acute renal failure?
Answer:
sustained prerenal ischemia, glomerulonephritis, acute tubular necrosis, intravenous
contrast, aminoglycosides (gentamycin, tobramycin, vancomycin, NSAIDs, ACE
inhibitors)
Question:
What are post causes of acute renal failure?
Answer:
BPH, neoplasms or trauma, strictures, obstruction of collecting ducts with crystallization
,Question:
Factors for pre-renal ARF
Answer:
hypoperfusion (decreased systolic and decreased MAP)
Question:
Factors for intra-renal ARF
Answer:
tissue damage
Question:
Factors for post-renal ARF
Answer:
obstruction of urine flow (BUN a nd creatinine changes occur)
Question:
What antihypertensives are given to help with renal problems?
Answer:
ACE, ARB, Ca Cl blockers (in that order)
Question:
Phases of ARF
Answer:
initiation phase, oliguric phase, recovery phase
Question:
Initiation phase of ARF
Answer:
normal kidney response starts to deteriorate several hours to 2 days
Question:
Oliguric phase of ARF
Answer:
severe biochemical imbalances- hyperkalemia, increased BUN and creatinine, metabolic
acidosis, low Ca and high phosphate, anemia, urine output up to 400 mL/day
, Question:
What happens during the oliguric phase for nonoliguric ARF?
Answer:
normal UO, but retention of water
Question:
What happens during the recovery phase of ARF?
Answer:
renal tissue recovers and repairs itself 4-6 months, chemistries return to normal, may
have permanent damage (1-3% reduction in GFB)
Question:
Av fistula assessment
Answer:
check for bruit and thrill
Question:
Post-dialysis asssessment
Answer:
get a set of vitals and weight, monitor for complications (if temp greater than 99.6
suspect sepsis: anticipate blood cultures), assess for dysrhythmias, hypovolemia,
bleeding at access site, disequilibrium syndrome, hepatitis and other blood borne
pathogens, anemia secondary to ESRD and HD
Question:
Dialysis indications
Answer:
BUN >90mg/dl, serum creatinine >9 mg/dl, hyperkalemia, drug toxicity, fluid volume
excess, metabolic acidosis, uremia, mental changes (confusion, lethargy, somulence)
Question:
Peritoneal dialysis technique
Answer:
use sterile technique, there is a permanent catheter surgically placed into the peritoneal
space below the umbilicus, dextrose and fluid are usually warmed for comfort and to
prevent hypothermia