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3 components of stroke volume - ANSpreload = blood volume afterload = resistance (how clamped or dilated the vessels are) contractility = Squeeze of the heart 4 phases of AKI - ANS- onset - oliguric - diuretic = indicates return of tubular function - recovery ACE inhibitors - ANS- initial dose can drop BP dramatically - subsequent double dosing shold not drop the BP significantly -- BP is not a good parameter for finding effective dose for HF patient acute kidney injury - ANS- decreased kidney function within 48 hrs - UO 0.5 ml/kg/hr for 6 to 12 hrs ADH (antidiuretic hormone) - ANS- water retainer - vasoconstrictor (also called Vasopressin) - produced by hypothalamus - store and released from posterior pituitary ADH pathway - ANS- hypothalamus senses low blood volumed and increased serum osmolality - signal pituitary to release ADH - ADH causes kidney to retain water - water retention increases blood volume and decreases serum osmolality ANP (atrial natriuretic peptide) - ANS- cardiac hormone stored in atria - released when atrial pressure increases *works opposite of RAAS by decreasing BP and reducing intravascular volume - important diagnostic marker in CHF assessment for postrenal failure - ANS- oliguric or anuric - fluid excess assessment for prerenal renal failure - ANS- oliguria - fluid deficit (hypotension, tachycardia, dry membranes, weak, change in LOC) AV fistula - ANS- listen for bruit - feel for thrill - requires 2 to 3 months to heal before using - lasts longest - fewest infections - fewest clotting problems AV graft - ANS- synthetic graft material that connects artery to vein - 4 to 8 weeks to heal - increased risk for clotting and infection best time for blood transfusion to dialysis pt - ANS- during dialysis blood - ANS- not a risk free fluid replacement - this is liquid transplant blood pressure pitfalls - ANS- insensitive sign of early shock - must compare to patient baseline - first BP should always be done manually *just because you have a BP does not

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