CCRN - GU

The afferent arteriole ____________ increases flow to the glomerular capillaries, and the efferent arteriole _________ decreases flow from the glomerular capillaries.

Dilates

Constricts

What are some nephrotoxic substances?

ATBs

NSAIDs

ACEIs

Antineoplastics

Contrast media

Diuretics

BUN measures the amount of ___________ in the blood that comes from _____ in the liver. This is worsened by dehydration and shock.

Nitrogen

Urea

Serum creatinine is a better indicator of ______ than BUN.

GFR

Normal GFR is ______ mL/minute and is ______________ related to serum creatinine.

125

Inversely

_____________ can be an early indication of renal disease. Normoalbuminuria is less than ____ mg/day. Routinely assessing patients with diabetes for this is important in detecting early diabetic __________.

Proteinuria

30

Nephropathy

An extremely high CK is indicative of __________________.

Rhabdomyolysis

Clinical renal assessment

Flank pain: __________ _________

Bladder distension: ___________

U/S for kidney size; stones or retention

Possible infection

Obstruction

AKI is an increase in serum creatinine > ____ times the baseline within 7 days.

1.5

___________ failure is the most common type of ARF and seldom requires hemodialysis.

Prerenal

What are drugs that contribute to prerenal failure?

NSAIDs: block production of prostaglandins in the afferent arteriole —>constriction—>decrease blood flow into the glomerulus

ACEIs: prevents angiotensin II—>efferent arteriole stays dilated—>can’t maintain adequate glomeruli pressure

Contrast dyes

Who is most likely a candidate for dialysis?

A

E

I

O

U

Acidemia

Electrolyte disorders (hyperkalemia)

Intoxication (methanol, aspirin, lithium, theophylline)

Overload (HF)

Uremia (elevated BUN with mental status changes)

T/F: patients with prerenal kidney injury respond to lasix.

True

>40 mL/hr

Rationale: renal tubules and nephrons are structurally intact compared to intrarenal kidney injury

T/F: a wide BUN:SCr ratio (20-40:1) is usually associated with intrarenal failure.

False

Narrow ratio (10-15:1) is associated with intrarenal failure

Hypocalcemia <8.5

S/s: anxiety, irritability, ___________ around the mouth, laryngospasm, ___________ and __________ sign, torsades

Causes: pancreatitis, hyperkalemia, ______parathyroidism, hypoalbuminemia, ____ __ deficiency, chronic renal failure

Tx: IV fluids, calcium gluconate

Twitching, Chvostek’s, Trouseau’s

Hypo, Vit D

Hypercalcemia >10.5

S/s: lethargy, fatigue, AMS, decreased _____, abdominal pain, constipation, NV, muscle ________, kidney stones

Causes: renal disease, hypokalemia, hyperparathyroidism, prolonged ____________, malignancies

Tx: IV fluids, __________ decrease GI absorption of calcium, calcitonin

DTRs, weakness

Immobilization

Glucocorticoids

Hypokalemia <3.5

S/s: muscle ________, decreased reflexes, NV, paralytic _______, ___________ respirations, mental depression, VT/VF

Causes: diuretics, metabolic alkalosis, acute ____________, uncontrolled DM, excessive sweating, excessive __________

Tx: KCl, replace chloride, fix hypo__________

Weakness, ileus, shallow

Alcoholism, aldosterone

Magnesemia

Hyperkalemia >5

S/s: muscle weakness, nausea, diarrhea, ________ T waves, widened ____, bradycardia

Causes: RF, ______, crush injuries, excessive K intake, metabolic acidosis, __________ insufficiency

Tx: calcium chloride, correct acidosis, ___________, dialysis

Peaked, QRS

Burns, adrenocortical

Kayexalate

Hyponatremia <135

S/s: _______, fatigue, muscle cramps, weakness, lethargy, confusion, decreased ______, seizures, _____

Causes: HF, cirrhosis, excessive water, __________

Tx: water restriction, ____________, ___ saline if severe

Edema, DTRs, coma

SIADH

Diuretics, 3%

Hypernatremia >145

S/s: _______, tachycardia, _____ mucous membranes, obtunded, stupor

Causes: dehydration, diuresis, _____, _______, DI

Tx: slow correction with ____ NS, sodium restriction

Thirst, dry

DKA, HHNS

0.45

Hypomagnesemia <1.6

S/s: _________, ventricular arrhythmias, ________ resistance, agitation, confusion

Causes: chronic ________, vomiting, diarrhea, NG suction, DKA, HHS, __________ syndrome, malnutrition

Tx: magnesium sulfate

Hyperreflexia, insulin

Alcoholism, nephrotic

Hypermagnesemia >2.2

S/s: __________ DTRs, respiratory depression, lethargy, coma, NV, flushing

Causes: RF, _______ abuse, ________ OD

Tx: _______, lasix, dialysis

Decreased

Mag-containing antacid, iatrogenic

Calcium

Are these electrolytes inversely or directly proportional?

Na and K: ___________

K and Mag: ___________

Ca and K: __________

Phos and Ca: ___________

Mag and Phos: ________

Inversely

Directly; low magnesium can make it hard to replace potassium

Inversely

Inversely

Inversely