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KIDNEY INJURY
Cooper/Burian/Pearson
Renal Physiology
Functions of the Kidney
Regulation of water/fluid balance
Regulation of electrolytes
Regulation of acid-base balance
Regulation of blood pressure
Excretion of metabolic waste products & drug
metabolites
Production of hormones
Assessment of Renal
Function
BUN (Blood Urea Nitrogen)
Creatinine
BUN: Creatinine Ratio Normal 10:1 to 20:1
GFR (Glomerular Filtration Ratio)
Urine Analysis
Urine Culture
Additional Signs of Kidney
Dysfunction
Low urine output
Fluid overload
SOB, Chest pain
Electrolyte imbalances
Azotemia (nitrogen in the blood)
Uremia (urine in blood)
Phases of Acute Renal Failure
3 Causes:
Post-renal
Pre-renal
Intra-renal
Acute Renal Failure (ARF)
Pre-renal Failure
Acute Chronic
Causes Causes
Phases Phases
Management Management
Concerns Concerns
Stages of Chronic Kidney
Disease
Electrolyte Imbalances &
Treatments
Severe Acidosis
Treatment?
Hypocalcemia
Treatment?
Hyperphosphatemia
Treatment?
Hyperkalemia
Treatment?
Effects of Hyperkalemia on
Electrocardiogram
Indications for Dialysis
AV Fistula
Vas Cath
AV Graft
Types of Dialysis
Hemodialysis
Fluid balance goal determined by nephrologist
Monitor VS and volume status during removal
Hold medications that may be cleared during dialysis
Draw labs, administer blood or EPOGEN (epoetin alfa)
CRRT
Maintain patency of the system, heparin or citrate
Determine hourly fluid needs and hourly filtration rate
Close monitoring of VS, hemodynamics and I/O, frequent labs
Monitor for bleeding, infection, issues with machine
CRRT
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Questions