Learning Guide for Acute Renal Failure/Vascular/Trauma
CMJ 2010
1.
What are the functions of the kidney? Name at least 6: (p. 1136-1139)
2.
The kidney regulates acid-base balance of HCO3 and ___(name the ion).
(p. 1138)
Explain why metabolic acidosis develops in renal failure. P. 1200, 1207
Why does Kussmaul breathing occur? P. 1200, 1207
What role do prostaglandins play in renal disease/hypertension? Why? P. 1139
What category of drugs inhibit prostaglandin synthesis (have antiinflammatory effect) and thus may effect renal function (even lead to renal
failure)? (p. 1139 & 1203)
Why are ACE Inhibitors sometimes contraindicated in renal failure? p. 1203,
1210.
3.
Where is erythropoietin produced? p 1139
What effect does ARF have on erythropoietin production? p. 1200
Why would Epogen/Procrit sc be ordered? (p. 1210) *Note-use generally for
CKD
What lab values (include all) do you expect to be altered? p. 1200
4.
Activated Vitamin D is necessary to absorb Calcium in GI tract. If a client has
ARF, what usual changes are seen in the client’s serum calcium level? Why does
this occur? P. 1200
6.
(Review) Key features of these disease processes:
Lewis pp. 1166-1169; 1176-1177
Disorder
Due to/Manifestation/Treatment
Acute Poststreptococcal
Glomerulonephritis
Goodpasture Syndrome
Chronic
Glomerulonephritis
Nephrotic Syndrome
Vascular Disorders of the Kidneys: What percentage of the cardiac output do the
kidneys receive? ________ p 1137
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7.
What are several risk factors for renal vein thrombosis (occlusion)? P.1175
What are some common manifestations/complications of renal vein occlusion?
8.
Renal artery stenosis: What is the most common manifestations/complication of
renal artery stenosis? P. 1175
9.
Renal trauma: p. 1175 Why is the H&H important when there is renal trauma?
(p. 1175/Notes)
Describe the usual management of renal trauma.
10. Renal surgery: Nephrectomy What should the urinary output be if client has a
bilateral nephrectomy? pp. 1188 & 1227
Why is TCDB & use of incentive spirometry important post-op? (p. 1188)
11. Define acute renal failure. What is acute tubular necrosis? (p. 1198-1199)
12. Complete the table-compare/contrast the various causes ARF: p. 1148; Tab 471
Type
Pre-renal
Cause/Management of Acute Renal Failure
Causes (name several)
Key Features-Mgt
Intra-renal
Post-renal
13. What lab test most accurately reflects renal function and how are they
determined? (Include both serum and urine based (p. 1146-1152; Notes)
14. What is the normal serum phosphorus level?
level? (p. 1146-1152; 1200, Notes)
What is the normal serum calcium
Explain why these values are altered when a client has acute renal failure
(applies also to CKD). (p. 1200, p. 1210)
How are these alterations “managed” include diet, medications? (p. 1202-1204,
Notes)
a. What is usual amount of protein permitted?
b. What about sodium and potassium?
c. How are calcium and phosphate levels managed-include meds? P.
1210
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15. Summarize in ARF/Laboratory Studies/Priority Actions (Lewis p. 1199-1201Notes) *Include BUN, serum creatinine clearance; “Fluid challenge
Typical onset &
duration
Critical lab
Priority management
ARF Stages
results
Issues
Initiating Phase
Oliguric Phase
Diuretic Phase
Recovery Phase
16. How is fluid managed in acute renal failure once vascular volume and renal
perfusion has been restored (after fluid challenge)- What formula is used to
ensure that the client does not become fluid overloaded? (p. 1201 & 1203)
17. Why would a “fluid challenge” be used when a client is first discovered to have
acute renal failure (may be anuric or oliguric)? (To discover this answer, read
text, p. 1201 and Notes; note that the exact wording of “fluid challenge” is not
used)
Why would Dopamine may be given IV and what effect would it have on the on
the kidneys? (Notes)
18. What is Kayexalate and when would this be used? Why is sodium bicarbonate
used in ARF? What are indications for use of regular insulin and glucose IV:
(Lewis p. 1202; Table 47.5)
19. Name some phosphate binders. When should phosphate binders be given and
why? (p. 1210) What is risk of aluminum based phosphate binders? (p. 1210)
20. Why is a diet low in protein usually indicated for the client with renal failure?
(p. 1202)
21. Identify medications/drugs that are known to be nephrotoxic.
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