Professional Documents
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Objectives
Causes Symptoms
Dialysis
Anatomy
Kidney Function
Detoxify blood Increase calcium absorption
calcitriol erythropoietin
renin
Classifications
Acute versus chronic Pre-renal, renal, post-renal Anuric, oliguric, polyuric
Acute
sudden onset rapid reduction in urine output Usually reversible Tubular cell death and regeneration Progressive Not reversible Nephron loss
Chronic
Post-renal = 5-15%
Causes of ARF
Pre-renal =
vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure cardiac failure, liver dysfunction, or septic shock Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins
Intrinsic
Post-renal =
prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders neurogenic bladder bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus
Symptoms of ARF
Decrease urine output (70%) Edema, esp. lower extremity Mental changes Heart failure Nausea, vomiting Pruritus Anemia Tachypenic Cool, pale, moist skin
Make/think about the diagnosis Treat life threatening conditions Identify the cause if possible
Hyperkalemia Symptoms
K > 5.5 -6 Tall, peaked Ts Wide QRS Prolong PR Diminished P Prolonged QT QRS-T merge sine wave
Hyperkalemia Treatment
Calcium gluconate (carbonate) Sodium Bicarbonate Insulin/glucose Kayexalate Lasix Albuterol Hemodialysis
CRF Symptoms
Seizure Constipation Peptic ulceration Diverticulosis Anemia Pruritus Jaundice Abnormal hemostasis
Dialysis
of patients with CRF eventually require dialysis Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body 2 types
Hemodialysis
3-4 times a week Takes 2-4 hours Machine filters blood and returns it to body
Types of Access
Surgeon constructs by combining an artery and a vein 3 to 6 months to mature Man-made tube inserted by a surgeon to connect artery and vein 2 to 6 weeks to mature
AV graft
Temporary Catheter
Access Problems
AV graft thrombosis AV fistula or graft bleeding AV graft infection Steal Phenomenon
Early post-op Ischemic distally Apply small amount of pressure to reverse symptoms
Peritoneal Dialysis
Abdominal lining filters blood 3 types
EMS Considerations
Make sure the dressing remains intact Do not push or pull on the catheter Do not disconnect any of the catheters Always transport the patient and bags/catheters as one piece Never inject anything into catheter
At end of early sessions Confusion, tremor, seizure Due to decrease concentration of blood versus brain leading to cerebral edema