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NUR 230 > AKI/CKD > Flashcards

AKI/CKD Flashcards

1
Q

what are nitrogenous wastes a biproduct of

A

protein metabolism

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2
Q

what do kidneys excrete

A

nitrogenous wastes: drugs and toxins

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3
Q

how do kidneys keep acid base balance

A

excrete h+ ions
reabsorb bicarb

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4
Q

what hormones are released by kidneys

A

erthropoietin
renin
calcitriol (vit d3)

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5
Q

what does calcitriol do

A

absorbs calcium from intestines

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6
Q

what is normal gfr

A

> 60

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7
Q

what is gfr

A

mL of blood filtered per minute through glomeruli

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8
Q

what happens when kidneys fail

A

decreased gfr
accumulation of nitrogenous comounds
oliguria

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9
Q

what happens when there is an accumulation of nitrogenous comounds

A

Azotemia- Elevated BUN/Creatinine
* Uremia- syndrome of ESRF: increased urea/creatinine, fatigue, metallic taste in mouth, anorexia, N/V, pruritis, confusion; can progress to coma and death

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10
Q

what is oliguria

A

decreased urine ouput
< 400mL in 24 hours
* <0.5mL/kg/hr for at least 6 hours

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11
Q

what is normal urine output

A

30 ml/hr

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12
Q

what is the gold standard marker

A

creatinine

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13
Q

what is aki

A

sudden
full recovery possible
mortality higher if rrt needed, age increased, comorbidities increased
Decreased GFR/Creatinine
Clearance
* Fluid, electrolyte, acid-
base imbalances
* Treatment focused on
managing fluid,
electrolyte, acid base
imbalances + drug
treatment depending on
cause

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14
Q

what is ckd

A

gradual
progressive and permanent
treatment can slow progression
managing underlying conditions also slows progression
eskd fatal without rrt
lifespan reduced
complex med regimen
more susceptible to aki

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15
Q

what is prerenal in aki

A

perfusion problem
drop in bp or interuption of blood flow to kidneys
hypovolemia

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16
Q

what is intrarenal in aki

A

damage to kidney itself
direct damage to kidneys by infalmmation, toxins, drugs, infection or reduced blood supply, injury
-Acute tubular necrosis (ischemia,
nephrotoxic drugs)
-Inflammation (infections, autoimmune,
diabetes, nephrotoxic drugs, hypersensitivity
reaction)
-Other: Rhabdo, hemolysis

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17
Q

what is postrenal in aki

A

obstruction of urine flow
sudden obstruction of urine flow d/t enlarged prostate, kidney stones, bladder tumor or injury
extra or intrarenal
increased liklihood of aki if bilateral ureters or urethra obstructed

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18
Q

what do you look for with prerenal

A

Vomiting, diarrhea, diaphoresis,
hemorrhage/trauma, surgery, infection, diuretic use, heart
failure

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19
Q

s/s of hypovolemia

A

Dizziness, thirst
* Hypotension (including orthostatic hypotension)
* Tachycardia
* Decreased urine output
* Decreased cardiac output
* Decreased CVP
* **BUT: CVP ↑ in HF
* Lethargy

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20
Q

s/s of postrenal aki

A

Oliguria or Intermittent anuria
* Hydronephrosis
* Changes in urine stream
* Difficulty urinating
* Hematuria (kidney stone) or particles in urine
* Leads to s/s uremia
* Lethargy, etc

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21
Q

s/s of intrarenal

A
  • Oliguria or anuria
  • HTN results
  • JVD, crackles, SOB, edema
  • RBC, protein, casts in urine
  • Lethargy, Change in LOC (azotemia)
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22
Q

what causes extrarenal post renal aki

A

compression by tumor or prostate (BPH),
neurogenic bladder

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23
Q

what causes intrarenal post renal aki

A

kidney stone, blood clot, tumor, blocked Foley

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24
Q

increased or decreased gfr with post renal aki

A

decreased
caused by renal tubule pressure increase

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25
Q

what is initiation phase of aki

A

Begins with initial insult and ends when oliguria develops

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26
Q

what is oliguric phase aki

A

Begins within a day post hypotensive/nephrotoxic event.
Glomerular dysfunction & less urine production.
* Serum BUN & Creatinine increase
* May have fluid overload, pulmonary edema, hypernatremia

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27
Q

what is diurectic phase aki

A

When perfusion returns, previously damaged glomeruli
not functioning up to par and cannot concentrate the urine
Can have extreme loss of Na, K, fluid during this phase

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28
Q

what is recovery phase of aki

A

Can take up to 3 months to fully return to normal GFR
and creatinine

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29
Q

diagonostics for aki

A

Renal US
* CT scan (w/o contrast)
* Renal biopsy

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30
Q

labs for aki

A

increase in both BUN/Cr
* decrease Creatinine Clearance/GFR
* Abnormal electrolytes- K, Na,
phosphorus, magnesium
* pH- metabolic acidosis
* Anemia may be present
* Urine Studies
* Sediment- cells, casts,
crystals
* Sodium
* Protein
* RBCs

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31
Q

aki treatment/management

A

Treat/eliminate cause
* Hypotension/hypovolemia
* Nephrotoxins
* Obstruction
* Maintain fluid balance
* IV fluid challenge/blood transfusion
* Loop diuretics
* Closely monitor I&O
* Correct electrolyte/acid-base imbalances
* Nutritional support- high catabolism
* Diet- low sodium, potassium, phosphorus; high calorie and carbohydrate
* Renal replacement therapy- continuous (CRRT) vs. intermittent HD

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32
Q

aki prevention

A

Dehydration
* Infection
* Hypoperfusion
* Toxic drug effects
* Close monitoring and assessment + early intervention
* I & O
* Renal function labs
* Urine characteristics
* Daily weights
* Catch decreased urine output early (report if oliguria persists more than 2 hours)

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33
Q

what is aeiou

A

acid base
electrolyte
intoxication
overload
uremic complications

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34
Q

ckd gfr rate

A

<60 for greater than 3 mo

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35
Q

is ckd reverable

A

no

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36
Q

what are the top 2 cuases of ckd

A

DM and HTN

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37
Q

other causes of ckd

A

Other causes: unresolved AKI, chronic inflammation (glomerulonephritis, pyelonephritis),
lupus, polycystic kidney disease

38
Q

stage 1 ckd

A

> 90 ml/min gfr
At risk, normal kidney function.
Kidney disease may or may not be
present

39
Q

stage 2 ckd

A

60-89
mild ckd

40
Q

stage 3 ckd

A

30-59
moderate ckd
see azotemia, proteinuria

41
Q

stage 4 ckd

A

15-29
severe ckd
consider or initiate dialysis

42
Q

stage 5 ckd

A

<15
ESKD
cannot survive w/out dialysis or transplant

43
Q

functioning nephrons comensate for which stages

A

1, 2 ,3

44
Q

early ckd

A

glomerular compensation, increased output of dilute
urine, hyponatremia
* Monitor for dehydration

45
Q

later stage ckd

A

disruption of RAAS, oliguria, hypernatremia
* HTN
* Heart failure, JVD, peripheral edema
* Pulmonary edema
* Management- monitor respiratory status, daily weights, and I&O; loop
diuretics (ineffective for ESKD); fluid restriction (dependent on urine output);
sodium restriction; antihypertensives, dialysis

46
Q

hyperkalemia assessment

A

vitals-dysrhythmias
cardiac/ekg monitoring

47
Q

treatment hyperkalemia

A

iv insulin and dextrose
sodium polystyrene sulfonate (kayexalate)

48
Q

management/prevention of hyperkalemia

A

k+ restriction
dialysis

49
Q

buildup of nitrogenous wastes- manifestations

A

uremia

50
Q

what is uremia

A

azotemia with symptoms; Uremic syndrome = lab and clinical
manifestations of ESKD

51
Q

cardiac sy,ptoms of uremia

A

pericarditis (friction rub), tamponade

52
Q

hemotologic symptoms uremia

A

reduced WBC (increased infection risk), platelet dysfunction &
fragile capillaries (abnormal bleeding, bruising)

53
Q

gi symptoms uremia

A

halitosis, metallic taste in mouth, mouth ulcerations, anorexia, N/V, abd
pain/cramping peptic ulcers, colitis, GI bleeding
* Inability to ingest, digest, or absorb food/nutrients leads to weight loss

54
Q

neuro uremia symptoms

A

lethargy, inability to focus, asterixis, peripheral neuropathy/paresthesia,
ataxia, seizures/coma (uremic encephalopathy)

55
Q

skin uremia symptoms

A

sallow (yellow-gray) pigmentation, pruritis, dry skin, ecchymosis, purpura,
uremic frost (late sign)

56
Q

sexual dysfunction uremia symptoms

A

impotence, infertility, amenorrhea

57
Q

managemet for buildup of nitrogenous wastes

A

dialysis
protein restriciton
prevent bleeding and infection
psychosocial support
symptom specific

58
Q

management of anemia

A

Epoetin alfa (Epogen)
* PO/IV iron
* Folic acid
* Conserve energy, balance activity and rest

59
Q

what causes anemia in ckd

A

decreased erythropoitin production

60
Q

acid base imbalance of ckd

A

metabolic acidosis- hydrogen ions NOT excreted, bicarb not reabsorbed
if chronic- skeletal bone buffering

61
Q

management of ckd acid base imbalance

A

oral sodium bicarb
dialysis

62
Q

effect of calcium in ckd

A

Decreased production
of calcitriol by kidneys
= decreased active
vitamin D = decreased
absorption of calcium
from GI tract
decreased serum calcium

63
Q

effect of phosphate in ckd

A

phosphate retention (hyperphophatemia)
binding of phosphate with calcium
decreased serum calcium

64
Q

effect of phosphate and calcium in ckd

A

release of pth by parathyroid glands
release of calcium stored in bones (bone demineralization and bone density loss)
increased serum calcium
binding of phosphate with calcium (further metastatic calcification)
hyperparathyroidism

65
Q

what is renal osteodystrophy

A

weakening of bones

66
Q

what is osteomalacia

A

bone softening

67
Q

management of renal osteodytroohy

A

Safety- prevent injury/fracture
* Phosphate restriction
* Phosphate binders with every meal
* Calcium acetate (PhosLo), calcium carbonate (Caltrate), sevelamer (Renvela)

68
Q

ckd diagnostics

A

Bone x-rays- osteodystrophy
* US or CT- small kidney size

69
Q

ckd labs

A

Urine
* Serum Sodium
* Hyponatremia - early
vs. Hypernatremia -
later
* Magnesium increased
* Potassium increased
* Metabolic acidosis
* Ca++ decreased /Phos increased
* Hgb/Hct decreased

70
Q

ckd treatment

A

Fluid restriction
* Pharmacological
* BP control
* Hemodialysis
* CRRT
* Peritoneal dialysis
* Renal transplant

71
Q

who recives rrt

A

AKI (Acute Kidney Injury)
* ESRD (End Stage Renal Disease)
* Post Transplant
* Failed Transplant
* Toxicology cases
* Young, old and everyone in between

72
Q

what is hemodyalysis

A

typically 3 days a week approx. 3-6 hours per
treatment

73
Q

what is peritoneal dialysis

A

CCPD, CAPD- typically completed every night
while the patient is sleeping
no extreme fluid and electrolyte shifts

74
Q

what is plasmapheresis

A

Dependent on the cause for need

75
Q

what is crrt

A

used for clients too
unstable for traditional hemodialysis

76
Q

what is home hemodyalysis

A

typically 5 days per week (can be more or less
depending on the patient and physician’s orders

77
Q

types of dialysis access

A

avf- preffered, connection btwn artery and vein
avg
cvc- risk for infection
pd cath

78
Q

what do you feel and listen for with avf

A

thrill and bruit

79
Q

care for avf

A

No venipunctures, blood pressures
* Limb alert band/sleeve
* Client education- no heavy lifting/sleeping on side of fistula

80
Q

nsg responsibilities for dialysis

A

Assessing patients for signs or symptoms of fluid overload or electrolyte
imbalances, signs or symptoms of infection or need for dry weight
adjustment.
* Accessing CVC or AVF for treatment as needed.
* Monitoring vital signs throughout treatment.
* Administer medications.
* Communicate with physician findings that are abnormal.
* Draw lab work, monitor results for abnormalities.
* Adjust medications per algorithms.
* Hold pressure on sites following completion of treatment.

81
Q

before treatment assessment for dialysis

A

ital signs, lung sounds, signs or symptoms of
fluid overload, NVD, bleeding, cramping, falls, injuries or bleeding, fluid
goal, access site for signs or symptoms of infection or functionality

82
Q

during treatment assessment for dialysis

A

ssessment of vital signs, presence of bleeding at access
site, level of consciousness, machine settings, arterial and venous
pressures every 30 minutes.

83
Q

post reatment assessment for dialysis

A

Vital signs, post treatment weight, hemostasis, patient
response to fluid removal

84
Q

which has less diatary and fluid restrictions hemo or perit

A

peritoneal

85
Q

complications of hemodialysis

A

disequilibrium syndrome
muscle cramps and back pain
headache
itching
hemodynamic and cardiac adverse events
infection
increased risk for subdural and intracranial hemmorrhage

86
Q

complications for peritoneal

A

protein loss
peritonitis
hyperglycemia
resp distress
bowel perforation
infection
wt gain

87
Q

contraindications of hemodialysis

A

hemodynamic intability or severe cardiac disease
severe vascular disease affecting access
bleeding disorders
uncontrolled diabetes

88
Q

contraindications peritoneal

A

extrensive peritoneal adhesions, fibrosis, or active inflammatory gi disease
ascities or massive central obesity
recent abd surgery

89
Q

nsg interventions ckd

A

Head to toe assessment
* VS, O2 sats
* EKG monitoring
* Strict I & O
* Fluid/dietary restriction
* Daily weights
* Phosphate binders with
meals, calcium & iron
supplements
* Monitor vascular access
site
* Monitor labs (esp K+, Ca,
& Phos, ABG)
* Stools occult blood
* Good skin and oral care
* Emotional support
* Energy conservation
* Safety- fractures, bleeding,
meds (renal dosing, avoid
nephrotoxins)
* Patient education

90
Q

ckd nutrional considerations

A

Typically restricted:
* Sodium, potassium, phosphorus, magnesium
* Fluid intake
* May have protein restriction
* Generally high calorie, moderate fat

91
Q
A

NUR 230 (16 decks)

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