UNIT 1 Chapter 63 Acute Kidney Injury and Chronic Kidney Injury Flashcards
Lab value for Creatinine
Male: 0.6-1.2 mg/dL
Female: 0.5-1.1 mg/dL
Lab value for Blood Urea Nitrogen
Both Sexes: 10-20 mg/dL
Lab value for GFR
90-120 mL/min
Lab value for Platelet count
150,000-400,000 mm3
Lab value for PT
Both Sexes: 11-12.5 sec
Pregnant: decreased
** 1.5-2.5 times the normal
control (on warfarin)
Lab value for INR
Normal is 0.9-1.2 seconds
Desirable therapeutic level is 2-3
times the normal (on warfarin)
Lab value for aPTT
Both Sexes: 30-40 sec
** 1.5-2.5 times the normal
control (on Heparin)
Lab value for HCT AND HGB
HGB-Male: 14-18 g/dL
Female: 12-16 g/dL
HCT-Male: 42-52%
Female: 37-47%
Lab value for Na
Both Sexes: 135-145 mEq/L
Lab value for K+
3.5-5
Lab for WBC
5,000-10,000
What is Acute Kidney Injury?
sudden dysfunction to the kidney that is reversible.
-The causes of AKI are reduced perfusion to the kidneys, damage to kidney tissue, and obstruction of urine outflow.
Sudden (hours to days)
What are the s/s of AKI
OLIGURIA
-azotemia;build up of nitrogen waste
-fluid overload
-Anemia
-pulmonary crackles,
-dependent and generalized edema (anasarca),
-decreased oxygenation
- (low peripheral oxygenation or SpO 2), -confusion,
-increased respiratory rate,
-dyspnea
-tachycardia
-bounding pulse
-hypertension
What are the 3 causes of AKI?
-Pre-Renal AKI
-Intra-Renal AKI
-Post-renal AKI
What is the cause of Pre-Renal AKI
Prerenal AKI is caused by a source outside of the kidney creating conditions that impair renal perfusion. Common causes include
-Shock,
-Dehydration,
-Hypovolemia
-Fluid volume Deficit
-Hemrohage
-Burns, and
-Sepsis.
The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient’s recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones
b. Dehydration
A marathon runner comes into the clinic and states <I have not urinated very much in the last few days.= The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram.
a. Give the client a bottle of water immediately.
What is the cause of Intra Renal AKI
Intrinsic renal injury occurs inside the kidney by disorders that directly affect the renal cortex or medulla. Examples of disorders causing intrinsic renal AKI include allergic disorders, embolism or thrombosis of the renal vessels, and nephrotoxic agents. P
The nurse is assessing a client with a diagnosis of intrarenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient’s recent history?
a. Pyelonephritis
b. Dehydration
c. sepsis
d. Kidney stones
a. Pyelonephritis
What is the cause of Post Renal AKI
Postrenal AKI is caused by a urine flow obstruction. The obstruction can be caused by tumors, kidney stones, or strictures
The nurse is assessing a client with a diagnosis of postrenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient’s recent history?
a. Pyelonephritis
b. Dehydration
c. sepsis
d. Kidney stones
d. Kidney stones
Which of the following Labs would you suspect to be increased for a patient with Akute Kidney Injury? SELECT ALL THAT APPLY
Creatinine
Potassium
Sodium
BUN
GFR
pH(Acidosis or alkaline)
Calcium
Magnesium
Creatinine
Potassium
BUN
Which of the following labs would you suspect to be decreased? SELECT ALL THAT APPLY
Creatinine
Potassium
Sodium
BUN
GFR
pH
Calcium
Magnesium
Sodium
GFR
Ph(Acidosis)
Magnesium
Calcium
Your patient with Acute Kidney injury had been diagnosed with pre-renal AKI secondary to dehydration. Which of the following statements by the patient required intervention?
A. my recovery can take up to 1 day.
B.This diagnosis occurred suddenly due to dehydration.
C. Oral rehydration may be in my care plan.
D. If my dehydration gets worse I may need dialysis.
A. my recovery can take up to 1 day.
FROM BOOK
- Resolution of kidney injury may occur over several months, and follow-up care may be provided by a nephrologist or by the primary health care provider in consultation with the nephrologist. Frequent medical visits are necessary, as are scheduled laboratory blood and urine tests to monitor kidney function. A registered dietitian nutritionist can plan modifications to the patient’s diet according to the degree of kidney function and ongoing nutrition needs. Fluid restrictions and daily weights may be advised to avoid fluid overload while kidneys are recovering.
Phases of Acute Kidney Injury
Onset Phase:
* Starts with the precipitating event and continues until oliguric development.
- Oliguric Phase:
- Lasts 1-3 weeks.
- The longer this phase lasts, the poorer the prognosis.
- Dialysis may be required during this phase.
*Diuretic Phase:
* Urine output may be 1000 – 2000 ml/day.
- Recovery Phase:
- 3–12 months.
Oliguric Phase, how long does this phase last?
A.1-3 weeks
B. 6 hours
C. 5 hours
D. 2 hours
** Lasts 1-3 weeks**
* The longer this phase lasts, the poorer the prognosis.
* Dialysis may be required during this phase.
What occurs during the diuretic phase?
What is the priory nursing action in the phase?
*Diuretic Phase:
* Urine output may be 1000 – 2000 ml/day
increase fluid intake to prevent dehydration.
How long does the recovery phase last?
- 3–12 month
Medical management priority for patients with Acute Kidney injury?
What is the Nursing Care plan?
Prevent acute renal failure.
* Adequate hydration and diuresis in high-risk patients.
- Maintain fluid and electrolyte balance.
- Monitor serum and urine electrolytes. *
Replace renal function.
Patient may need dialysis.
Prevent infection
Prevent infection
* Significant cause of death in patients with ARF.
* Avoid indwelling catheters if possible.
What is the most common diuretic that is used for patients with Acute Kidney injury in the Oliguric phase?
A. Spironlactone
B. Furosemide
C. Eplerenone
D. Triamterene
B. Furosemide
-potassium wasting diuretics aid in creating fluid and electroytes balance or help recover from fluid and electrolyte imbalance
You are precepting a new graduate nurse in the ICU. She is currently assigned to a patient with Acute Kidney Injury. She is about to call the HCP to order a urinary catheter due to the patient’s oliguria. What is your priority action?
A. Teach her the best way of initiating an order for her patient
B. tell her to reduce the iv hydration for her patient.
C. immediately stop her from asking for that order because the urinary catheter may lead to infection which is the major cause of death in these patients.
D. Ask her to order an diuretic instead.
C. immediately stop her from asking for that order because the urinary catheter may lead to infection which is the major cause of death in these patients.
Prevent infection
* Significant cause of death in patients with ARF.
* Avoid indwelling catheters if possible.
What’s a complication that would warrant immediate attention for a patient with Akute Kidney Injury?SELECT ALL THAT APPLY
A. seizures
B.hypertenstion
C.Oliguria
D.urine specific gravity 1.005
E. WBC 20,000
A. seizures
E. WBC 20,000
due to hypocalcemia, and fluid imbalance can cause seizures
A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client’s history?
a. <Have you been taking any aspirin, ibuprofen, or naproxen recently?
b. <Do you have anyone in your family with renal failure?
c. <Have you had a diet that is low in protein recently?
d. <Has a relative had a kidney transplant lately?
a. <Have you been taking any aspirin, ibuprofen, or naproxen recently?
There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory
drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the
patient since both the serum creatinine and BUN are elevated, indicating some renal problems.
A diet high in protein could be a factor in an increased BUN.
Which of the following drugs are contraindicated for patients with Acute Kidney Injury? SELECT ALL THAT APPLY
A. Insulin
B. Metformin
C. Acetominophin
D. Contrast Iodine
E. Gentamycin
F. Furosemide
G. Spironolactone
H. Aspirin,
J. Ibuprofen
K. Naproxen
B. Metformin
D. Contrast Iodine
E. Gentamycin
G. Spironolactone
H. Aspirin,
J. Ibuprofen
K. Naproxen
A client with diabetes mellitus type 2 has been well controlled with metformin. The client is
scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the
nurse take at this time?
a. Teach the client about the purpose of the MRI.
b. Assess the client9s blood urea nitrogen and creatinine.
c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics.
c. Tell the client to withhold metformin for 24 hours before the MRI.
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal damage.
Your patient is in the oliguric phase and is currently in Fluid volume overoad.What can edema cause?
A. high perfusion
B. decreased skin integrity
C. 30 grade of pitting edema
D. hypotension
B. decreased skin integrity
When your patient is the fluid overload state monitor for skin integrity
The skin is most likey to tear when a patient has edema. Which can lead to infection , which is the major cause of death in Acute Renal Failure patients.
What are risk factors medications or types of food for an increase state of Acute Renal failure?
Avoid risk factors
* Contrast media
* Nephrotoxic medications
* Foods such as certain proteins
What foods should this patient avoid>?
- Nutritional concerns
- Client needs to eat
-specific proteins,
restrictions of
anticipate sodium and potassium
restrictions
What is the the recommended daily sodium grams intake for a patient with Acute Kidney Injury?
1-3G
What are the 2 compensatory organs for acid-base balance?
A. heart
B. spleen
C. kidney
D. lungs
C. kidney
D. lungs