Acute & Chronic Kidney Injury Flashcards
(80 cards)
1
Q
acute renal failure / acute kidney injury (AKI)
A
- abrupt disease in kidney function
- a rapid, progressive process
- difficult to detect
2
Q
acute renal failure is reversible if
A
identified and treated early
3
Q
acute renal failure is identified by
A
oliguria and elevated serum BUN and creatinine
4
Q
elevation of BUN and creatinine =
A
azotemia
5
Q
BUN and creatinine are both products of
A
protein metabolism
6
Q
azotemia
A
medical condition characterized by increase levels of nitrogen in the body
7
Q
risk factors for acute kidney injury
A
- hx of renal problems
- hx of htn
- hx od diabetes
- use of nephrotoxic agents
- exposure to heavy metals or organic solvents
- recent hypotensive episode
- tumor or vascular obstruction
- infection
-sepsis
8
Q
common causes of acute kidney injury
A
- arterial occlusion
- absolute decrease in effective in blood volume
- relative decrease in blood volume
9
Q
prerenal injury
A
caused by renal blood flow resulting in renal hypoperfusion and ischemia
10
Q
prerenal injury causes a decreases in the
A
GFR
11
Q
pre renal injury is often reversible? or irreversible?
A
reversible
12
Q
causes of prerenal injury
A
- decreased cardiac output
- increased vascular capacity
- drugs that alter renal hemodynamics
13
Q
acute tubular necrosis (ATN) is a type of _____ renal injury
A
intrinsic renal injury
14
Q
what is acute tubular necrosis (ATN)
A
destruction of renal tubular epithelial cells
15
Q
ATN is caused by
A
- ischemia
- sepsis
- vascular problems (such as malignant htn)
- acute glomerulonepritis and other infections
- drug allergies and toxicity
- rhabdomyolosis (breakdown of skeletal muscle and release of myoglobin which plugs glomeruli)
16
Q
2 types of ATN
A
(1) ischemic
(2) toxic
17
Q
ischemic ATN
A
prolonged hypoperfusion
(surgical procedure, anasthesia)
18
Q
toxic ATN
A
from aminoglycoside anti-infectives, contrast induced nephropathy (CIN)
19
Q
oliguric ATN
A
less likely to recover renal function
- has a high mortality rate
20
Q
non-oliguric ATN
A
commonly seen with toxic injury
- renal concentrating defect
- hyperkalemia common complication
21
Q
postrenal injury
A
caused by an obstruction to the outflow or urine from the kidneys
22
Q
obstruction to one kidney does not likely lead to renal failure unless
A
the other kidney is not functioning or absent
23
Q
uremia occurs when
A
2/3 of total number of nephron loss
24
Q
fluid overload can lead to
A
HF, pulmonary edema, hear crackles
25
wastes can cause
homeostasis and anemic disorders when there are extra wastes
26
nursing care for AKI and fluid volume overload
diuretics, fluid restriction as prescribed, monitor for S&S of fluid volume excess, intake and output, oral care, ice chips
27
possible neurologic symptoms in pt with AKI
decreased mental function, peripheral neuropathy, cerebral edema
28
possible cardiovascular and pulmonary symptoms in pt with AKI
htn, pulmonary edema, electrolyte imbalance, pneumonia
29
possible GI symptoms in pt with AKI
poor appetite, GI bleeding, constipation, diarrhea
30
possible hematologic symptoms in pt with AKI
anemia, blood clots
31
possible integumentary symptoms in pt with AKI
pale appearance, bruising, pruritis, dry skin, thin hair, brittle nails, uremic frost
32
possible skeletal symptoms in pt with AKI
usteodystrophy
33
BUN reflects
GFR and urine concentrating capacity
34
BUN increases as GFR
decreases
35
BUN is affected by
hydration status, level of catabolism, protein intake, and GI bleeding therefore is not considered a reliable measure of GFR
36
creatinine is the end product of
muscle metabolism and is released into the blood at a constant rate
37
creatinine is eliminated at a rate =
equal to renal function
38
normal BUN and creatinine ratio is
10:1 or 15:1
39
what BUN:creatinine ratio is indicative of AKI
20:1
40
a decrease in creatinine clearance rate indicates a decrease in
glomerular function
41
normal BUN
3.6 - 7.1 mmol/L
42
normal creatinine
44 - 133 mmol/L
43
creatinine clearance =
urine creatinine x urine volume
44
diagnosis of AKI
(1) urine output
(2) renal insufficiency
(3) renal failure
(4) ESRD
45
in dx of AKI urine output would
diminished renal reserve - output may be normal as remaining nephrons are able to compensate
46
in dx of AKI renal insufficiency is
inability to concentrate urine and results in polyuria
47
renal failure =
oliguria
48
ESRD =
anuria
49
osmolarity is
serum and urine
50
osmolarity is the measure of
solute concentration/kg
51
what is a major factor that affects osmolarity
sodium
52
when renal function decreases, urine osmolality ______ and urine specific gravity _______, serum osmolality ________
increases; increases; stays the same
53
symptoms of metabolic acidosis related to renal tubule dysfunction
- hyperkalemia
- hyperventilation
- cardiac dysrhythmias
54
chronic renal failure (CRF)
the irreversible loss of renal function, affecting nearly all organ systems
55
what does chronic renal failure result from
primary renal condition (such as polycystic kidney disease, glomerulonephritis) or other diseases that affect the kidneys (diabetes, htn)
56
risk factors for chronic renal failure
diabetes mellitus, htn, proteinuria, family history, increasing age
57
in chronic renal failure regulation in GFR =
reduction in number of functional nephrons
58
in chronic renal failure kidneys compensate for damage by
hyperfiltration
59
hyperfiltration =
further loss of function over time
60
in chronic renal failure the kidneys experience generalized
wasting (shrinking) and progressive scarring
61
it is usually not until over ___% of kidney function is lost the pts start to experience symptoms
70%
62
cardiovascular S&S of chronic renal failure
- htn
- hf
- heart disease
- stroke
- peripheral vascular disease
- pericarditis
63
hematologic S&S of chronic renal failure
- anemia
- reduced erythropoietin
- GI blood loss
- iron deficiency
- thrombocytopenia
64
GI S&S of chronic renal failure
- nausea
- vomiting
- anorexia
- GI bleeding
65
neurologic S&S of chronic renal failure
- sleep disorders
- memory loss
- impaired judgement
- muscle cramps
- twitching
- asterixis
- seizures
- coma
- peripheral neuropathy
66
medical treatment for chronic renal failure (CRF) is aimed at maintaining homeostasis by
- reducing fluid volume overload
- monitoring electrolytes
- treating acid base imbalances
- treating and preventing infection
- metabolic imbalance
- treating electrolyte excess
67
for chronic renal failure (CRF) fluid overload is avoided by
- fluid restriction
- diuretics
68
for chronic renal failure (CRF) catabolic processes are avoided by
decreased protein intake = decreased protein diet
69
for chronic renal failure (CRF) electrolyte imbalances are avoided by
IV solutions with more free water; 0.45% saline or isotonic
70
types of renal replacement therapy (RRT)
(1) hemodialysis
(2) peritoneal dialysis
(3) continuous renal replacement therapy
71
how does renal replacement therapy work
dissolved particles are transferred across a semipermeable membrane from one fluid compartment to another
72
renal replacement therapy does not correct renal impairment but does correct _____
fluid, electrolyte, and acid-base imbalances, and removes waste products
73
hemodialysis
allows more gradual removal of excess electrolytes
- used in critical care setting so that ongoing assessment can occur
- uses 5 different methods to clear excess fluids
74
what 5 different methods are used in hemodialysis to clear excess fluids
(1) fluids
(2) solutes
(3) electrolytes
(4) creatinine
(5) urea
75
peritoneal dialysis
peritoneal cavity is used as the semipermeable membrane to removes wastes, excess fluids, and electrolytes
- a sterile catheter is inserted into the peritoneal cavity through the abdominal wall
- as dialysate solution is instilled through the catheter, waste and excess products cross the semipermeable peritoneal membrane and into the dialysate
- continuous or intermittent
76
peritoneal dialysis depends on
diffusion and osmosis
77
in peritoneal dialysis osmosis and a high glucose concentrate in the dialysate allows water to migrate from the ________ and into the
the blood and into the peritoneal cavity
78
advantages of peritoneal dialysis
- can be performed on a regular basis so that fluid and electrolyte shift is less dramatic
- can be performed in pt home
- ambulatory pts may work or do other activities while dialysis occurs
- if hemodynamically unstable there is a less dramatic alteration in fluid balance
79
disadvantages of peritoneal dialysis
- considerable infection risk
- respiratory distress associated with the volume of fluid and "dwelling"
- significant protein depletion
80
when a pt is on dialysis it is important to monitor and assess _________
monitor and maintain fistula and assess for bruit
