Acute Kidney Injury

Question 1

Kidney stone diet **

Answer 1

look in blue box on page 2 of the kidney stone diet handout

Question 2

Acute kidney injury

Answer 2

almost always recoverable - rapid loss of kidney function
elevated serum creatinine
decreased urine output (oliguria)
potentially reversible

Question 3

azotemia

Answer 3

too much nitrogen in the blood

Question 4

3 types of kidney injury

Answer 4

pre-renal
inter-renal
post-renal

Question 5

prerenal causes

Answer 5

caused by:  Ischemia- whats causing it? 
severe dehydration
heart failure (or anything that decreases cardiac output) 
arythmias/tachycardia/ ect 
anything that decreases CO

ischemia decreases GFR
causes oliguria
autoregulatory mechanisms attempt to prevent blood flow (only as effective as the blood flow)

Question 6

intrarenal damage

Answer 6

tissue damaged by conditions 
prolonged ischemia
NEPHROTOXINS
abx (gentamycin) 
NSAIDS
Hgb released from hemolyzed RBC 
Myoglobin released from necrotic muscle cells

Question 7

ATN acute tubular necrosis

Answer 7

results from ischemia, nephrotoxins, or sepsis

potentially reversible

Question 8

only need about % of one kidney to survive

Answer 8

40%

Question 9

Post renal causes (5) :

Answer 9

BPH
Prostate cancer 
calculi   
trauma (ex bike injury on urethra) 
extrarenal tumors

Question 10

AKI
RIFLE classification-
how much filtration rate is lost?

Answer 10

Risk for injury? 
Injury ( start having scant urine) 
Failure  (lost all but  50% GFR) 
Loss (lost all but 25% GFR)
End stage kidney disease

Question 11

oliguric phase urine output?

Answer 11

urine output <400mL/day
occurs 1-7 days after insult
lasts 10-14 days

Question 12

oliguric phase UA may show?

Answer 12

UA may show casts, RBC WBC

Question 13

oliguric phase =fluid retention

sx are-

Answer 13

neck veins distended 
bounding pulse 
pulmonary edema 
HTN 
anasarca

Question 14

Kussmaul respiration

Answer 14

lungs try to make pt take deeper breaths faster

trying to maintain acid pH balance in body

Question 15

hyponatremia can lead to

Answer 15

cerebral edema

Question 16

anasarca becomes life threatening when:

Answer 16

it spreads to brain tissue-the swelling has no where to go (cerebral edema limits amount of blood that can get into the brain)
33:03

Question 17

quickest way to die from renal prob?

Answer 17

potassium excess

affects electrocardiac activity of heart= EKG changes

Question 18

what happens to lab value from waste product accumulation?

Answer 18

Elevated BUN ans serum creatinine levels

Question 19

Diuretic phase of AKI-
how much urine?
what should you monitor?

Answer 19

daily urine output 1-3L
May reach 5L or more

monitor for hyponatremia, hypokalemia, and dehydration

Question 20

AKI - diagnostic studies?

Answer 20

UA
serum creatinine
kidney ultrasonography- looking for hydronephrosis fluid buildup in kidney
renal scan-
CT of abdomen with contrast dye (risk to kidneys from dye)
renal biopsy 14G needle apply pressure dressing and keep pt on that side to limit bleeding

Question 21

therapy for hyperkalemia ( biggest life or death)

Answer 21

Kayexalate med- very sweet pulls K+ from colon thru pooping
combo of IV insulin/ IV dextrose/ Ca Gluconate
47:50

Question 22

osmotic diuretic

Answer 22

mannitol or albumin

Question 23

CRRT continuous renal replacement therapy

Answer 23

ICU 1 nurse monitors pt- 1 nurse monitor machine to verify I and O

Question 24

nutrition therapy for AKI

Answer 24

adequate caloric intake
restrict Na, K
increase dietary fat ( so they still get amino acids)
enteral nutrition
LIMIT protein= causes higher nitrogenous wastes

Question 25

Assessment for AKI

Answer 25

VS I and O examine urine assess appearance of pt (itching? skin turgor? dehydration?) observe access site for dialysis LOC oral mucosa lung sounds (crackles? sign of pulonary edema) heart rythym (irregular = hyper/hypo kalemia)

Question 26

Nusing DX for AKI

Answer 26

excess fluid volume risk for infection fatique anxiety

Question 27

1KG water = how much water retained?

Answer 27

1L

Question 28

chronic kidney disease ******see table 47-6 memorize the TABLE!

Answer 28

progressive irreversible loss of kidney function | SEE TABLE 47-6 stages of kidney disease++

Question 29

leading cause of ESKD

Answer 29

diabetes HTN leads to atherosclerosis= succession of blood flow glomulonephritis interstitial nephritis polycystic kidney disease (cysts increase size of kidney/decrease function) prolonged obstuction of urinary tract vesicoureter reflux chronic pyelonepritis (infection leads to inflammation and scarring)

Question 30

oliguria

Answer 30

scant urine

Question 31

isothenuria

Answer 31

large qty of very dilute urine

Question 32

anuria

Answer 32

producing almost no urine

Question 33

which dialysis is least extreme?

Answer 33

peritoneal dialysis- aka continuous ambulatory dialysis- peritoneum of body is used as a permeable membrane as pt ambulates

Question 34

peritoneal dialysis is started when-

Answer 34

pt GFR is 15mL or less | begun when pt uremia can no longer be managed conservatively

Question 35

peritoneal dialysis is done by

Answer 35

inserting a catheter thru the abdominal wall= direct access into inner part of body STERILE TECHNIQUE MANDATORY!

Question 36

peritoneal dialysis based on pt

Answer 36

weight and BP

Question 37

Dialysis solutions

Answer 37

1, 2, or 3L bags concentration of 1.5%, 2.5%, or 4.25% dextrose must be warmed slowly to BODY TEMP do not microwave!!!!!!!! Pt takes BP and dry weight (empty) in the AM to determine fluid deficient 1.5%/ neutral2.5% /overload 4.25%

Question 38

dialysate should be:

Answer 38

``` clear (no infection) no strings (fibrin starting to form clotting cascade- dr would give heparin to prevent that from progressing) ```

Question 39

dialysate should be:

Answer 39

``` clear (no infection) no strings (fibrin starting to form clotting cascade- dr would give heparin to prevent that from progressing) allows independence allows travel short training program fewer dietary restrictions greater mobility than with hemodialysis ```

Question 40

benefit of peritoneal dialysis

Answer 40

allows freedom of movement , go about life

Question 41

complications of peritoneal dialysis

Answer 41

``` exit site infection hernia (walking around with 3KG of fluid in abdomen) peritonitis lower back problem (from the weight of the 3KG of fluid) clog in tubing bleeding pulmonary complications protein loss ```

Question 42

hemodialysis complication

Answer 42

``` Complications: Thrombosis Infection Aneurysm Ischemia – “steal syndrome” ```

Question 43

dialyzer

Answer 43

artificial kidney

Question 44

access sight for hemodialysis

Answer 44

arteriovenous fistula and graft, temporary vascular access ** risk for infection, clotting

Question 45

hemodialysis vascular access

Answer 45

fistula - surgically created anastamosis of artery and vein - much less likely to blow like a vein would do (more common- but if poor blood supply or cant use large enough needle) shunt/graft- same process, but using teflon or dacron but deaing with a foreign substance in the body

Question 46

Dialyzer/blood lines are primed with saline solution to eliminate air/blood in the line T or F?

Answer 46

TRUE

Question 47

Fill a thrill means?

Answer 47

turbulance that can be felt at site

Question 48

hemodialysis complications?

Answer 48

``` Hypotension Muscle cramps Loss of blood Hepatitis (getting lower) Disequilibrium syndrome ```

Question 49

nursing considerations for pt with hemodiallysis:

Answer 49

NEVER use HD catheter without a physician order NO….. In affected extremity Blood pressure measurements Insertion of IVs Phlebotomy Palpate for thrills and auscultate for bruits every 4 hours while pt is awake Assess the patient’s distal pulses and circulation in the arm with the access Elevate the affected extremity post operatively Encourage routine range of motion exercises Check for bleeding at needle insertion sites Assess for s/s of infection at the needle insertion site. Instruct pt not to carry heavy loads in the affected arm Instruct pt not to sleep with the body weight on the affected arm

Question 50

more nursing considerations for hemodialysis

Answer 50

Monitor vital signs Monitor laboratory values before, during and after dialysis Assess the client for fluid overload prior to the procedure Assess patency of the blood access device Weigh the client before and after the procedure to determine fluid loss. Know the Patient’s dry weight. Assess the patient’s LOC Assess for headache, nausea or vomiting.

Question 51

MORE nursing considerations for hemodialysis

Answer 51

Hold antihypertensives and other medications that can affect the BP prior to the procedure, as prescribed Hold medications that could be dialyzed off, such as water-soluble vitamins and certain antibiotics Monitor for shock and hypovolemia during the procedure Provide adequate nutrition (client may eat prior to the procedure)