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Exam 4 > Acute Kidney injury/Acute Renal failure > Flashcards

Acute Kidney injury/Acute Renal failure Flashcards

1
Q

When the kidneys are unable to remove the metabolites from the blood, it results in…

A

Renal failure

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2
Q

Increased nitrogenous waste in the blood is known as…

A

Azotemia

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3
Q

A rapid decline in renal fx., particularly in GFR due to reduced excretion fx. of kidneys that leads to increased creatinine, and urea levels is called…

A

Acute Kidney Injury (AKI)

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4
Q

Two common causes of AKI are..

A
  • -ischemia (insufficient blood supply)

- -nephrotoxins

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5
Q

Exposure to this can cause direct damage to the renal tissue.

A

Nephrotoxins

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6
Q

The acronym RIFLE defines the severity of AKI. RIFLE stands for…

A
  • -Risk for injury
  • -Injury
  • -Failure
  • -Loss of fx.
  • -End stage renal failure
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7
Q

There are 3 stages to AKI, Prerenal, Intrarenal, and post renal. Prerenal is classified when kidney fx. is at what percent?

A

55%

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8
Q

In the prerenal stage, reduced blood flow can lead to AKI w/o directly affecting integrity of kidney tissue. This results from conditions that happen BEFORE the kidneys are affected such as:

A
  • -Hypovolemia
  • -reduced CO
  • -altered vascular resistance
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9
Q

Some prerenal causes of AKI are:

A
  • -dehydration
  • -shock
  • -Vomiting, Diarrhea
  • -Surgery
  • -Cardiac failure
  • -Diuretics, NSAIDS, ACE inhibitors
  • -Liver failure
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10
Q

Prerenal AKI is rapidly reversed when…

A

blood flow is restored, and renal parenchyma remains undamaged.

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11
Q

Intrarenal (intrinsic) AKI is when the kidney functions at ___%

A

40%

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12
Q

In intrarenal stage there is direct damage to kidney tissue, acute damage to parenchyma and nephrons. the most common cause is due to…

A

Acute tubular necrosis

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13
Q

What are common causes of Intrarenal AKI?

A
  • -Acute Glomerulonephritis/pyelonephritis
  • -Aminoglycoside antibiotics
  • -Sepsis
  • -Aneurysms
  • -Cholesterol embolus
  • -radiation
  • -intratubular obstruction
  • -nephrotic drugs
  • -Diabetic Neuropathy
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14
Q

Acute tubular necrosis can be caused by:

A
  • **ischemia (primary cause)
  • -toxins (drugs)
  • -heavy metals
  • -hemolysis
  • -rhabdomyolysis
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15
Q

Post-renal AKI is when the kidney is functioning at ___%

A

5%

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16
Q

The precipitating factor associated with postrenal AKI is..

A

Urethral/Ureteral obstruction

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17
Q

Ureteral obstructions can be caused by…

A
  • *Calculi

* *Cancer

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18
Q

Urethral obstructions can be caused by…

A
  • **BPH (most common)
  • *Enlarged prostate
  • *Calculi
  • *cancer
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19
Q

The destruction of tubular epithelial cells with an abrupt progressive decline of renal function is known as…

A

Acute Tubular necrosis

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20
Q

Ischemia lasting longer than ___ hours can cause severe, irreversible damage to kidney tubules causing necrosis and sloughing.

A

2 hours

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21
Q

Common neurotoxins associated with acute tubular necrosis is…

A
  • *aminoglycoside antibiotics (“cin” meds)
  • -contrast media
  • -NSAIDS
  • -chemotherapy
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22
Q

The two most common causes of hospital acquired AKI are:

A
  • -decreased renal perfusion

- -nephrotoxic meds

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23
Q

The 3rd most common cause of hospital acquired AKI is:

A

–contrast (want to reduce number of tests done with dye)

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24
Q

What are some ways to prevent AKI?

A
  • -take BP meds (counteract vasoconstriction)
  • -enhance blood flow to kidneys
  • -reduce antibiotic, NSAID use
25
Q

There are 3 stages when it comes to clinical manifestations of AKI. they are the initiation, maintenance, and recovery phase. The initiation phase can last ___ to ____. It begins at ____________ and ends when _____ ____ occurs. It is usually asymptomatic.

A
  • -hours to days
  • -time of event (injury)
  • -tubular injury occurs
26
Q

Maintenance phase is when there is a significant fail in GFR. Urine may be produced but, kidney cannot eliminate metabolic waste, water, electrolytes, and acids properly which leads to a manifestation of…

A

oliguria

27
Q

In the maintenance phase the patient will present with…

A
  • -azotemia
  • -fluid retention
  • -metabolic acidosis
  • -edema
  • -hyperkalemia, hyperphosphatemia, hypocalcemia
  • -anemia (b/c of suppressed erythropoietin secretion)
28
Q

When waste and fluids aren’t filtered and stay in the blood this can cause what syndrome?

A

Uremic syndrome

29
Q

The recovery phase is when the tubule cells repair and return GFR to normal. the patient may lose large amounts of urine which is called…

A

Diuresis

30
Q

In the recovery phase renal function starts to improve rapidly. How long could it take for the kidneys stabilize?

A

up to 1 year

31
Q

Diagnostic tests associated with AKI are:

A
  • -UA (specific gravity of 1.010)
  • -BUN
  • *creatinine (most definitive to dx. renal issues)
  • -electrolytes (hyperkalemia, hyponatremia)
  • -ABG’s (metabolic acidosis)
  • -CBC (anemia)
  • -Renal ultrasound (obstruction?)
  • -Renal biopsy (acute or chronic?)
32
Q

Pharm therapy for AKI include:

A
  • -IV fluids (perfusion)
  • -Dopamine IV (increases renal blood flow)
  • -Furosemide (manages salt and water retention)
33
Q
  • -The patient can also be given this med which will excrete sodium, potassium in poop.
  • -The med can be given with___ to prevent constipation
A
  • *Kayexalate

- -sorbitol

34
Q

Once volume and renal perfusion is restored the patient will be put on a ____ _____.

A

Fluid restriction

35
Q

To calculate fluids the nurse must allow for how many mL of insensible loss?

A

500 mL

36
Q

How is fluid restriction calculated?

A

Take 500 mL of insensible loss and add amount excreted in urine from prior shift.
Example: A patient had 275 mL output from previous shift.
500 mL + 275 mL = 775 fluid restriction for next day

37
Q
  • -Proteins must be limited _______/day to minimize azotemia.
    • The nurse should instruct the pt. to eat high value proteins such as:
  • -The pt. should be on a high ___ diet to provide adequate calories.
A
  • -0.6g/kg per day
  • -eggs, fish, protein shakes
  • -Carb
38
Q

Parenteral nutrition can be used if the pt. cant have PO nutrition. the disadvantages to this is the risk for…

A
  • -fluid volume overload (increased volume of fluid needed)

- -infection (venous line)

39
Q
  • -Continuous arteriovenous hemofiltration (CAVH) is used to remove…
  • -It works by circulating blood through a ____ then returning it to the pt. The ultrafiltrates are collected in a drainage bag.
A
  • -Fluid and some solutes

- -hemofilter

40
Q

Continuous arteriovenous hemodialysis (CAVHD) is done by removing….
Arterial blood circulates through hemofilter surrounded by____, then returns to client.

A
  • -fluid and waste products

- -Dialysate

41
Q

Continuous venovenous hemodialysis (CVVHD) is used to remove….
Venous blood circulates through hemofilter surrounded by dialysate then returns to client through….

A
  • -Fluid and waste products

- -double lumen venous catheter

42
Q

when a person does hemodialysis they will have a ___ or ____ in their arm.

A

AV graft or fistula

43
Q

A person on dialysis will do it ____ times weekly, for about ___ hours each session.

A
    • 3 to 4 times

- - 3 to 4 hours

44
Q

Complications of hemodialysis are:

A
  • *hypotension (most frequent)
  • -bleeding
  • -infection
45
Q

Prior to dialysis the nurse should monitor VS and hold what meds?

A

-hold BP meds

46
Q

If a patient is anemic a ____ injection can be given prior to dialysis tx.

A

erythropoietin

47
Q
  • -due to having to access the graft regularly the patient is at risk for_______.
  • -Other risks are…
  • -They are most commonly caused by…
A
  • -Infection
  • -HIV/AIDS, Hep. B/C
  • -Healthcare workers (poor hand hygiene, cross contamination, contaminated equipment)
48
Q

What therapy functions closely to our own renal function?

A

Continuous renal replacement therapy (CRRT)

49
Q

CRRT can last for a period of ___ hours or more. It is a slower process and is done in the ____.

A
    • 12 hours

- - ICU

50
Q

For HD and CRRT it is done in the subclavian, jugular, or femoral vein with a double lumen catheter. If it is functional the nurse will note…

A

palpable pulsation, and bruits heard on auscultation

51
Q

when a patient has a graft or fistula in the arm the nurse should put a sign in the patients room that states….

A

No IV’s or BP in that arm

52
Q

Peritoneal dialysis is performed by using…

A

warmed sterile dialysate

53
Q

where is the catheter placed with peritoneal dialysis?

A

Peritoneal cavity

54
Q

During peritoneal dialysis fluid is drained by ____ out of peritoneal cavity and into a sterile bag.
The fluid in the bag should be ____.

A
  • -gravity

- -clear

55
Q

With peritoneal dialysis the patient is at risk for…

A

Peritonitis

56
Q

Peritoneal dialysis is contraindicated in pts. with…

A
  • -recent abd. surgery
  • -lung disease
  • -peritonitis
57
Q

Three nursing diagnosis for AKI may be…

A
  • -Excess fluid volume
  • -ineffective renal tissue perfusion
  • -Risk for altered cardiac perfusion
58
Q

when caring for a pt. with AKI/ARF, the nurse should implement what in to her care plan?

A
  • -Weigh daily
  • -monitor I & O’s
  • -VS q4h
  • -Semi fowlers
  • -Put on cardiac monitor (hyperkalemia)
  • -Q2 turns if needed
  • -fluid restrictions (give hard candies or do mouth care)

Exam 4 (10 decks)

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