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MS FINALS TOPICS > ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE > Flashcards

ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE Flashcards

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1
Q

is a rapid loss of renal function due to damage to the kidneys and is accompanied by serum creatinine elevation and/ or reduction in urine output

A

Acute Kidney Injury

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2
Q

Potentially reversible, but has a high mortality rate

A

Acute Kidney Injury

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3
Q

Acute Kidney Injury Etiology

A

-Pre-renal causes
- Intrarenal causes
- Post-renal causes

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4
Q

-External to the kidneys
-Factors that reduce systemic circulation, causing decreased renal blood flow
-Reduced glomerular filtration
- May lead to intrarenal disease if renal ischemia is prolonged

A

Pre-renal Causes

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5
Q

Conditions that cause direct damage to kidney tissue, resulting in impaired nephron function

A

Intrarenal Causes

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6
Q

Cause obstruction of intrarenal structures by crystallizing or by causing damage to the epithelial cells of the tubules

A

Nephrotoxins

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7
Q

Blocks the tubules and causes renal vasoconstriction

A

Hgb and Myoglobin

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8
Q

Involve mechanical obstruction of urine outflow

A

Post-renal causes

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9
Q

A 5-tier system and describes the stages of AKI

A

RIFLE Classification

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10
Q

The RISK, INJURY and FAILURE describe the

A

SEVERITY

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11
Q

The LOSS and ESKD describe the

A

OUTCOME

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12
Q

Begins with the initial insults and ends when oliguria develops

A

Initiation Phase

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13
Q

4 Phases of AKI

A

-Initiation
-Oliguria
-Diuresis
-Recovery

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14
Q

It is characterized by decreased urine output (less than 400 mL/day or <0.5 mL/kg/hr)

A

Oliguria Phase

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15
Q

A phase where uremic symptoms begin to appear

A

Oliguria Phase

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16
Q

Accompanied by an increase in the serum concentration of substances usually excreted by the kidneys

A

Oliguria Phase

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17
Q

-Marked by a gradual increase in urine output
-The renal function may still be abnormal and uremic symptoms may still be present

A

Diuresis Phase

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18
Q

This phase may take 3 to 12 months and the laboratory values return to normal

A

Recovery Phase

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19
Q

In this phase, the patient MUST avoid nephrotoxic agents

A

Recovery Phase

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20
Q

The most common initial manifestation

A

Oliguria

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21
Q

Clinical Manifestations of Acute Kidney Injury (AKI)

A

-Oliguria
-Jugular vein distention
- Bounding pulse
- Edema
- Hypertension
- Kussmaul respirations- rapid, deep respirations
- Hyponatremia, hyperkalemia

-Elevated serum creatinine and BUN
- Neurologic changes
(fatigue)
(Seizure, stupor, coma)
( Asterixis)

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22
Q

Occurs within 24 hours if the _____ is the cause

A

ISCHEMIA

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23
Q

Delayed up to 1 week if the cause is _________

A

NEPHROTOXICITY

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24
Q

Clinical manifestations of AKI were flapping tremors when the wrist is extended

A

Asterixis

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25
Goal of AKI for the Medical Management
Goal: Restore normal chemical balance and prevent complications until repair of renal tissue and restoration of renal function can occur. -Treat underlying cause - Maintaining fluid balance - Renal Replacement therapy
26
A treatment of hyperkalemia that causes a shift of potassium back into the cell
HR+ D50W
27
A treatment of hyperkalemia that can correct the acidosis and cause a shift of potassium into cells
NaHCO3 (Sodium Bicarbonate)
28
A treatment of hyperkalemia that temporarily raises the threshold at which dysrhythmias occur
Calcium Gluconate
29
Treatment of hyperkalemia that removes potassium from the body
Kayexelate
30
Most effective therapy to remove potassium
Dialysis
31
Medical Management for Renal Replacement Therapy
-Volume Overload -Hyperkalemia -Metabolic acidosis -BUN >120 mg/dl - Significant changes in mental status - Pericarditis, pericardial effusion, cardiac tamponade
32
Method of choice when rapid changes are required in a short time
Hemodialysis
33
Is the most immediate life-threatening imbalances seen in AKI
Hyperkalemia
34
Acute Kidney Injury Nursing Management
-Bed rest to reduce metabolic rate - Assist patient to turn, cough, and take deep breaths - Maintain asepsis on invasive lines and catheters -Provide meticulous skin care (bathe in cool water, frequent turning, keeping skin clean and well-moisturized) -Attend to psychosocial needs of patient and family
35
is an umbrella term that describes kidney damage or a decrease in the glomerular filtration rate (GFR) lasting for 3 or more months
Chronic Kidney Disease
36
4th leading cause of death among Filipinos
Chronic Kidney Disease
37
CKD risk factors are:
-Cardiovascular Disease -Diabetes - Hypertension -Obesity
38
GFR ≥ 90 mL/min/1.73 m2
Stage 1
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GFR 60-89 mL/min/1.73 m2
Stage 2
40
GFR 30-59 mL/min/1.73 m2
Stage 3
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GFR 15-29 mL/min/1.73 m2
Stage 4
42
GFR <15 mL/min/1.73 m2
Stage 5
43
Requires a permanent renal replacement therapy
End-Stage Kidney Disease (ESKD)
44
Progression is faster in those with significant proteinuria or hypertension
End-Stage Kidney Disease (ESKD)
45
A syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems
Uremia
46
Clinical Manifestations in Metabolic (Waster product Accumulation)
-Elevated serum creatinine -Elevated BUN -Nausea and vomiting -Lethargy -Fatigue -Impaired thought process -Headaches
47
Clinical Manifestations in Metabolic (Altered CHO metabolism)
-CKD causes insulin resistance -Hyperglycemia -Hyperinsulinemia
48
Cause to elevate triglycerides
Hyperinsulinemia
49
Due to the conversion of urea back to ammonia
Stomatitis and GI bleeding
50
Yellow-bronze pigmentation of skin due to elevated serum levels of urochrome
Sallow complexion
51
Brain tissue damage due to elevated levels of urea and nitrogenous waste
Renal Encephalopathy
52
Renal Encephalopathy clinical manifestations
-Vomiting -Emotional volatility -Decreased cognitive function -Confusion -Stupor -Coma
53
Due to the accumulation of urate in the skin
Uremic Frost
54
Decreased libido, impotence, and infertility are due to
Hormonal Imbalance
55
Severe anemia is due to
Due to the inability of the kidneys to secrete erythropoietin
56
Clinical Manifestations related to fluid, electrolyte and acid-base balance
-Edema (due to water retention) - Hyperkalemia (due to the inability of the kidneys to excrete potassium) - Hypermagnesemia -Sodium disturbance (due to the inability of kidneys to regulate sodium balance) -Metabolic acidosis (due to inability of kidneys to buffer hydrogen, regenerate bicarbonate, and excrete metabolic wastes
57
Demineralization from slow bone turnover and defective mineralization of newly formed bone
Osteomalacia
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Decalcification of the bone and replacement of bone tissue with fibrous tissue
Osteitis fibrosa
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1+ protein on standard dipstick testing two or more times over a 3- month period
Persistent proteinuria
60
Done to detect any obstructions and to determine the size of the kidneys
UTZ of kidneys
61
May provide a definitive diagnosis
Kidney Biopsy
62
Medical Management for hyperkalemia
-Low potassium diet - IV glucose with insulin or IV calcium gluconate -Kayexelate, PO or Enema
63
Medical Management for hypertension
- Target BP less than 130/80 mm Hg for patients with CKD and 125/75 mm Hg for patients with significant proteinuria
64
Medical Management for metabolic acidosis
Sodium bicarbonate
65
Medical Management for CKD-MBD
Phospate Binders -Calcium based: Calcium carbonate (Caltrate) -Non-calcium based: sevelamer carbonate -Administered with each meals Side Effects: Constipation
66
Calcium carbonate mechanism of action
Binds with phosphate in bowel and excreted in stool
67
Medical Management for persistent hypocalcemia
Calcium and Vitamin D supplements
68
Exogenous erythropoietin
Epoetin alfa (Epogen) IV/SQ
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Increase in hematocrit and hemoglobin may not be seen for 2 to 3 weeks
Epoetin alfa (Epogen)
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Side effect of Epoetin alfa (Epogen)
Iron deficiency
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Contraindication of Epoetin alfa (Epogen)
Hypertension
72
Medical Management for Dyslipidemia
HMG-CoA Reductase Inhibitors The drug of choice is atorvastatin (lipitor)
73
Has minimal clearance and has a lesser chance of causing myopathy
Atorvastatin (Lipitor)
74
The breakdown products of dietary and tissue proteins accumulate rapidly in the blood when there is impaired renal clearance
Protein Restriction
75
Are those that are complete proteins and supply the essential amino acids necessary for growth and cell repair
High-biologic value proteins
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Medical Management for Nutritional Therapy
High Calorie, low sodium, low potassium, low phosphate
77
Prevents wasting
Carbohydrates and fat
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Prevents further water retention and edema (may vary from 2 to 4 grams per day)
Low sodium
79
helps resolve the hyperkalemia
Low potassium
80
To prevent hyperphosphatemia
Low phosphate
81
The high sodium foods are
Processed meats and cheese Canned foods Soy sauce Salad dressings
82
The high phosphate foods
-Meat -Dairy Products (milk, ice cream, cheese, yoghurt) -Foods containing dairy products (pudding)
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Nursing Management (Maintain fluid and electrolyte balance)
-Weigh the patient daily -Measure and record I and O - Assess presence and extent of edema - Auscultate for breath sounds (rales and crackles) indicate for pulmonary edema - Restrict fluids, as ordered -Monitor vital signs - Avoid OTC medications

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