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

ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE Flashcards

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
Q

Goal of AKI for the Medical Management

A

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

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26
Q

A treatment of hyperkalemia that causes a shift of potassium back into the cell

A

HR+ D50W

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27
Q

A treatment of hyperkalemia that can correct the acidosis and cause a shift of potassium into cells

A

NaHCO3 (Sodium Bicarbonate)

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28
Q

A treatment of hyperkalemia that temporarily raises the threshold at which dysrhythmias occur

A

Calcium Gluconate

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29
Q

Treatment of hyperkalemia that removes potassium from the body

A

Kayexelate

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30
Q

Most effective therapy to remove potassium

A

Dialysis

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31
Q

Medical Management for Renal Replacement Therapy

A

-Volume Overload
-Hyperkalemia
-Metabolic acidosis
-BUN >120 mg/dl
- Significant changes in mental status
- Pericarditis, pericardial effusion, cardiac tamponade

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32
Q

Method of choice when rapid changes are required in a short time

A

Hemodialysis

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33
Q

Is the most immediate life-threatening imbalances seen in AKI

A

Hyperkalemia

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34
Q

Acute Kidney Injury Nursing Management

A

-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
Q

is an umbrella term that describes kidney damage or a decrease in the glomerular filtration rate (GFR) lasting for 3 or more months

A

Chronic Kidney Disease

36
Q

4th leading cause of death among Filipinos

A

Chronic Kidney Disease

37
Q

CKD risk factors are:

A

-Cardiovascular Disease
-Diabetes
- Hypertension
-Obesity

38
Q

GFR ≥ 90 mL/min/1.73 m2

A

Stage 1

39
Q

GFR 60-89 mL/min/1.73 m2

A

Stage 2

40
Q

GFR 30-59 mL/min/1.73 m2

A

Stage 3

41
Q

GFR 15-29 mL/min/1.73 m2

A

Stage 4

42
Q

GFR <15 mL/min/1.73 m2

A

Stage 5

43
Q

Requires a permanent renal replacement therapy

A

End-Stage Kidney Disease (ESKD)

44
Q

Progression is faster in those with significant proteinuria or hypertension

A

End-Stage Kidney Disease (ESKD)

45
Q

A syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems

A

Uremia

46
Q

Clinical Manifestations in Metabolic (Waster product Accumulation)

A

-Elevated serum creatinine
-Elevated BUN
-Nausea and vomiting
-Lethargy
-Fatigue
-Impaired thought process
-Headaches

47
Q

Clinical Manifestations in Metabolic (Altered CHO metabolism)

A

-CKD causes insulin resistance
-Hyperglycemia
-Hyperinsulinemia

48
Q

Cause to elevate triglycerides

A

Hyperinsulinemia

49
Q

Due to the conversion of urea back to ammonia

A

Stomatitis and GI bleeding

50
Q

Yellow-bronze pigmentation of skin due to elevated serum levels of urochrome

A

Sallow complexion

51
Q

Brain tissue damage due to elevated levels of urea and nitrogenous waste

A

Renal Encephalopathy

52
Q

Renal Encephalopathy clinical manifestations

A

-Vomiting
-Emotional volatility
-Decreased cognitive function
-Confusion
-Stupor
-Coma

53
Q

Due to the accumulation of urate in the skin

A

Uremic Frost

54
Q

Decreased libido, impotence, and infertility are due to

A

Hormonal Imbalance

55
Q

Severe anemia is due to

A

Due to the inability of the kidneys to secrete erythropoietin

56
Q

Clinical Manifestations related to fluid, electrolyte and acid-base balance

A

-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
Q

Demineralization from slow bone turnover and defective mineralization of newly formed bone

A

Osteomalacia

58
Q

Decalcification of the bone and replacement of bone tissue with fibrous tissue

A

Osteitis fibrosa

59
Q

1+ protein on standard dipstick testing two or more times over a 3- month period

A

Persistent proteinuria

60
Q

Done to detect any obstructions and to determine the size of the kidneys

A

UTZ of kidneys

61
Q

May provide a definitive diagnosis

A

Kidney Biopsy

62
Q

Medical Management for hyperkalemia

A

-Low potassium diet
- IV glucose with insulin or IV calcium gluconate
-Kayexelate, PO or Enema

63
Q

Medical Management for hypertension

A
  • Target BP less than 130/80 mm Hg for patients with CKD and 125/75 mm Hg for patients with significant proteinuria
64
Q

Medical Management for metabolic acidosis

A

Sodium bicarbonate

65
Q

Medical Management for CKD-MBD

A

Phospate Binders
-Calcium based: Calcium carbonate (Caltrate)
-Non-calcium based: sevelamer carbonate
-Administered with each meals

Side Effects: Constipation

66
Q

Calcium carbonate mechanism of action

A

Binds with phosphate in bowel and excreted in stool

67
Q

Medical Management for persistent hypocalcemia

A

Calcium and Vitamin D supplements

68
Q

Exogenous erythropoietin

A

Epoetin alfa (Epogen) IV/SQ

69
Q

Increase in hematocrit and hemoglobin may not be seen for 2 to 3 weeks

A

Epoetin alfa (Epogen)

70
Q

Side effect of Epoetin alfa (Epogen)

A

Iron deficiency

71
Q

Contraindication of Epoetin alfa (Epogen)

A

Hypertension

72
Q

Medical Management for Dyslipidemia

A

HMG-CoA Reductase Inhibitors

The drug of choice is atorvastatin (lipitor)

73
Q

Has minimal clearance and has a lesser chance of causing myopathy

A

Atorvastatin (Lipitor)

74
Q

The breakdown products of dietary and tissue proteins accumulate rapidly in the blood when there is impaired renal clearance

A

Protein Restriction

75
Q

Are those that are complete proteins and supply the essential amino acids necessary for growth and cell repair

A

High-biologic value proteins

76
Q

Medical Management for Nutritional Therapy

A

High Calorie, low sodium, low potassium, low phosphate

77
Q

Prevents wasting

A

Carbohydrates and fat

78
Q

Prevents further water retention and edema (may vary from 2 to 4 grams per day)

A

Low sodium

79
Q

helps resolve the hyperkalemia

A

Low potassium

80
Q

To prevent hyperphosphatemia

A

Low phosphate

81
Q

The high sodium foods are

A

Processed meats and cheese
Canned foods
Soy sauce
Salad dressings

82
Q

The high phosphate foods

A

-Meat
-Dairy Products (milk, ice cream, cheese, yoghurt)
-Foods containing dairy products (pudding)

83
Q

Nursing Management (Maintain fluid and electrolyte balance)

A

-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

MS FINALS TOPICS (5 decks)

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