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The Acutely Ill Adult > AKI > Flashcards

AKI Flashcards

1
Q

What results from the kidneys not being able to filter blood normally?

A

Build up of waste, fluid and electrolyte imbalance

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2
Q

What occurs in the prerenal stage that results in reduced kidney function

A

Issue with perfusion of blood to the kidneys - reduced amount of blood going to the kidneys to be filtered so kidneys deprived of nutrients

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3
Q

What leads to reduce perfusion of blood to the kidneys?

A

-reduced cardiac output
- bleeding (internal/external)
- dehydration- hypovolemia
- burns

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4
Q

What are the intrarenal causes ?

A

Damage to the nephrons - reduced ability to filter blood, remove waste and ++ H2O and maintain electrolyte lvls

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5
Q

What can cause damage to the nephron?

A

-nephrotoxic drugs eg. NSAIDS
- infection
-injury

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6
Q

What occurs during the postrenal stage?

A

Blockage in urinary tract that prevents draining out of urinary system

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7
Q

What does a blockage in urinary tract result in ?

A

Increased pressure on the kidneys and build up of waste

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8
Q

What does a normal adult void per day

A

1-2l/day

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9
Q

What does urine consist of ?

A

Ions, urea, creatinine, H2O

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10
Q

What is creatinine ?

A

Waste product from muscle breakdown

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11
Q

How is creatinine filtered

A

Solely filtered from the blood via the glomerulus an is not re absorbed/secreted in the nephron

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12
Q

What does creatinine measurement tells us

A

Shows kidney filtering ability

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13
Q

What does an increased lvl of creatinine in the blood indicate ?

A

Reduced kidney function

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14
Q

What is the creatinine clearance lvl

A

Amount of blood kidneys make per min that is free of creatinine
Females- 85-123ml/min
Males- 95-140ml/min

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15
Q

What does GFR show?

A

How well the glomerulus is filtering

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16
Q

What are the stages of AKI

A

-initiation
-oliguric
-diuresis
- recovery

17
Q

When does the initiation stage start and end ?

A

Starts when something causes damage to the kidneys and ends when S&S begin to show

18
Q

How do we know when the oliguric stage has started

A

Urine output <400ml/day

19
Q

Why is there reduced urinary output in the oliguric state ?

A

Glomerulus loses its ability to filter blood which results in a reduced GFR

20
Q

What are the S&S during the oliguric stage ?

A

-^BUN and creatinine lvls
-change in neuro status eg.confusion
-itching
-hyperkalemia - reduced excretion of k+ in urine
-^ fluid in body - oedema, risk of pul + cardiac issues, HTN
- metabolic acidosis - pH<7.35 - confusion, kussmauls breathing
- very concentrated urine
- risk of infection
- GIT- anorexia, nausea, vomiting,
- bruising nd bleeding

21
Q

What occurs during the diuresis stage ?

A
  • nephrons on their way to recovery- ability 2 filter blood again but can’t concentrate urine
  • GFR improves
  • ^ mental status - pt starts to become more alert + orientated
    -last 1-3 wks
22
Q

What is osmotic diuresis ?

A

High amounts of urea in newly filtered filtrate - causes increased urination
- lasts 1-3 wks

23
Q

What does osmotic diuresis lead to ?

A

Hypovolemia, dehydration, htn, hypokalemia, rlly diluted urine

24
Q

When does the recovery stage start ?

A

When GFR returns back to norm

25
Q

What are the indications of GFR returning back to norm?

A
  • voiding 1-2l/day
  • norm BUN and creatinine lvls
  • norm electrolytes
26
Q

What is the treatment of AKI

A

-reduce protein in diet ( ^ BUN + creatinine)
-safety measures in place ( neuro changes eg.confusion)
- restrict K+ rich foods, monitor ECG and labs ( hyperkalemia)
- limit fluid intake - I&O chart (oliguric stage)
- daily wgts
- monitor vitals regularly
- check for signs of swelling
- IV access ( fluid resuscitation if needed)
- Meds - loop diuretics, ACE inhibitors 4 HTN,
- breathing- look for signs of kussmals breathing, using accessory muscles etc

27
Q

What are some of the mobilising and psychological care involved ?

A
  • early mobilisation
  • assess 4 signs of DVT, PE
  • assess anxiety lvls
  • pt education

The Acutely Ill Adult (10 decks)

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