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NUR 230 > AKI/CKD > Flashcards

AKI/CKD Flashcards

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1
Q

what are nitrogenous wastes a biproduct of

A

protein metabolism

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2
Q

what do kidneys excrete

A

nitrogenous wastes: drugs and toxins

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3
Q

how do kidneys keep acid base balance

A

excrete h+ ions
reabsorb bicarb

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4
Q

what hormones are released by kidneys

A

erthropoietin
renin
calcitriol (vit d3)

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5
Q

what does calcitriol do

A

absorbs calcium from intestines

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6
Q

what is normal gfr

A

> 60

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7
Q

what is gfr

A

mL of blood filtered per minute through glomeruli

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8
Q

what happens when kidneys fail

A

decreased gfr
accumulation of nitrogenous comounds
oliguria

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9
Q

what happens when there is an accumulation of nitrogenous comounds

A

Azotemia- Elevated BUN/Creatinine
* Uremia- syndrome of ESRF: increased urea/creatinine, fatigue, metallic taste in mouth, anorexia, N/V, pruritis, confusion; can progress to coma and death

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10
Q

what is oliguria

A

decreased urine ouput
< 400mL in 24 hours
* <0.5mL/kg/hr for at least 6 hours

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11
Q

what is normal urine output

A

30 ml/hr

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12
Q

what is the gold standard marker

A

creatinine

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13
Q

what is aki

A

sudden
full recovery possible
mortality higher if rrt needed, age increased, comorbidities increased
Decreased GFR/Creatinine
Clearance
* Fluid, electrolyte, acid-
base imbalances
* Treatment focused on
managing fluid,
electrolyte, acid base
imbalances + drug
treatment depending on
cause

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14
Q

what is ckd

A

gradual
progressive and permanent
treatment can slow progression
managing underlying conditions also slows progression
eskd fatal without rrt
lifespan reduced
complex med regimen
more susceptible to aki

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15
Q

what is prerenal in aki

A

perfusion problem
drop in bp or interuption of blood flow to kidneys
hypovolemia

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16
Q

what is intrarenal in aki

A

damage to kidney itself
direct damage to kidneys by infalmmation, toxins, drugs, infection or reduced blood supply, injury
-Acute tubular necrosis (ischemia,
nephrotoxic drugs)
-Inflammation (infections, autoimmune,
diabetes, nephrotoxic drugs, hypersensitivity
reaction)
-Other: Rhabdo, hemolysis

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17
Q

what is postrenal in aki

A

obstruction of urine flow
sudden obstruction of urine flow d/t enlarged prostate, kidney stones, bladder tumor or injury
extra or intrarenal
increased liklihood of aki if bilateral ureters or urethra obstructed

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18
Q

what do you look for with prerenal

A

Vomiting, diarrhea, diaphoresis,
hemorrhage/trauma, surgery, infection, diuretic use, heart
failure

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19
Q

s/s of hypovolemia

A

Dizziness, thirst
* Hypotension (including orthostatic hypotension)
* Tachycardia
* Decreased urine output
* Decreased cardiac output
* Decreased CVP
* **BUT: CVP ↑ in HF
* Lethargy

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20
Q

s/s of postrenal aki

A

Oliguria or Intermittent anuria
* Hydronephrosis
* Changes in urine stream
* Difficulty urinating
* Hematuria (kidney stone) or particles in urine
* Leads to s/s uremia
* Lethargy, etc

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21
Q

s/s of intrarenal

A
  • Oliguria or anuria
  • HTN results
  • JVD, crackles, SOB, edema
  • RBC, protein, casts in urine
  • Lethargy, Change in LOC (azotemia)
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22
Q

what causes extrarenal post renal aki

A

compression by tumor or prostate (BPH),
neurogenic bladder

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23
Q

what causes intrarenal post renal aki

A

kidney stone, blood clot, tumor, blocked Foley

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24
Q

increased or decreased gfr with post renal aki

A

decreased
caused by renal tubule pressure increase

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25
what is initiation phase of aki
Begins with initial insult and ends when oliguria develops
26
what is oliguric phase aki
Begins within a day post hypotensive/nephrotoxic event. Glomerular dysfunction & less urine production. * Serum BUN & Creatinine increase * May have fluid overload, pulmonary edema, hypernatremia
27
what is diurectic phase aki
When perfusion returns, previously damaged glomeruli not functioning up to par and cannot concentrate the urine Can have extreme loss of Na, K, fluid during this phase
28
what is recovery phase of aki
Can take up to 3 months to fully return to normal GFR and creatinine
29
diagonostics for aki
Renal US * CT scan (w/o contrast) * Renal biopsy
30
labs for aki
increase in both BUN/Cr * decrease Creatinine Clearance/GFR * Abnormal electrolytes- K, Na, phosphorus, magnesium * pH- metabolic acidosis * Anemia may be present * Urine Studies * Sediment- cells, casts, crystals * Sodium * Protein * RBCs
31
aki treatment/management
Treat/eliminate cause * Hypotension/hypovolemia * Nephrotoxins * Obstruction * Maintain fluid balance * IV fluid challenge/blood transfusion * Loop diuretics * Closely monitor I&O * Correct electrolyte/acid-base imbalances * Nutritional support- high catabolism * Diet- low sodium, potassium, phosphorus; high calorie and carbohydrate * Renal replacement therapy- continuous (CRRT) vs. intermittent HD
32
aki prevention
Dehydration * Infection * Hypoperfusion * Toxic drug effects * Close monitoring and assessment + early intervention * I & O * Renal function labs * Urine characteristics * Daily weights * Catch decreased urine output early (report if oliguria persists more than 2 hours)
33
what is aeiou
acid base electrolyte intoxication overload uremic complications
34
ckd gfr rate
<60 for greater than 3 mo
35
is ckd reverable
no
36
what are the top 2 cuases of ckd
DM and HTN
37
other causes of ckd
Other causes: unresolved AKI, chronic inflammation (glomerulonephritis, pyelonephritis), lupus, polycystic kidney disease
38
stage 1 ckd
>90 ml/min gfr At risk, normal kidney function. Kidney disease may or may not be present
39
stage 2 ckd
60-89 mild ckd
40
stage 3 ckd
30-59 moderate ckd see azotemia, proteinuria
41
stage 4 ckd
15-29 severe ckd consider or initiate dialysis
42
stage 5 ckd
<15 ESKD cannot survive w/out dialysis or transplant
43
functioning nephrons comensate for which stages
1, 2 ,3
44
early ckd
glomerular compensation, increased output of dilute urine, hyponatremia * Monitor for dehydration
45
later stage ckd
disruption of RAAS, oliguria, hypernatremia * HTN * Heart failure, JVD, peripheral edema * Pulmonary edema * Management- monitor respiratory status, daily weights, and I&O; loop diuretics (ineffective for ESKD); fluid restriction (dependent on urine output); sodium restriction; antihypertensives, dialysis
46
hyperkalemia assessment
vitals-dysrhythmias cardiac/ekg monitoring
47
treatment hyperkalemia
iv insulin and dextrose sodium polystyrene sulfonate (kayexalate)
48
management/prevention of hyperkalemia
k+ restriction dialysis
49
buildup of nitrogenous wastes- manifestations
uremia
50
what is uremia
azotemia with symptoms; Uremic syndrome = lab and clinical manifestations of ESKD
51
cardiac sy,ptoms of uremia
pericarditis (friction rub), tamponade
52
hemotologic symptoms uremia
reduced WBC (increased infection risk), platelet dysfunction & fragile capillaries (abnormal bleeding, bruising)
53
gi symptoms uremia
halitosis, metallic taste in mouth, mouth ulcerations, anorexia, N/V, abd pain/cramping peptic ulcers, colitis, GI bleeding * Inability to ingest, digest, or absorb food/nutrients leads to weight loss
54
neuro uremia symptoms
lethargy, inability to focus, asterixis, peripheral neuropathy/paresthesia, ataxia, seizures/coma (uremic encephalopathy)
55
skin uremia symptoms
sallow (yellow-gray) pigmentation, pruritis, dry skin, ecchymosis, purpura, uremic frost (late sign)
56
sexual dysfunction uremia symptoms
impotence, infertility, amenorrhea
57
managemet for buildup of nitrogenous wastes
dialysis protein restriciton prevent bleeding and infection psychosocial support symptom specific
58
management of anemia
Epoetin alfa (Epogen) * PO/IV iron * Folic acid * Conserve energy, balance activity and rest
59
what causes anemia in ckd
decreased erythropoitin production
60
acid base imbalance of ckd
metabolic acidosis- hydrogen ions NOT excreted, bicarb not reabsorbed if chronic- skeletal bone buffering
61
management of ckd acid base imbalance
oral sodium bicarb dialysis
62
effect of calcium in ckd
Decreased production of calcitriol by kidneys = decreased active vitamin D = decreased absorption of calcium from GI tract decreased serum calcium
63
effect of phosphate in ckd
phosphate retention (hyperphophatemia) binding of phosphate with calcium decreased serum calcium
64
effect of phosphate and calcium in ckd
release of pth by parathyroid glands release of calcium stored in bones (bone demineralization and bone density loss) increased serum calcium binding of phosphate with calcium (further metastatic calcification) hyperparathyroidism
65
what is renal osteodystrophy
weakening of bones
66
what is osteomalacia
bone softening
67
management of renal osteodytroohy
Safety- prevent injury/fracture * Phosphate restriction * Phosphate binders with every meal * Calcium acetate (PhosLo), calcium carbonate (Caltrate), sevelamer (Renvela)
68
ckd diagnostics
Bone x-rays- osteodystrophy * US or CT- small kidney size
69
ckd labs
Urine * Serum Sodium * Hyponatremia - early vs. Hypernatremia - later * Magnesium increased * Potassium increased * Metabolic acidosis * Ca++ decreased /Phos increased * Hgb/Hct decreased
70
ckd treatment
Fluid restriction * Pharmacological * BP control * Hemodialysis * CRRT * Peritoneal dialysis * Renal transplant
71
who recives rrt
AKI (Acute Kidney Injury) * ESRD (End Stage Renal Disease) * Post Transplant * Failed Transplant * Toxicology cases * Young, old and everyone in between
72
what is hemodyalysis
typically 3 days a week approx. 3-6 hours per treatment
73
what is peritoneal dialysis
CCPD, CAPD- typically completed every night while the patient is sleeping no extreme fluid and electrolyte shifts
74
what is plasmapheresis
Dependent on the cause for need
75
what is crrt
used for clients too unstable for traditional hemodialysis
76
what is home hemodyalysis
typically 5 days per week (can be more or less depending on the patient and physician’s orders
77
types of dialysis access
avf- preffered, connection btwn artery and vein avg cvc- risk for infection pd cath
78
what do you feel and listen for with avf
thrill and bruit
79
care for avf
No venipunctures, blood pressures * Limb alert band/sleeve * Client education- no heavy lifting/sleeping on side of fistula
80
nsg responsibilities for dialysis
Assessing patients for signs or symptoms of fluid overload or electrolyte imbalances, signs or symptoms of infection or need for dry weight adjustment. * Accessing CVC or AVF for treatment as needed. * Monitoring vital signs throughout treatment. * Administer medications. * Communicate with physician findings that are abnormal. * Draw lab work, monitor results for abnormalities. * Adjust medications per algorithms. * Hold pressure on sites following completion of treatment.
81
before treatment assessment for dialysis
ital signs, lung sounds, signs or symptoms of fluid overload, NVD, bleeding, cramping, falls, injuries or bleeding, fluid goal, access site for signs or symptoms of infection or functionality
82
during treatment assessment for dialysis
ssessment of vital signs, presence of bleeding at access site, level of consciousness, machine settings, arterial and venous pressures every 30 minutes.
83
post reatment assessment for dialysis
Vital signs, post treatment weight, hemostasis, patient response to fluid removal
84
which has less diatary and fluid restrictions hemo or perit
peritoneal
85
complications of hemodialysis
disequilibrium syndrome muscle cramps and back pain headache itching hemodynamic and cardiac adverse events infection increased risk for subdural and intracranial hemmorrhage
86
complications for peritoneal
protein loss peritonitis hyperglycemia resp distress bowel perforation infection wt gain
87
contraindications of hemodialysis
hemodynamic intability or severe cardiac disease severe vascular disease affecting access bleeding disorders uncontrolled diabetes
88
contraindications peritoneal
extrensive peritoneal adhesions, fibrosis, or active inflammatory gi disease ascities or massive central obesity recent abd surgery
89
nsg interventions ckd
Head to toe assessment * VS, O2 sats * EKG monitoring * Strict I & O * Fluid/dietary restriction * Daily weights * Phosphate binders with meals, calcium & iron supplements * Monitor vascular access site * Monitor labs (esp K+, Ca, & Phos, ABG) * Stools occult blood * Good skin and oral care * Emotional support * Energy conservation * Safety- fractures, bleeding, meds (renal dosing, avoid nephrotoxins) * Patient education
90
ckd nutrional considerations
Typically restricted: * Sodium, potassium, phosphorus, magnesium * Fluid intake * May have protein restriction * Generally high calorie, moderate fat
91

NUR 230 (16 decks)

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