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Renal > care of patients with acute/chronic kidney injury ch 71 > Flashcards

care of patients with acute/chronic kidney injury ch 71 Flashcards

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1
Q

onset

difference between acute/chronic

A

acute: sudden (hours to days)
chronic: gradual (months to years)

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2
Q

% of nephrons involved

difference between acute/chronic

A

acute: 50%
chronic: 90-95%

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3
Q

duration of disease

difference between acute/chronic

A

acute: 2-4 weeks, less than 3 months
chronic: permanent

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4
Q

prognosis of disease

difference between acute/chronic

A

acute: good for return of kidney function with supportive care. high mortality in some situations
chronic: fatal without a renal replacement therapy such as dialysis or transplantation

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5
Q

azotemia

A

the retention and buildup of nitrogenous wastes in the blood

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6
Q

When BUN rises faster than the serum creatinine level, the cause is usually related to ____

A

protein breakdown or dehydration

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7
Q

when both the BUN and creatinine levels rise and the ratio between the two remains constant, this indicates ____

A

kidney dysfunction

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8
Q

causes of pre renal AKI

A

any condition that decreases blood flow to the kidneys and leads to ischemia in the nephrons

shock (hypovolemia, hemorrhage, distributive, obstructive)
HF
PE
anaphylaxis
sepsis
pericardial tamponade

most common: shock, HF

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9
Q

causes of intrarenal AKI

A

actual physical, chemical, hypoxic, immunologic image directly to the kidney tissue

usually occurs with damage to glomeruli, interstitial tissue, or tubules

acute interstitial nephritis
exposure to nephrotoxins
acute glomerular nephritis
vasculitis
acute tubular necrosis
renal artery or vein stenosis
renal artery or vein thrombosis
formation of crystals or precipitates in the nephron tubules
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10
Q

normal osmolarity

A

270-300

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11
Q

HCO3 range

A

22-26

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12
Q

PaCO2

A

35-45

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13
Q

early AKI can often be revered by:

A

correcting blood volume
increasing BP
improving cardiac output

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14
Q

drugs that most often cause intrarenal AKI

A 
aminoglycoside antibiotics (gentamicin, neomycin, streptomycin, kanamycin, tobramycin)
NSAIDs
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15
Q

causes of postrenal AKI

A

obstruction of the urine collecting system anywhere from the calyces to the urethral meatus
obstruction must be bilateral to cause post renal failure, unless only 1 kidney is functional

ureter, bladder, urethral cancer
kidney, ureter, bladder stone
bladder atony
prostatic hyperplasia or cancer
urethral stricture
cervical cancer
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16
Q

onset phase of AKI

  • description
  • characteristics
A

begins with precipitating event and continues until oliguria develops

last hours to days

the gradual accumulation of nitrogenous wastes, such as increasing serum creatinine and BUN

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17
Q

oliguric phase of AKI

  • description
  • characteristics
A

characterized by urine output of 100-400 mL/24 hr that does not respond to fluids or diuretics
lasts 1-3 weeks

increasing serum creatinine and BUN
hyperkalemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, hypermagnesemia
sodium retention
urine specific gravity and urine osmolarity do not vary as plasma osmolarity changes

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18
Q

diuretic phase of AKI

  • description
  • characteristics
A

high output phase
often has a sudden onset within 2-6 wk after oliguric stage
urine flow increases rapidly over a period of several days
diuresis can result in an output of 10 L/day of dilute urine

BUN levels start to fall and continues till it reaches normal levels
normal kidney tubular function is re-established

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19
Q

recovery phase of AKI

  • description
  • characteristics
A

patient begins to return to normal levels of activity

complete recover can take up to 12 months

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20
Q

manifestations of volume depletion

yellow box 1541

A 
low urine output
decreased systolic BP
decreased pulse pressure
orthostatic hypotension
thirst
rising blood osmolarity
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21
Q

potential nephrotoxic substances

A 
rifampin
vancomycin
ibuprofen
ketorolac
naproxen
tylenol
captopril
metformin
myoglobin
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22
Q

manifestations of prerenal azotemia AKI

A 
hypotension
tachycardia
decreased cardiac output
decreased central venous pressure 
decreased urine output
lethargy
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23
Q

renal manifestations of intrarenal/postrenal AKI

A

oliguria or anuria

increased urine specific gravity

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24
Q

cardiac manifestations of intrarenal/postrenal AKI

A 
HTN
tachycardia
JVD
increased central venous pressure
tall T waves
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25
respiratory manifestations of intrarenal/postrenal AKI
``` SOB orthopnea crackles pulmonary edema friction rub ```
26
gastrointestinal manifestations of intrarenal/postrenal AKI
anorexia n/v flank pain
27
neurologic manifestations of intrarenal/postrenal AKI
lethargy headache tremors confusion
28
lab values in pt with prerenal azotemia
``` BUN/creatine ration of greater than 20 sodium often less than 10-20 urine concentrated urine sediment (RBCs, RBC casts, tubular cells) myoglobin, hemoglobin ```
29
lab values for intrarenal problem
BUN/creatine ration less than 15 urine sodium less than 40 specific gravity less than 1.01
30
lab values for postrenal problem
urine sodium may be normal | specific gravity 1.000-1.010
31
main problems during the oliguric phase
close monitoring for life threatening electrolyte changes and nitrogen retention
32
problems during the diuretic phase
hypovolemia | electrolyte loss
33
what do calcium channel blockers do in AKI
can be given if caused by nephrotoxic acute tubular necrosis prevent movement of calcium into the kidney cells, maintain kidney cell integrity, improve the GFR by improving kidney blood flow
34
action/purpose of Digoxin (cardiac glycosides) for kidney disease
digoxin (Lanoxin) used when HF induces kidney injury/disease or makes it worse Improves ventricular contraction, increasing stroke volume and cardiac output do not take antacids within 2 hrs
35
``` folic acid (Vitamin B9) -action/purpose ```
when pt is receiving dialysis, many essential vitamins and minerals are removed from the blood. replacement is needed to prevent deficiencies
36
ferrous sulfate | action/purpose
when pt is receiving dialysis, many essential vitamins and minerals are removed from the blood. replacement is needed to prevent deficiencies take with meals, daily stool softeners
37
epoetin alfa (Epogen, Procrit) -action/purpose
synthetic erythropoietin | drug prevents anemia by stimulating RBC growth and maturation in the bone marrow
38
epoetin alfa (Epogen, Procrit) -nursing interventions
teach pt to report any side effects as soon as possible: chest pain, difficulty breathing, high BP, rapid weight gain, seizures, rash, hives, swelling of feet or ankles (drug can induce cardiovascular problems such as an MI) must have hemoglobin levels monitored weekly
39
two types of synthetic erythropoietin
epoetin alfa (Procrit, Epogen) darbepoeitin alfa (Aranesp)
40
types of phosphate binders
aluminum hydroxide gel (Amphojel) aluminium carbonate gel (Basalijel)
41
purpose of phosphate binders
high blood phosphate levels cause hypocalcemia and osteodystrophy. drugs lower serum phosphate levels by binding phosphorus present in food
42
phosphate binders nursing interventions
take with meals (drug binds to phosphate in food) take digoxin 2 hours before/after take stool softeners report muscle weakness, slow or irregular pulse, confusions (manifestations of hypophosphatemia)
43
key features of uremia 1547
``` metallic taste in mouth anorexia n/v muscle cramps uremic frost on skin itching fatigue lethargy hiccups edema dyspnea muscle cramps paresthesias ```
44
GFR of >90 | -what is stage of CKD
stage 1 at risk; normal kidney function early kidney disease may or may not be present
45
GFR 60-89 -what is stage of CKD
stage 2 mild CKD may be slight elevation of metabolic wastes in the blood. Increased urinary output of dilute urine may occur, and if untreated, can cause dehydration
46
stage 1 CKD interventions
``` screen for risk factors: uncontrolled HTN DM chronic kidney or UTI presence of genetic kidney diseases exposure to nephrotoxic substances ```
47
stage 5 CKD end stage kidney disease interventions
implement renal replacement therapy kidney transplantation
48
rate of creatinine exception depends on
muscle mass physical activity diet
49
the method for assessing the GFR is the use of a formula that considers:
``` serum creatinine level age gender race body size ```
50
neurologic manifestations of CKD
``` lethargy, seizures, coma= uremic encephalopathy daytime drowsiness inability to concentrate slurred speech asterixis tremors, twitching, jerky movements myoclonus ataxia paresthesias ```
51
cardiovascular manifestations of CKD - result from: - examples:
result from fluid overload, HTN, HF, pericarditis, K induced dysrhythmias ``` cardiomyopathy HTN peripheral edema HF uremic pericarditis pericardial effusion pericardial friction rub cardiac tamponade ```
52
respiratory manifestations of CKD
``` uremic halitosis tachypnea deep sighing, yawning Kussmaul respirations uremic pneumonitis SOB pulmonary edema pleural effusion depressed cough reflex crackles ```
53
hematologic manifestations of CKD
anemia | abnormal bleeding and bruising
54
GI manifestations of CKD
``` anorexia n/v metallic taste in the mouth change sin taste acuity and sensation uremic colitis (diarrhea) constipation uremic gastritis possible GI bleeding breath odor stomatitis ```
55
urinary manifestations of CKD
``` polyuria nocturia (early) oliguria anuria (late) proteinuria hematuria diluted straw colored appearance (early) concentrated and cloudy appearance (later) ```
56
integumentary manifestations of CKD
``` decreased skin turgor yellow gray pallor dry skin pruritus ecchymosis purpura soft tissue calcifications uremic forst (late, premorbid) ```
57
musculoskeletal manifestations of CKD
muscle weakness and cramping bone pain pathologic fractures renal osteodystrophy
58
reproductive manifestations of CKD
decreased fertility infrequent or absent menses decreased libido impotence
59
priority problems for pts with CKD
``` fluid overload potential for pulmonary edema decreased cardiac output inadequate nutrition potential of infection potential for injury fatigue anxiety ```
60
early s/s of pulmonary edema
``` restlessness anxiety rapid HR SOB crackles the begin at base of lungs frothy pink tinged sputum ```
61
CKD and pulmonary edema | - nuring interventions
furosemide given cautiously measure urine output q15-30 minutes during acute episode assess breath sounds q2 hrs IV morphine to reduce myocardial oxygen demand
62
dietary protein recommendations -for pt with chronic uremia
0.55-0.60 g/kg/day | least amount of protein, compared to other conditions
63
dietary protein recommendations - for pt with hemodialysis
1-1.5 g/kg/day
64
dietary protein recommendations - for pt with peritoneal dialysis
1.2-1.5 g/kg/day | slightly higher compared to other 2
65
fluid recommendations - for pt with chronic uremia
depends on urine output but may be as high as 1500-3000 mL/day (pt can drink more fluid with this than other two conditions)
66
fluid recommendations - for pt with hemodialysis
500-700 mL/day plus amount of urine output
67
fluid recommendations - for pt with peritoneal dialysis
restriction based on fluid weight gain and BP
68
potassium recommendations - for pt with chronic uremia
60-70 mEq/day | least amount of K+ compared to other conditions
69
potassium recommendations - for pt with hemodialysis
70
70
potassium recommendations - for pt with peritoneal dialysis
usually no restriction
71
sodium recommendations - for pt with chronic uremia
1-3 g/day | lowest restriction compared to other conditions
72
sodium recommendations - for pt with hemodialysis
2-4 g
73
sodium recommendations - for pt with peritoneal dialysis
based on fluid wt gain and BP
74
complications of hemodialysis
``` disequilibrium syndrome muscle cramps hemorrhage air embolus hypotension anemia cardiac dysrhythmias infection ```
75
complications of peritoneal dialysis
``` protein loss peritonitis hyperglycemia respiratory distress bowel perforation infection ```
76
hemodialysis is started on these patients immediately
``` fluid overload that doesn't respond to diuretics pericarditis uncontrolled HTN neurologic problems development of bleeding ```
77
complications of AV access
``` thrombosis stenosis infection aneurysm formation ischemia HF ```
78
s/s of disequilibrium syndrome
``` headache nausea vomiting restlessness decreased LOC seizures coma death ```
79
treatment for disequilibrium syndrome
anticonvulsants | barbiturates
80
manifestations of peritonitis
``` cloudy dialysate outflow (earliest sign) fever abd tenderness abd pain general malaise n/v ```
81
post of care following kidney transplant
monitor output at least hourly for 48 hours urine pink/bloody right away, gradually turns normal over several days to weeks catheter might be used, remove in 3-7 days mannitol may be prescribed q2-4 hrs: measure BP, I&O
82
clinical manifestations of hyperacute rejection
increased temp increased BP pain at transplant site
83
clinical manifestations of acute rejection
``` oliguria or anuria temp over 100 increased BP enlarged tender kidney lethargy increased creatinine, BUN, K+ fluid retention ```

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