Exam 3 Flashcards
What are the phases of AKI?
oliguric: urinary output<400 mL/day, occurs within 1-7 days after injury (if caused by ischemia can occur earlier), lasts 10-14 days, UA shows casts, RBC, and WBC, fluid retention seen (bounding pulse, JVD, edema, HTN, crackles), metabolic acidosis (kassmaul respirations), hyponatremia (confusion), hyperkalemia (weakness, muscle twitching, EKG changes (peak T, wide QRS, ST depression)), leukocytosis, elevated BUN and crt
diuretic: urinary output 1-3L (caused by osmotic diuresis, unable to concentrate urine), lasts 1-3weeks, near end of phase labs start to stabilize, monitor for dehydration and hypo-Na/K
recovery: begins when GFR starts to increase, most improvement in first 1-2wks, may take up to 12 months for kidney function to stabilize (affected by pt’s overall health, comorbidities, how severe AKI was, age)
What can cause pre-renal AKI?
reduce in systemic circulation causing a reduction in renal blood flow: severe dehydration, HF, severe blood loss (surgery/trauma)
What can cause intrarenal AKI?
conditions that cause direct damage to kidney tissue causing impaired nephron function: #1 cause: acute tubular necrosis, prolonged ischemia (usually secondary to significant hypovolemic states such as vomiting, diarrhea, burns, too many diuretics, HF) and nephrotoxins (aminoglycosides, IV contrast, sulfa, antivirals, anti-rejection drugs, ACE inhibitors, ARBS), hemoglobin (released from hemolyzed RBC), myoglobin (released from necrotic muscle cells)
What is acute tubular necrosis?
1 cause of intrarenal AKI
damaged epithelial cells slough off and block tubules as a result from ischemia, nephrotoxins, or sepsis
severe ischemia causes disruption in basement membrane and patchy destruction of tubular epithelium
nephrotoxins cause necrosis of tubular epitehlial cells
potentially reversible if basement membrane is not destroyed and tubule epithelium regenerates
What are causes of postrenal AKI?
mechanical obstruction of outflow causing urine reflux into renal pelvis: BPH, prostate cancer, calculi, trauma, extrarenal tumors
What is CRRT?
continuous renal replacement therapy
most closely mimics physiologic filtration by kidneys by filtering continuously and removing solute by convection, osmosis, and diffusion
can be continued for 30-40 days, ultrafiltrate should be clear yellow
What are early signs of autism spectrum disorders?
behavioral indications present by 12-24 months
limited: response to name/orienting, affect sharing, joint attention (response and initiation), language/gesture use
increased: repetitive object use, abnormal body movements, temperament dysregulation
What screening tools are used to help diagnose ASD?
modified checklist for autism in toddlers: administered 18 months and 24 months but also can be for 16 to 30 months
autism diagnostic observation schedule, second edetion (ADOS-2)
What is the difference between clinical and educational diagnosis?
clinical: conducted by clinician
educational: conducted by school personnel, usually a team, consisting of people who are familiar with the child
What is required for a diagnosis of autism?
neurological condition causing: deficits in social communication, presence of restricted and repetitive behavior
What type of communication deficits are seen with ASD making relationships hard?
social-emotional reciprocity
nonverbal communication behaviors
developing, maintaining, and understanding relationships
What is the intervention of ASD?
comprehensive program involving teaching of specific behaviors
intervention begins early and is intensive
involves family
individualized to child
designed and delivered by interdisciplinary teams
objectives should target social interaction, communication, play, positive behavior supports
progress should be evaluated frequently
What are risk factors for ASD?
genetics
being a younger sibling of a child with autism
older parents
premature birth
low birth weight
perinatal: low apgar score, very short or long inter-pregnancy interval
What is a relapse versus psuedorelapse of MS?
relapse: primarily inflammation, new neurologic symptom lasting 24+ hrs
psuedorelapse: recurrent symptoms brought on by stress, heat, exhaustion, depression/anxiety, or anxiety (when body gets stressed they cannot accommodate for any more than they already have been and so their own symptoms return, once treat stressor things will return to normal)
What are symptoms of MS?
do not affect mobility: fatigue, depression, tremor, neurogenic bladder (overactive or retaining), sexual dysfunction, pain, vertigo, seizures, vision difficulties, cognition difficulties (memory loss, brain fog, word finding)
affect mobility: spacticity, ataxia, pain, foot drop, weakenss, contractures, tremor, sensory loss, fatigue, cognition, vision
