Excessive urine production Producing > 2,000/24mL hr

Fluid and Electroytes lecture Flashcards by Courtney Quintana

Acronym for maintaining Homeostasis in the body

A: Acid-Base Balance
W: Water removal: regulate fluid, ADH (Vasopressin)
E: Erythropoiesis: Production of RBC’s
T: Toxin Removal: waste products, urea, renal clearance
B: Blood pressure regulation: renin
E: Electrolyte Balance
D: Vitamin D activation

A WET BED

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Where does ADH come from and what is the purpose of ADH?

posterior pituitary gland; tells kidneys to hold on to more water

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What elevated labs can be indicitive of unhealthy kidneys?

Urea
Creatinine
Potassium

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Urine production <100 mL/24hr

Anuria

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What is anuria?

Urine production <100 mL/24hr

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Urine Production < 400 mL/24hr

Oliguria

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What is oliguria

Urine Production < 400 mL/24hr

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Excessive urine production
Producing > 2,000/24mL hr

Polyuria

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What is polyuria

Excessive urine production
Producing > 2,000/24mL hr

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Infection of the kidney’s medulla or cortex

Pyelonephritis

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Inflammation of the glomerular capillary wals, causing impaired filtration

Glomerulonephritis

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Medications used to manage renal failure patients

Angiotension-converting enzyme or ACE Inhibitors
Angiotension Receptor Blockers or ARB’s
Inotropic agents
Diuretics
Regular insulin and Dextrose
Epoetin Alfa
Iron supplements
Magnesium base antacids

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Enalapril is an example of what type of medication?

ACE Inhibitor

Angiotension Converting enzyme inhibitor

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Losartan is an example of what kind of medication?

ARB

Angiotension Receptor Blocker

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Medications that can reduce proteinuria and slow progression of kidney disease in diabetics

ACE Inhibitors & ARB’s

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Medications that can manage heart failure and pulmonary edema

Inotropic agents and diuretics

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Medications that can increase H&H

Epoetin alfa & Iron

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Patients with poor kidney function should avoid what OTC medication and why?

Magnesium based antacids due to high risk of toxicity

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Abrupt decline in renal function

Acute Kidney Injury or AKI

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Classifications of AKI causes

Pre-renal
Intra-renal
Post-renal

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What classifaction of AKI cause is this:

Sudden and severe drop in BP, shock, or interruption of blood flow to the kindeys from severe injury or illness

Pre-renal

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What classifaction of AKI cause is this:

Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

Intra-renal

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What classifaction of AKI cause is this:

Sudden obstruction of the urine flow due to enlarged prostate, kidney stones, bladder tumor or injury

Post-renal

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Is AKI reversible?

YES

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List some nephrotoxic medications

* Amnioglycosides * Digoxin * Phenytoin * ACE Inhibitors * Magnesium-containing agents * NSAIDs * Contrast Dye * Metformin

Nephrotoxic medications require _______ based on ____________?

adjustment, kidney clearance and function

Gentamycin and vancomycin are examples of what?

Amnioglycosides

Name the phases of AKI

1. Initiation 2. Oliguria 3. Diuresis 4. Recovery

# What phase of AKI is this? Urine output is still normal, pt usually does not know they are sick

Initiation or Non-oliguric

# What phase of AKI is this? * Urine output minimun approximately 400mL/24 hrs or 0.5mL/kg/hr * Increase uremic symptoms * Hyperkalemia

Oliguria

# What phase of AKI is this? Gradual increase in urine output and lab values begin to decrease but renal functions still abnormal

Diuresis

# What phase of AKI is this? * Can last 3-12 months * Labs begin returning to normal

Recovery

What is the term used when urea, nitrogen, creatinine wase in blood?

Azotemia

What is Azotemia?

Urea, nitrogen, creatinine waste in blood

Expected electrolyte imbalances in AKI pt's

* Increased K * Increased Phos * Decreased Ca * Decreased Na

What is uremia

Excess urea in blood causing renal decline and involving multiple body systems

Clinical manifestations of AKI

* Azotemia * Increased BUN and Creatinine * May or may not have oliguria * FVO * Electrolyte imbalances * Metabolic acidosis * Edema * Anemia * Uremia * Anorexia * N/V/D * Confusion * Lethargy * Seizures

Expected BUN and Creatinine for AKI patients

Elevated

What is a waste product of protein metabolism?

Urea

If AKI is found to be severe what may be required?

emergency or temporary dialysis

Diet required for AKI patients

* Adequate protein * Increased carbs * Low Na * Low K * Fluid restriction

What is the Goal when treating AKI?

eliminate cause and prevent complications!

During treatment for AKI, after the initial fluid replacement what is done?

Fluids are restricted

Management of AKI

* Monitor BP, HR, Temp, Strict I/O, skin color, and respiratory status * Eliminate cause and prevent complications * Monitor fluid balance by daily weights and serum Na * Avoid K in IV fluids an restrit in diet to avoid hyperkalemia * Diet with adequate protein, increased carbs, low Na * May require emergency/temporary dialysis if severe

ECG Peaked/Tall 'T' waves can indicate what?

Hyperkalemia

Medications used to treat AKI

* Diuretics * Sodium polystryrene sulfonate or Kayexalate * Calcium chloride/calcium gluconate * Sodium Bicarbonate, insulin, and glucose

Examples of diuretics

* Lasix or Furosemide * Mannitol * Bumex or Bumetanide

This medication is used to treat AKI Can be given PO or enema Exchanges Na or K to treat hyperkalemia

Sodium polystryene sulfonate or Kayexalate

Medications given to AKI pt's that help enhance reuptake of K into cell

* Sodium Bicarbonate * Insulin * Glucose

Expected findings in children with AKI

* Oliguria w/ sudden return to normal O/P * Drowsiness * Gross hematuria * Edema * FVO * Tachypnea * CNS manifestations * Cardiac arrythmias

# These are clinical manifestations of AKI in what age group? * Oliguria w/ sudden return to normal O/P * Drowsiness * Gross hematuria * Edema * FVO * Tachypnea * CNS manifestations * Cardiac arrythmias

Children

Clinical manifestation of AKI in older adults

* Oliguria may not be present * At greater risk for AKI * Structural changes

Progressive, irreversible loss of kidney function with decreased GFR lasting for 3 months or more

Chronic Kidney Disease or CKD

Risk factors for CKD

* Diabetes * HTN * CV disease * Obesity * Glomerulonephritis * Pyelonephritis * Polycystic kidney

Genetic growth of cysts in kidneys which replace normal structures and functions

Polycystic Kidney disease or PKD

# What stage of CKD is this? * GFR > 90 * Kidney damage with GFR WNL or increasing * DX/RX of underlying condition and comorbidities

Stage 1

# What stage of CKD is this? * GFR 60-89 * Mild * Estimate the rate of progression

Stage 2

# What stage of CKD is this? * GFR 30-59 * Moderate * Evaluate and treat complications

Stage 3

# What stage of CKD is this? * GFR 15-29 * Severe * Preparing for renal replacement therapy

Stage 4

# What stage of CKD is this? * GFR <15 * Kidney Failure * Dialysis or transplantation of uremic

Stage 5 | also called end-stage renal disease or ESRD

Prevention methods for CKD

* Aggressive management of chronic diseases * Low Na diet * Regular exercise and manage weight * Avoidance of smoking * Limiting ingestion of alcohol * Limit OTC NSAIDs

Low Na can be corrected with what?

Oral or IV supplementation

Pt with reduced production of ADH can cause ________ and can be treated by administering ________

Hypernatremia or high Na, ADH

Low K can be caused by what medication class

Diuretics

How to treat Hyperkalemia

* Calcium Chloride or Calcium gluconate and sodium bicarb * Glucose and insulin * Kayexalate

* Medications that correct hyperkalemia * Given initally to treat Acute Renal Failure

Calcium Chloride or Calcium gluconate and Sodium Bicarb

* Medications used to correct hyperkalemia * Can help drive K back into cell where elevates levels will create less risk

Glucose and insulin

What electrolyte can help treat hyperkalemia and assist in reducing the irritability of the heart

Calcium

If calcium is low phosporus is ___

high

Calcium Chloride or Calcium Gluconate are administered with phosphate binders and sevelamer hydrochloride to treat what?

Low calcium High Phos

Fluids and diuretics in RF patients or dialysis are used to get rid of excess what?

Potassium and Magnesium

Elevated BUN and Creatinine is indicitive of what?

Renal failure

Creatinine >50-80

Mild renal failure

Creatinine 30-50

Moderate renal failure

Creatinine < 30

Severe renal failure

Normal pH

7.35-7.45

Normal HCO3

22-26

Normal PaCO2

45-35

S/S of Metabolic Acidosis

* Headache * Decreased BP * Hyperkalemia * LOC Changes (Confusion, Lethargy) * Kussmaul Respirations * Muscle twitching * Warm flushed skin (vasodilation) * N/V/D

# The following are S/S of what? * Headache * Decreased BP * Hyperkalemia * LOC Changes (Confusion, Lethargy) * Kussmaul Respirations * Muscle twitching * Warm flushed skin (vasodilation) * N/V/D

Metabolic acidosis

Causes of Metabolic Acidosis

* DKA * Severe diarrhea * Renal failure * Shock

# The followinf are clinical manifestations of what? * Decreased Na, Ca, GFR, urine specific gravity, hgb/hct (chronic anemia) * BUN/Creatinine increased steadily * Increased K, Phos, Mg * Fluid excess * Hematuria * Proteinuria

CKD

Clinical Manifestations of CKD

* Decreased Na, Ca, GFR, urine specific gravity, hgb/hct (chronic anemia) BUN/Creatinine increased steadily * Increased K, Phos, Mg * Fluid excess * Hematuria * Proteinuria

CKD Treatment

* Support remaining function of kidneys * Limit protein intake 0.6-0.8 g/k, increase carbs, restrict Na and K to 2-4 g/day, restrict phos * Limit fluid intake to 1-2 L/day * Monitor daily weight (1-3 kg between dialysis * Renal Replacement therapy/dialysis * Renal transplant

Protein intake for a CKD pt

0.6-0.8g/kg

Amount of Na and K a CKD pt can have per day

2-4 g/day

Examples of foods that should be restricted for CKD patients

* Bananas * citrus fruits * juices * coffee

Daily fluid intake for CKD patients

1-2 L/day

Diet for CKD patients

* Increase carbs * Restrict Na, K, Phos, Protein

Nursing assessment for CKD patient

* Monitor VS, weight, urine OP * Assess dialysis site * Assess skin * Monitor labs * Encourage client and family to discuss fears if new to starting dialysis to provide emotional support

Education for CKD patients

* Importance of keeping dialysis appointments * Dietary restrictions * Smoking cecession * Clinical manifestations of CKD and complications * Avoid nephrotoxic substances * Daily weights * Medication compliance * Support groups available

A client with CKD IV asks what type of diet they should follow. Which diet will the nurse explain to the client? A. low protein, low sodium, low potassium, low phospate diet B. High protein, low sodium, low potassium, high phosphate diet C. low protein, high sodium, high potassium, high posphate diet D. low protein, low sodium, low potassium, high phosphate diet

A. Low protein, low sodium, low potassium, low phosphate

The nurse is reviewinf laboratory results on a client with acute renal failure. Which lab result would be reported immediately? A. Blood urea nitrogen 50 mg/dl B. Hgb 10.3 mg/dl C. Venus blood pH 7.30 D Serum potassium 6 mEq/L

D. Serum Potassium 6 mEq/L

Which S/S indicate ESRD? SATA A. Puritis B. GFR of 30 mL/min C. Uremia D. BUN 18 E. Serum Phos 2.2 mEq/dL F. Chronic anemia

A, C, F

Kidney enlargement caused by urine backing up from the bladder into the kidney or inability of urine to drain from the kidney into the bladder; excessive reflux stretches the kidney, causing functional damage to it

Hydronephritis

How is Hypermagnesmia corrected?

Oral or IV supplumentation

What is the term used to describe excess urea in blood causing renal decline and involving multiple body systems?

Uremia

Fluid and Electroytes lecture Flashcards

F/E, AKI, CKD (98 cards)