S4E2

Question 1

Name that condition….

Sudden decrease in renal function
Build up of waste, fluid & electrolytes

Answer 1

Acute kidney injury / Acute renal failure

Question 2

What’s happening during prerenal AKI

Answer 2

Issue with perfusion to kidney
⬇️ blood supply to filter
⬇️vascular nutrition
Oxygenation
Vascular

Question 3

Prerenal AKI can lead to

Answer 3

Intrarenal injury

Question 4

Causes of prerenal AKI

Answer 4

Cardiac issues (MI, ⬇️CO)
Massive internal/external bleeding
Dehydration/hypovolemia
Burns

Question 5

Intrarenal AKI damage is…

Answer 5

Damage to The nephrons
⬇️ability to filter blood, remove waste
Excessive water build up
Can’t maintain electrolyte levels

Question 6

Intrarenal AKI causes

Answer 6

Nephrotixic drugs
Infection : glomerulonephritis
Injury

Question 7

Nephrotoxic drugs

Answer 7

NSAIDs
Antibiotics :aminoglycoside family
Chemo drugs
Contrast dye

Question 8

Post renal AKI is

Answer 8

Blockage in urinary tract after the kidney to the urethra that prevents urine drainage
⬆️pressure in kidneys
⬆️waste in kidneys
⬇️kidney function

Question 9

Causes for post renal AKI

Answer 9

Renal calculi
Enlarged prostate
Neuro injury(bladder doesn’t empty completely)

Question 10

Creatinine levels

Answer 10

0.6-1.2

Question 11

Labs associated with AKI

Answer 11

Creatinine levels
Creatinine clearance
Glomerular filtration rate: GFR
BUN

Question 12

⬆️ creatinine means…

Answer 12

⬇️ kidney function

Question 13

Female creatinine clearance level

Answer 13

85-125

Question 14

Male creatinine clearance level

Answer 14

95-140

Question 15

Normal GFR

Answer 15

> 90

Question 16

⬇️GFR will lead to

Answer 16

⬇️UOP
⬆️water build up
⬆️waste and electrolytes imbalance

Question 17

Normal BUN level

Answer 17

6-20

Question 18

INITIATION stage of AKI

Answer 18

First stage
Starts with cause
Ends with s/s appear ( hrs-days)

Question 19

OLIGURIC stage of AKI

Answer 19

2nd stage

UOP <400 ml/day (⬇️GFR)
⬆️BUN & Creatinine
⬆️hyperkalemia >5.1
⬆️fluid in body
Metabolic acidosis
⬇️pH <7.35
⬇️mild hyponatremia
⬆️phos
⬇️cal
⬆️⬆️urine specific gravity >1.020

Question 20

What AKI stage can pts possibly skip

Answer 20

OLIGURIC stage

Question 21

OLIGURIC stage s/s

Answer 21

Neuro changes: Sluggish, Tired
Itching (from waste)
Tall peak T waves
Wide QRS
Prolonged PR intervals
Edema
Risk of pulm & cardiac issues
Htn
Confusion
Kussmaul breathing (deep&rapid)

Question 22

Nursing management for OLIGURIC stage

Answer 22

Low protein diet
Fall safety
Restrict potassium foods
EKG
Labs
Kayexalate po / rectal (⬇️ potassium)
Fluid restriction
Strict I/Os
Daily wts
Monitor BP
Lung sounds
O2 sat
Monitor swelling
Resp status
Monitor electrolyte foods

Question 23

Initiation stage nursing management

Answer 23

Find cause and correct to prevent damage to nephrons

Question 24

OLIGURIC stage time frame

Answer 24

1-2weeks
Shorter is better to decrease risk of nephrons damage

Question 25

Diuresis stage of AKI

Answer 25

Stage “3” Nephrons on the way to recovery Filters blood but can’t concentrate urine Improving GFR, BUN, Creat. (still abnormal)

Question 26

Diuresis stage s/s

Answer 26

Increase mental status Voiding 3-6L/day Hypovolemia Dehydration Hypotension Hypokalemia

Question 27

How long can Diuresis stage last

Answer 27

1-3 wks

Question 28

Diuresis stage nurse management

Answer 28

Strict IOs Daily wts S/s of dehydration Supplements IV fluids

Question 29

Recovery stage of AKI

Answer 29

Last stage Starts when: GFR, BUN, creat & electrolytes = normal Everything maintained

Question 30

How long is Recovery stage

Answer 30

Depends how much damage was done and pt age. Up to a year or more

Question 31

What if a pt doesn’t make it to recovery stage of AKI

Answer 31

Chronic kidney disease or end stage renal failure

Question 32

What stage of CKD Normal function Proteinuria GFR >90 3m or more

Answer 32

Stage 1

Question 33

What stage of CKD Mild loss of function Proteinuria GFR 60-89 3m or more

Answer 33

Stage 2

Question 34

What stage of CKD Mild to severe loss of function GFR 20-59

Answer 34

Stage 3

Question 35

What stage of CKD Severe loss of function GFR 15-29

Answer 35

Stage 4

Question 36

What stage of CKD End stage GFR <15

Answer 36

Stage 5

Question 37

When GFR decreases it leads to:

Answer 37

⬆️ urea ⬆️ creatinine Hypervolemic ⬇️ UOP

Question 38

UOP <400 ml/day

Answer 38

Oliguria

Question 39

UOP <100 ml/day

Answer 39

Anuria

Question 40

Types of burns

Answer 40

Thermal Chemical Electrical Recitation Smoke Inhalation

Question 41

Under 2/over 60 yo Burn risk factors

Answer 41

<2 -minimal protein stores -immature immune system -intolerant of fluid shifts >60 -immunocompromised -diabetes healing

Question 42

Past medical hx risk factors

Answer 42

Immunocompromised Diabetes Tetanus shot after 5 years

Question 43

Other burn risk factors

Answer 43

Adaptability Coping Concomitant injury(other injuries) Body size

Question 44

How to classify a burn

Answer 44

Extent of burn Depth of burn Location

Question 45

Rule of 9’s is used for…

Answer 45

Extent of burn

Question 46

1sr degree burn

Answer 46

Epidermis Superficial Redness Painful Blisters later

Question 47

2nd degree burn

Answer 47

Dermis vascular instant blister nerves severe body pain swelling Edema shiny epithelial regeneration possible

Question 48

Third-degree burns

Answer 48

That tissue expose muscle/bone decrease blood flow

Question 49

4thdegree burns

Answer 49

Dry waxy White Leathery/hard skin Visible thrombosed vessels Insensitive to pain Soft tissue or bones involved Surgery needed (graft/escharotomy)

Question 50

Emergent phase of burn

Answer 50

Burn onset-5 days Resolve immediate problems Fluids are shifting Evaporation Loss of RBC ⬆️H&H

Question 52

Emergent burn complications

Answer 52

Fluid shift is worst in the first 24 Hypovolemia Edema Dehydration Shock Hypothermia Hyponatremia Hyperkalemia Hemoconcentration Upper airway burns Inhalation injuries Dysthymias Acute tubular necrosis

Question 53

Emergent burn nurse management

Answer 53

Airway: Oxygen Intubation/mechanical vent IV/Central Line Access IVF Meds TPN Fluid therapy Parkland formula Fluid resuscitation Titrate to pt response Hourly UOP VS S/s of hypervolemia Wound care Drug therapy Nutritional therapy Eval outcomes

Question 54

Parkland formula

Answer 54

4g/kg/%TBSA=24 hrs 1/2 in first 8 hrs 1/4 next 8 hrs 1/4 in the next 8 hrs

Question 55

Burns acute phase

Answer 55

_>_ 5 days Mobilization of extracellular fluids Diuresis Burn is completely covered/healed Eschar Hyponatremia Hypokalemia

Question 56

Acute burn phase complications

Answer 56

Infection CV Resp Neuro GI Paralytic ileus (stress) Diarrhea (tube feeding) Altered nutrition (body needs)

Question 57

Acute burn phase nurse management

Answer 57

ABCs Wound care Pain management Nutrition therapy 2-4gm/kg 3500-5000cals/day Supplements PT/OT Psychosocial Comfort (drug therapy)

Question 58

Wound care for acute burn phase

Answer 58

Goal: prevent/minimize further destruction, promote comfort Daily observation/assess Dressing changes Skin graft Escharotomy Silver sulfadiazine

Question 59

Burn rehab phase

Answer 59

Months after burn Pt must be self-motivated Burn is covered or healed Capable of self-care activity F/E/UOP are normal Goals based on pt/fam/support system

Question 60

Rehab burn phase complications

Answer 60

Altered body image Ineffective coping Contractures Scarring

Question 61

Burn rehab phase nurse management

Answer 61

Assist with resume functional role in society (with PT/OT) Accomplish functional cosmetic reconstruction Support pt/fam psychosocial needs Comfort Positions ROM Splints Scarring Emollients Antihistamines(itching) Pressure suit Splints Neutral position

Question 62

Normal sodium

Answer 62

136-145

Question 63

Normal potassium

Answer 63

3.5-5

Question 64

What is added to fluids to keep fluids intravascular?

Answer 64

Albumin