T6: Acute Kidney Injury

Question 1

Acute Kidney Injury (AKI)

Answer 1

rapid (sudden) loss of renal function due to damage to the kidneys; formerly called acute renal failure

Question 2

AKI is accompanied by a rise in

Answer 2

serum creatinine level and/or a reduction in urine output

Question 3

mean arterial pressure for the kidney

Answer 3

60

Question 4

GFR tells you

Answer 4

how effective the kidney is

Question 5

azotemia

Answer 5

an accumulation of nitrogenous waste products [urea nitrogen, creatinine] in the blood

Question 6

pre-renal acute kidney injury

Answer 6

factors that reduce systemic circulation causing reduction in renal blood flow

Question 7

pre-renal causes

Answer 7

*Severe dehydration,
*heart failure,
*↓ CO

Question 8

HINT HINT: Prerenal azotemia results in

Answer 8

üreduction in the excretion of sodium (less than 20 mEq/L), increased salt and water retention, and decreased urine output.

Question 9

intrarenal acute kidney injury

Answer 9

causes include conditions that cause direct damage to kidney tissue

Question 10

intrarenal acute kidney injury causes

Answer 10

kindey stones, kidney cancer/tumors, DRUGS (nephrotoxic), bullet, crushed in accident, ect trauma

Question 11

Postrenal acute kidney injury

Answer 11

occurs with urinary tract obstructions that affect the kidneys bilaterally

Question 12

Postrenal acute kidney injury causes

Answer 12

*Benign prostatic hyperplasia (BPH)
*Prostate cancer
*Calculi
*Trauma
*Extrarenal tumors
*Bilateral ureteral obstruction

Question 13

HINT HINT: what is the rifle classification

Answer 13

used to describe the stages of AKI

Question 14

RIFLE classification

Answer 14

Risk (R)
Injury (I)
Failure (F)
Loss (L)
End-stage renal disease (E).

Question 15

what labs do we use to check for kidney failure

Answer 15

BUN and CRE

Question 16

oliguria UO amount

Answer 16

less than 400mL/day

Question 17

oliguric phase occurs within

Answer 17

1-7 days after injury

Question 18

oliguric phase lasts

Answer 18

10-14 days

Question 19

oliguric phase: fluid volume

Answer 19

Decreased urine output fluid retention:
*Neck veins distended
*Bounding pulse
*Edema
*Hypertension
*Fluid overload can lead to heart failure, pulmonary edema, and pericardial and pleural effusions

Question 20

oliguric phase: metabolic acidosis

Answer 20

*Impaired kidney cannot excrete hydrogen ions
*Serum bicarbonate production is decreased
*Severe acidosis develops
*Kussmaul respirations

Question 21

oliguric phase: potassium excess

Answer 21

*Impaired ability of kidneys to excrete potassium
*Increased risk with massive tissue trauma
*Usually asymptomatic
*ECG changes

Question 22

oliguric phase: hematologic disorders

Answer 22

leukocytosis

Question 23

oliguric phase: waste product accumulation

Answer 23

*Elevated BUN and serum creatinine levels

Question 24

oliguric phase: neuro disorders

Answer 24

*Fatigue and difficulty concentrating
*Seizures, stupor, coma

Question 25

Daily urine output

Answer 25

1-3L

Question 26

HINT HINT Diuretic phase

Answer 26

During the diuretic phase of AKI, daily urine output usually is around 1 to 3 L but may reach 5 L or more

Question 27

diuretic phase urine output

Answer 27

5L or more

Question 28

what needs to be monitored in the diuretic phase

Answer 28

*hyponatremia, hypokalemia, and dehydration

Question 29

recovery phase

Answer 29

*The recovery phase begins when the GFR increases, allowing the BUN and serum creatinine levels to decrease. Major improvements occur in the first 1 to 2 weeks of this phase, but kidney function may take up to 12 months to stabilize.

Question 30

diagnostics for AKI

Answer 30

*Thorough history *Serum creatinine *Urinalysis *Kidney ultrasonography *Renal scan *CT scan *Renal biopsy

Question 31

contraindicated diagnostics for AKI

Answer 31

*MRI with gadolinium contrast medium *Magnetic resonance angiography (MRA) with gadolinium contrast medium *Nephrogenic systemic fibrosis *Contrast-induced nephropathy (CIN)

Question 32

In patients with diabetes receiving metformin, the drug should be held for

Answer 32

48 hours prior to and after the use of contrast media to decrease the risk of lactic acidosis.

Question 33

position after kidney biopsy

Answer 33

lay patient on side of body that kidney was biopsied and check the skeets, kidneys are very vascular so you want to put pressure on it

Question 34

how to Ensure adequate intravascular volume and cardiac output in AKI

Answer 34

*Force fluids *Loop diuretics (e.g., furosemide [Lasix]) *Osmotic diuretics (e.g., mannitol)

Question 35

interventions for hyoerkalemia

Answer 35

*Insulin and sodium bicarbonate *Calcium carbonate *Sodium polystyrene sulfonate (Kayexalate)

Question 36

Renal replacement therapy (RRT)

Answer 36

a treatment that replaces kidney function; the treatment may be some type of dialysis or it may be kidney transplantation

Question 37

Peritoneal dialysis (PD)

Answer 37

The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane

Question 38

Continuous renal replacement therapy (CRRT)

Answer 38

-Typically done in an ICU setting and is continuous, so the patient doesn't have drastic fluid shifts -DONE 24 hr 7 days a week to slowly pee all day long

Question 39

*Indications for renal replacement therapy (RRT)

Answer 39

*Volume overload *Elevated serum potassium level *Metabolic acidosis *BUN level > 120 mg/dL (43 mmol/L) *Significant change in mental status *Pericarditis, pericardial effusion, or cardiac tamponade

Question 40

*Nutritional therapy

Answer 40

*Maintain adequate caloric intake *Primarily carbohydrates and fat *LIMIT protein *RESTRICT sodium *Increase dietary fat *Enteral nutrition

Question 41

nursing implementation: acute care

Answer 41

*Accurate intake and output *Daily weights *Assess for signs of hypervolemia or hypovolemia *Assess for potassium and sodium disturbances *Meticulous aseptic technique *Careful use of nephrotoxic drugs *Skin care measures/mouth care

Question 42

nursing interventions: ambulatory care

Answer 42

*Regulate protein and potassium intake *Follow-up care *Teaching *Appropriate referrals

Question 43

Gerontologic Considerations: why are they more susceptible to AKI

Answer 43

*Dehydration *Polypharmacy- diuretics, laxatives *Illness and immobility *Hypotension *Diuretic therapy *Aminoglycoside therapy *Obstructive disorders *Surgery Infection