4 AKI Flashcards
Normal GFR
80-125
Prerenal AKI
Injury before kidney
(Hypovomeia/vasodilation/decreased CO)
Intrarenal AKI
Within kidney
Acute tubular necrosis
(kidneys become toxic from meds):
—aminoglycosides
—vancomycin
—NSAIDS
—IV contrast dye
Do what if patient needs contrast but has high creatinine?
Meds or bolus to protect them
Postrenal AKI
Obstruction of flow of urine
(Post void residual >100)
—not emptying bladder
Treatments for intrarenal AKI
Diuretics
Dopamine (improve renal perfusion)
Nacetylcysteine (prophylactic prior to IV contrast)
How often to check a trough level for ABX?
30 min prior to giving med
Leading cause of AKI (nephrotoxicity)
—what it damages?
—lab we see (when we see it)
—tx
Damages tubule cells and reduce blood flow
Lab:
Increased serum creatinine within 48-72hrs
Tx:
—IV fluids
—acetylcysteine (mucomyst)
Phases of AKI
Initiation/onset phase
Maintenance phase
Recovery phase
Initiation/onset phase of AKI
What is taking place
Time
Time event until change in UOP
Hours to days
Maintenance phase of AKI
Another name for phase
Symptom (1)
Complications (3)
Anuric/oliguric phase
<400ml/no urine
Complications:
—hyperkalemia
—infection
—uremic
Recovery phase of AKI
What happens
When does it take place
UOP increases / Labs improve
Takes 4-6months
Assessment
VS?
Respiratory?
Cardiac?
VS:
HTN
Increased RR (compensation for acidosis)
Resp/cardiac:
Fluid overload
Assessment
Hematologic
Electrolyte/acid/base
Hematologic:
—decreased erythropoietin/RBCs
Electrolyte/acid/base:
—metabolic acidosis
—hyperkalemia
—hypocalcemia
—hyperphophatemia
Uremic toxins
Cause:
What are normal creat/BUN
Anorexia
Encephalopathy
uremic frost on skin
Labs:
Creatinine: 0.6-1.2
BUN: 8-20
Fluid volume excess s/s
3 s/s
1 lab
1 tx
S/S:
—HTN
—Crackles
—JVD
Lab:
—Decreased HCT
TX:
—Diuretics
Preventing AKI (2)
—avoid what (4)
—optimize what?
-2 vitals
-hydrate with what
-hold what
Avoid nephrotoxins
(contrast/aminoglycosides/NSAIDS/ACE/ARB)
Optimize volume before procedures:
—UOP: 0.5-1ml/kg/hr
—MAP >80
Hydrate w/ NS before and after contrast dye
Hold diuretics before procedures
Preventuion of AKI
Reduce what?
-2 things
Aggressively treat what?
-most common cause of AKI
Reduce nosocomial infections:
—CAUTI
—Asepsis w/ IV lines
Treat sepsis aggressively:
—HOTN most common cause of AKI
Electrolyte imbalances with AKI
Hyperkalemia/hyponatremia
—s/s
—tx
Hyperkalemia:
—weakness/cramps/EKG changes
Tx: kayexlate/insulin/dextrose/bicarb
Hyponatremia:
—confusion/sz/n/v
Tx: increase UOP to decrease NA dilution
Electrolyte imbalances with AKI
Hypocalcemia/hyperphosphatemia
—s/s
—tx
Hypocalcemia:
—laryngospasms/stridor/chvostek/trousseau sign
Tx: ca supplement
Hyperphosphatemia:
—similar to s/s
TX: ca supplement, phosphorus binding meds
2 principles of dialysis
Diffusion:
-clear waste
Ultrafiltration:
-remove water by osmosis (control fluid volume)
Vascular access for dialysis
—how often to change dressing
—risks (2)
—must ensure what?
—do not what?
Change q7days
Risk: infection/bleeding
Must ensure clamps are closed when not in use
Do not use to infuse meds
Vascular access for dialysis:
Fistulas are what?
Auscultate what
Palpate what
Limb alert (no what 3 things in that arm)
Fistulas (permanent)
Auscultate a bruit
Palpate a thrill
No:
—BP
—blood draws
—infections
Dialysis complications
Avoid administering what for how long before tx
HOTN
Dysrhythmias
Blood clots within filter (USE HEPARIN)
Avoid administering HTN meds 4-6hr before tx
