409 Final 3 (AKI)

Question 1

In oliguric phase, you’re concerned with ___ ___ and build up of ___ __

Answer 1

electrolyte imbalance and build up of nitrogenous waste

Question 2

In the diuretic phase, you’re concerned with ___ ___ and ___

Answer 2

electrolyte LOSS and hypovolemia

Question 3

In the diuretic phase, you really concerned with replacing

Answer 3

fluids and electrolytes

Question 4

If the patient has prerenal AKI but they’re not oliguric and don’t have fluid overload, give

Answer 4

give fluids and diuretics

Question 5

These patients may need invasive techniques for measuring

Answer 5

BP

Question 6

Also in oliguric patients you’re always watching out for signs of

Answer 6

fluid overload

Question 7

The body starts breaking down muscle because

Answer 7

it needs to replace the protein lost

Question 8

Muscle breakdown causes an increase in

Answer 8

BUN

Question 9

In AKI, the amount of fluids they should take is usually the output + 500 ml, but

Answer 9

it might depend on their status

Question 10

Sometimes AKI affects their appetite, so

Answer 10

they might need TPN or other supplement

Question 11

____ is used when heart failure causes kidney injury

Answer 11

Digoxin

Question 12

___ ___ and ___ ___ may be used if the patient is on dialysis and they’re losing important vitamins/minerals

Answer 12

folic acid and ferrous sulfate

Question 13

If you have too much phosphate you could develop

Answer 13

hypocalcemia

Question 14

Don’t take phosphate binders within 2 hours of

Answer 14

taking digoxin

Question 15

Ferrous sulfate should be taken

Answer 15

with meals

Question 16

If you’re taking an iron supplement, you may also need a

Answer 16

stool softener

Question 17

HD: with triple lumen catheters, the 3rd lumen

Answer 17

can be used for drawing blood and giving meds without interrupting the dial

Question 18

An example of Continuous Renal Replacement is

Answer 18

hemofiltration

Question 19

The nice thing about hemofiltration (a type of CRR) is that its more

Answer 19

more tolerable than HD for critically ill ppl

Question 20

Post hospital care: Even if the AKI is resolving, they still need to

Answer 20

come back frequently for blood/urine tests

Question 21

Post hospital care: They might still need

Answer 21

dial

Question 22

Post hospital care: tell them to limit p____, p____, s____, p____

Answer 22

protein, potassium, sodium, phosphate

Question 23

Post hospital care: they may or may not need to limit

Answer 23

fluids

Question 24

Patho: when there’s not enough perfusion to the kidneys, the body responds with 3 main things

Answer 24

vasoconstriction
RAAS
ADH

Question 25

Patho: overall the body’s responses are to

Answer 25

maintain blood volume and therefore improve perfusion to the kidneys

Question 26

Patho: overall the body’s responses are to maintain blood volume and therefore improve perfusion to the kidneys. The downside is this also causes ___ and ___

Answer 26

oliguria and azotemia (because the body is now holding in nitrogenous wastes)

Question 27

RBC casts can be found in the urine because

Answer 27

the kidney cells are dying and sloughing off

Question 28

If fluid/pressure build up inside the kidney (intrarenal) the GFR

Answer 28

stops because theres too much opposing pressure to filter.

Question 29

If fluid/pressure build up inside the kidney (intrarenal) the GFR stops because theres too much opposing pressure to filter. The lack of filtering means

Answer 29

wastes pile up in the blood. Wastes like BUN and creat

Question 30

BUN should be

Answer 30

10 to 20

Question 31

Creat should be

Answer 31

.5 to 1

Question 32

Oliguric phase:
H\_\_\_\_
decreased \_\_\_\_\_
H\_\_\_\_
Hypo\_\_\_\_

Answer 32

hyperkalemia
decreased bicarb
Hyperphosphatemia (which is why you need phosphate binders)
Hypocalcemia

Question 33

in the Oliguric phase, you actually have more sodium retained but

Answer 33

its diluted because your holding more water

Question 34

Diuretic phase: you’re losing ____ and ____ wastes

Answer 34

electrolytes and nitrogenous wastes

Question 35

Diuretic phase: a little later in the diuretic phase, the BUN

Answer 35

decreases (which is good)

Question 36

Recovery phase: Patients will still be tired during this phase, as they recover. Its also normal to have

Answer 36

abnormal kidney test values for a while

Question 37

Some patients don’t have the oliguric phase; in this case the urine volume is normal BUT

Answer 37

the creat will be increased

Question 38

It’s important to note that even in healthy people you can have AKI is

Answer 38

dehydration occurs (which is why I and O are important)

Question 39

Signs of decreased fluid volume include:
increased s___ b__ p___
decreased p___ p___
th___

Answer 39

increased systolic BP
decreased pulse pressure
thirst

Question 40

the earliest sign of tubular damage is

Answer 40

decreased urine SG

Question 41

Watch out for nephrotoxic drugs like ___ and ___

Answer 41

abx and NSAIDs

Question 42

In prerenal AKI the BP will be ___, but in intrarenal it’ll be

Answer 42

hypo, hyper

Question 43

in intrarenal AKI, because the fluid is backing up, not only do you have htn, you have

Answer 43

edema and fluids in the lungs

Question 44

In intrarenal AKI, you could have ECG changes caused by

Answer 44

increased K

Question 45

In prerenal AKI, the urine is concentrated, the SG will be

Answer 45

over 1030

Question 46

In intrarenal and post renal, SG is

Answer 46

dilute, less than 1010

Question 47

X rays and US can show ___ size and ___

Answer 47

kidney size and obstructions

Question 48

Biopsy may be done if

Answer 48

the cause of AKI is unclear