409 Final 3 (AKI) Flashcards
In oliguric phase, you’re concerned with ___ ___ and build up of ___ __
electrolyte imbalance and build up of nitrogenous waste
In the diuretic phase, you’re concerned with ___ ___ and ___
electrolyte LOSS and hypovolemia
In the diuretic phase, you really concerned with replacing
fluids and electrolytes
If the patient has prerenal AKI but they’re not oliguric and don’t have fluid overload, give
give fluids and diuretics
These patients may need invasive techniques for measuring
BP
Also in oliguric patients you’re always watching out for signs of
fluid overload
The body starts breaking down muscle because
it needs to replace the protein lost
Muscle breakdown causes an increase in
BUN
In AKI, the amount of fluids they should take is usually the output + 500 ml, but
it might depend on their status
Sometimes AKI affects their appetite, so
they might need TPN or other supplement
____ is used when heart failure causes kidney injury
Digoxin
___ ___ and ___ ___ may be used if the patient is on dialysis and they’re losing important vitamins/minerals
folic acid and ferrous sulfate
If you have too much phosphate you could develop
hypocalcemia
Don’t take phosphate binders within 2 hours of
taking digoxin
Ferrous sulfate should be taken
with meals
If you’re taking an iron supplement, you may also need a
stool softener
HD: with triple lumen catheters, the 3rd lumen
can be used for drawing blood and giving meds without interrupting the dial
An example of Continuous Renal Replacement is
hemofiltration
The nice thing about hemofiltration (a type of CRR) is that its more
more tolerable than HD for critically ill ppl
Post hospital care: Even if the AKI is resolving, they still need to
come back frequently for blood/urine tests
Post hospital care: They might still need
dial
Post hospital care: tell them to limit p____, p____, s____, p____
protein, potassium, sodium, phosphate
Post hospital care: they may or may not need to limit
fluids
Patho: when there’s not enough perfusion to the kidneys, the body responds with 3 main things
vasoconstriction
RAAS
ADH
Patho: overall the body’s responses are to
maintain blood volume and therefore improve perfusion to the kidneys
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 ___
oliguria and azotemia (because the body is now holding in nitrogenous wastes)
RBC casts can be found in the urine because
the kidney cells are dying and sloughing off
If fluid/pressure build up inside the kidney (intrarenal) the GFR
stops because theres too much opposing pressure to filter.
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
wastes pile up in the blood. Wastes like BUN and creat
BUN should be
10 to 20
Creat should be
.5 to 1
Oliguric phase: H\_\_\_\_ decreased \_\_\_\_\_ H\_\_\_\_ Hypo\_\_\_\_
hyperkalemia
decreased bicarb
Hyperphosphatemia (which is why you need phosphate binders)
Hypocalcemia
in the Oliguric phase, you actually have more sodium retained but
its diluted because your holding more water
Diuretic phase: you’re losing ____ and ____ wastes
electrolytes and nitrogenous wastes
Diuretic phase: a little later in the diuretic phase, the BUN
decreases (which is good)
Recovery phase: Patients will still be tired during this phase, as they recover. Its also normal to have
abnormal kidney test values for a while
Some patients don’t have the oliguric phase; in this case the urine volume is normal BUT
the creat will be increased
It’s important to note that even in healthy people you can have AKI is
dehydration occurs (which is why I and O are important)
Signs of decreased fluid volume include:
increased s___ b__ p___
decreased p___ p___
th___
increased systolic BP
decreased pulse pressure
thirst
the earliest sign of tubular damage is
decreased urine SG
Watch out for nephrotoxic drugs like ___ and ___
abx and NSAIDs
In prerenal AKI the BP will be ___, but in intrarenal it’ll be
hypo, hyper
in intrarenal AKI, because the fluid is backing up, not only do you have htn, you have
edema and fluids in the lungs
In intrarenal AKI, you could have ECG changes caused by
increased K
In prerenal AKI, the urine is concentrated, the SG will be
over 1030
In intrarenal and post renal, SG is
dilute, less than 1010
X rays and US can show ___ size and ___
kidney size and obstructions
Biopsy may be done if
the cause of AKI is unclear
