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NURS 322 > Acute and Chronic Kidney Disease > Flashcards

Acute and Chronic Kidney Disease Flashcards

1
Q

What are the 3 types of acute kidney injury (AKA acute renal failure)?

A
  1. prerenal: affecting blood flow to the kidney
    • CVA, hypovolemia, CHF, bradycardia
  2. intrarenal: inside kidney
    • glomerulonephritis, polycystic kidney
  3. postrenal: affecting flow out of the kidney
    • kidney stones, strictures
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2
Q

What is prerenal azotemia?

A

any condition that reduces the blood flow to the kidneys, resulting in a build up of nitrogenous wastes

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3
Q

What are the 4 phases of AKI?

A
  1. onset – precipitating event
  2. oliguric – reduced urine output = 100 - 400 mL/day
    • administration of diuretics or fluid bolus has no effect
    • elevated levels of BUN and Cr
  3. diuretic – increased fluid output
    • BUN and Cr levels return to normal
  4. recovery – return to normal
    • occurs approximately 12 months after onset of AKI
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4
Q

How does hypovolemic shock relate to AKI? What signs may indicate AKI?

A

– severe hypotension from shock can lead to decreased kidney perfusion and prerenal AKI

– signs:

  • reduced output
  • decreased weight
  • labs that reflect poor kidney function – BUN, Cr, GFR
  • nephrotoxic medications – be careful with dosing
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5
Q

What is chronic kidney disease (CKD)? What 3 things could CKD result in?

A

– chronic kidney disease (CKD): progressive, irreversible kidney injury – kidney function does not recover

– 3 possible results:

  1. end-stage kidney disease (ESKD) – kidney function not sustainable; dialysis needed
  2. azotemia – abdominal cramping, metallic taste in mouth from urea, fatigue
  3. uremia/uremic syndrome – damage to small BVs in kidneys
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6
Q

What are the 5 stages of CKD?

A
  1. stage 1 – at risk
    • reduced renal reserve
    • GFR > 90 mL/min
  2. stage II – mild CKD
    • nephron damage
    • slight elevation of metabolic waste
    • GFR = 60 - 89 mL/min
  3. stage III – moderate CKD
    • continued nephron damage
    • BUN, Cr increase
    • restriction of fluids, electrolytes, protein
    • GFR = 30 - 59 mL/min
  4. stage IV – severe CKD
    • manage complications
    • prepare for renal replacement therapy
    • GFR = 15 - 29 mL/min
  5. stage V – ESKD
    • severe fluid, electrolyte, acid-base imbalance
    • fatal if no renal replacement therapy
    • GFR < 15 mL/min
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7
Q

What are the main kidney changes that develop with CKD?

A

increase BUN and Cr, decreased urine output

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8
Q

What are the main metabolic changes that develop with CKD?

A

increased production of urea and creatinine (from muscle metabolism)

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9
Q

What are the main electrolyte changes that develop with CKD?

A
  • decreased sodium in early stages; increased in later stages
  • chronic increased potassium
  • acid-base imbalance
  • decreased calcium
  • increased phosphorus
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10
Q

What are the main cardiac changes that develop with CKD?

A
  • hypertension – contributes even further to renal failure
  • hyperlipidemia
  • HF
  • pericarditis
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11
Q

What are the main hematologic changes that develop with CKD?

A

decreased EPO –> decreased RBCs

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12
Q

What are the main GI changes that develop with CKD?

A

uremia in mouth due to flora changes in mouth

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13
Q

What are dietary restrictions to consider for AKI pts?

A
  • sodium – administer in early stages, restrict in later stages
  • potassium – restrict intake
    • bananas
    • leafy greens
  • fluid restrictions
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14
Q

What is a visible/physical manifestation of AKI?

A

uremic frost – tiny urea crystals form on skin after sweat evaporates

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15
Q

What is the purpose of hemodialysis, and who benefits from hemodialysis treatment? What should the nurse be wary of when pts are on hemodialysis?

A

– purpose – lower levels of GFR

– who – pts with AKI who don’t respond well to diuretics

– be wary of clot formations in the machine

  • determine with an aPTT lab
  • administer anticoagulants like heparin
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16
Q

When should subclavian dialysis catheters be used?

A

for short-term dialysis or when waiting for AV fistula to heal

17
Q

What is an AV fistula?

A

graft or fusion of an artery and a vein together or long-term, permanent access to vascular system

18
Q

What are complications of AV fistulas?

A
  • thrombosis/stenosis
  • infection
  • aneurysm
  • ischemia
  • HF
19
Q

How should medications be handled for pts on dialysis?

A

meds need to be flushed out during dialysis

20
Q

What are the most common reactions in pts after dialysis?

A
  • hypotension
  • bleeding
  • h/a
  • n/v
  • malaise
  • dizziness
  • muscle cramps
  • avoid anything invasive 4 hours after dialysis
21
Q

What are 2 complications of hemodialysis?

A
  1. dialysis disequilibrium syndrome
    • sickness during/after
    • fluid volume change
    • electrolyte change
  2. infection
    • hepatitis B
    • hepatitis C
    • HIV
22
Q

What is peritoneal dialysis? What are the 3 types?

A

– peritoneal dialysis: catheter placed into abdominal cavity for infusion; used mostly for home environment

– 3 types:

  1. continuous ambulatory peritoneal dialysis
  2. automated intermittent
  3. continuous-cycle
23
Q

What are some complications of peritoneal dialysis?

A
  • peritonitis
    • can prevent by making sure the connection site is sterile
  • pain
    • 1st time will be painful, but subsequent dialysis treatment shouldn’t be
    • should be warmed on plate prior to prevent
  • exit site/tunnel infections
  • poor dialysis flow
    • may need enema to prevent constipation
  • dialysate leakage
24
Q

Where is a transplanted kidney placed in the pt? What happens to the bad kidney?

A

– new kidney placed in iliac region of pelvis due to proximity to bladder and iliac vein

– bad kidney is not removed unless there is limited space in pt

25
Q

What is important to assess post-operatively in pts receiving kidney transplants?

A
  • assess hourly urine output x 48hr
    • pink for a few days, then should return to yellow
  • complications
    • rejection
    • tubular necrosis
    • thrombosis
    • renal artery stenosis
26
Q

What medications should be held when pts are about to have hemodialysis?

A

anything vasoactive – like beta-blockers

27
Q

Why is it expected for a pt coming off of dialysis to present with a higher temperature?

A

blood warms up in dialyzer

however, if temperature is low grade (101 F), worry about infection

NURS 322 (19 decks)

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