acute & chronic kidney disease Flashcards
acute kidney injury
- rapid reduction in kidney function
- failure to maintain waste elimination, fluid and electrolyte balance and acid base balanc e
- occurs few hours or days
acute kidney injury serium creatinine
increase serum creatinine by .3 mg/dl
- increase in serum creatinine to 1.5 times or more occurring in 7 days
acute kidney injury causes
- reduced perfusion to kidneys damage to kidney tissue, and obstruction or urine outflow
- RISK FACTORS INCLUDE: SHOCK, CARDIAC SURGERY, HYPOTENSION, PROLONGED MECHANICAL VENTILATION, SEPSIS
- OLDER ADULTS WITH DIABETES, HYPERTENSION, PERIPHERAL VASCULAR DISEASE, LIVER DISEASE, CKD
acute kidney injury physical assessment
- hourly urine output
- assess for fluid overload
- evaluate vital signs for hypoperfusion and hypoxemia
- build up of nitrogenous waste and decreased urine output
acute kidney injury lab assessment
- creatinine, BUN
- blood electrolyte values
- urine tests
acute kidney injury imaging assessments
- US, CT, xrays (pelvis, kidneys, KUB), MAG3
acute kidney injury other diagnostic
- kidney biopsy
acute kidney injury intervention/ management
- avoid hypotension, maintain normal fluid fluid balance
- reduce exposure to nephrotoxic agents and drugs
- frequently monitor lab values
- closely watch I/o
- drug therapy
- nutrition
- kidney replacement therapy
acute kidney injury history
- changes in urine appearance, frequency, volume
- recent surgery or trauma, transfusion, allergic reactions
- drug history
- coexisting conditions
- immunity- mediated aki
- anticipate aki after hypotension or shock
- history of obstructive problems
acute kidney injury health promotion
- teach healthy adults to drink 2-3l water daily
- dehydration reduces perfusion
- nurses should monitor kidney function
- urine output 30 for 2 hr or dark amber urine should be reported
- avoid exposure
chronic kidney disease
- progressive, irreversible disorder
- ckd become end stage kidney
azotemia
buildup of nitrogen based waste in the blood
uremia
azotemia with symptoms
uremic syndrome
urea and other waste products build up in body bc kidneys are unable to eliminate
chronic kidney disease causes
- hypertension
- diabetes mellitus
chronic kidney disease physical assessment s/s
- neurologic changes
- cardivascular symptoms
- respiratory symptoms
- hematologic symptoms
- skeletal symtoms
- urine symtoms
skin symtoms
chronic kidney disease psychoscial
- anxiety, fear
- coping mechanisms
- support recommendation or mental health
chronic kidney disease lab assessment
- creatinine BUN
- sodium, potassium , calcium, phosphorus, bicarb
- hemoglobin and hematocrit
- GFR
- urinalysis
chronic kidney disease intervention
- managing fluid volume
- improving cardiac function
- enhancing nutrition
- preventing injury
- minimising psychosocial compromise
stage 1
at risk, normal kidney function but urine indicate kidney
stage 2
slightly reduced kidney function
stage 3
moderately reduced kidney function
stage 4
severely reduced kidney function; a noticeable jaundice may occur, partially around eyes
stage 5
end stage kidney disease
chronic kidney disease changes: Kidney changes
- reduced GFR
- BUN increases, urine output decreases
- risk for fluid overload with edema, pulmonary crackles, shortness of breath, and pleural or pericardial effusion
chronic kidney disease changes: metabolic changes
- fluid and electrolyte balance is disrupted
- acid and base balance disrupted
chronic kidney disease changes: cardiac changes
- hypertension
- hyperlipidemia
- heart failure
- pericarditis
chronic kidney disease changes: hematologic and immunity changes
- anemia
- increased bleeding or bruising
- reduced immunity= increased risk for infection
chronic kidney disease changes: GI changes
- halitosos (uremic fetor), stomatitis (mouth inflammation), anorexia, n/v, hiccups, peptic ulcer disease, uremic colitis, hemorrhagic shock from severe GI bleed
ckd health promotion and maintenance
control diseases that lead to ckd
- dietary adjustments
- weight maintenance
- smoking cessation
- exercise
- limitation of alc
ckd anaylysis cues
- fluid overload inability of disease kidneys to maintain body fluid balance
- decreased cardaic function due to reduced stroke volume , dysrhythmias, fluid overload, and increased peripheral vascular resistance
- weight loss due to inability to ingest, digest, absorb food and nutrients
- potential for injury due to effects of kidney disease on bone density, blood clotting, and drug elimination
hemodialysis procedure
dialysis works by passive transfer of toxins by diffusion
- beaware of blood clotting
hemodialysis precuations
- check pedal pulses and cap refil in arm with fistula or graft
- check for bruit or thrill by auscultating or palpating access site
hemodialysis access complications
- thrombosis
- stenosis
- infection
- aneurysm
- ischemia
hf
hemodialysis drug intervene
- many drugs are dialyzable
- some drugs are held after dialysis
- short acting hypertensives can lead to hypotension
complications of dialysis
- hypotension
- dialysis equilibrium syndrome
- cardiac events
- reactions to dialyzers
peritoneal dialysis procedure
- soft plastic tube is placed in pt. abdominal cavity
- sterile cleansing fluid put into catheter
- after filtering process is finsihed fluid leaves pt. body through catheter
types of peritoneal dialysis
- continuous ambulatory peritoneal
- intermittent peritoneal
- intermittent perutoneal
peritoneal dialysis complications
peritonitis
pain
do not microwave fluid
peritoneal dialysis nursing care
- assess vitals
- weigh pt. using same scale
- monitor pt. dry weight
- baseline lab test doen before and during
- check dressings
- measure and record overflow
kidney transplantation: candidate selection
- advanced kidney disease
- reasonable life expectancy
- medically and surgically fit
- in u.s waiting list when gfr <20 ml
kidney transplantation donors
- living donors (highest rate of graft survival)
- non-heart beating donors
- cadaveric donars
kidney transplantation preoperative care
- immunologic studies
- dialysis 24 hours before surgery
- blood transfusion before surgery
kidney transplantation operative procedures
- varies depending on status of donar
- failed kidneys are left in place
- new kidneys placed in right or left anterior iliac fossa
kidney transplantation post operative care
- urologic management
- assess hourly urine output x 48 hours
- cbi
- monitor i/o
- immunosuppressive drug therapy
kidney transplantation post operative care complications
- rejection
- thrombosis
- renal artery stenosis
specific gravity
the concentration of particles, electrolytes and waste
- test done thru urine
specific gravity normal range
1.005- 1.030
serum cr. male range
.6-1.2
serum cr. normal range female
.5-1.1
blood urea nitrogen normal range
10-20
