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Med-Surg > Acute & Chronic Kidney Injury > Flashcards

Acute & Chronic Kidney Injury Flashcards

1
Q

acute renal failure / acute kidney injury (AKI)

A
  • abrupt disease in kidney function
  • a rapid, progressive process
  • difficult to detect
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2
Q

acute renal failure is reversible if

A

identified and treated early

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3
Q

acute renal failure is identified by

A

oliguria and elevated serum BUN and creatinine

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4
Q

elevation of BUN and creatinine =

A

azotemia

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5
Q

BUN and creatinine are both products of

A

protein metabolism

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6
Q

azotemia

A

medical condition characterized by increase levels of nitrogen in the body

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7
Q

risk factors for acute kidney injury

A
  • hx of renal problems
  • hx of htn
  • hx od diabetes
  • use of nephrotoxic agents
  • exposure to heavy metals or organic solvents
  • recent hypotensive episode
  • tumor or vascular obstruction
  • infection
    -sepsis
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8
Q

common causes of acute kidney injury

A
  • arterial occlusion
  • absolute decrease in effective in blood volume
  • relative decrease in blood volume
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9
Q

prerenal injury

A

caused by renal blood flow resulting in renal hypoperfusion and ischemia

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10
Q

prerenal injury causes a decreases in the

A

GFR

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11
Q

pre renal injury is often reversible? or irreversible?

A

reversible

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12
Q

causes of prerenal injury

A
  • decreased cardiac output
  • increased vascular capacity
  • drugs that alter renal hemodynamics
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13
Q

acute tubular necrosis (ATN) is a type of _____ renal injury

A

intrinsic renal injury

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14
Q

what is acute tubular necrosis (ATN)

A

destruction of renal tubular epithelial cells

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15
Q

ATN is caused by

A
  • ischemia
  • sepsis
  • vascular problems (such as malignant htn)
  • acute glomerulonepritis and other infections
  • drug allergies and toxicity
  • rhabdomyolosis (breakdown of skeletal muscle and release of myoglobin which plugs glomeruli)
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16
Q

2 types of ATN

A

(1) ischemic
(2) toxic

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17
Q

ischemic ATN

A

prolonged hypoperfusion
(surgical procedure, anasthesia)

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18
Q

toxic ATN

A

from aminoglycoside anti-infectives, contrast induced nephropathy (CIN)

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19
Q

oliguric ATN

A

less likely to recover renal function
- has a high mortality rate

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20
Q

non-oliguric ATN

A

commonly seen with toxic injury
- renal concentrating defect
- hyperkalemia common complication

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21
Q

postrenal injury

A

caused by an obstruction to the outflow or urine from the kidneys

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22
Q

obstruction to one kidney does not likely lead to renal failure unless

A

the other kidney is not functioning or absent

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23
Q

uremia occurs when

A

2/3 of total number of nephron loss

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24
Q

fluid overload can lead to

A

HF, pulmonary edema, hear crackles

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25
Q

wastes can cause

A

homeostasis and anemic disorders when there are extra wastes

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26
Q

nursing care for AKI and fluid volume overload

A

diuretics, fluid restriction as prescribed, monitor for S&S of fluid volume excess, intake and output, oral care, ice chips

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27
Q

possible neurologic symptoms in pt with AKI

A

decreased mental function, peripheral neuropathy, cerebral edema

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28
Q

possible cardiovascular and pulmonary symptoms in pt with AKI

A

htn, pulmonary edema, electrolyte imbalance, pneumonia

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29
Q

possible GI symptoms in pt with AKI

A

poor appetite, GI bleeding, constipation, diarrhea

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30
Q

possible hematologic symptoms in pt with AKI

A

anemia, blood clots

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31
Q

possible integumentary symptoms in pt with AKI

A

pale appearance, bruising, pruritis, dry skin, thin hair, brittle nails, uremic frost

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32
Q

possible skeletal symptoms in pt with AKI

A

usteodystrophy

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33
Q

BUN reflects

A

GFR and urine concentrating capacity

34
Q

BUN increases as GFR

A

decreases

35
Q

BUN is affected by

A

hydration status, level of catabolism, protein intake, and GI bleeding therefore is not considered a reliable measure of GFR

36
Q

creatinine is the end product of

A

muscle metabolism and is released into the blood at a constant rate

37
Q

creatinine is eliminated at a rate =

A

equal to renal function

38
Q

normal BUN and creatinine ratio is

A

10:1 or 15:1

39
Q

what BUN:creatinine ratio is indicative of AKI

A

20:1

40
Q

a decrease in creatinine clearance rate indicates a decrease in

A

glomerular function

41
Q

normal BUN

A

3.6 - 7.1 mmol/L

42
Q

normal creatinine

A

44 - 133 mmol/L

43
Q

creatinine clearance =

A

urine creatinine x urine volume

44
Q

diagnosis of AKI

A

(1) urine output
(2) renal insufficiency
(3) renal failure
(4) ESRD

45
Q

in dx of AKI urine output would

A

diminished renal reserve - output may be normal as remaining nephrons are able to compensate

46
Q

in dx of AKI renal insufficiency is

A

inability to concentrate urine and results in polyuria

47
Q

renal failure =

A

oliguria

48
Q

ESRD =

A

anuria

49
Q

osmolarity is

A

serum and urine

50
Q

osmolarity is the measure of

A

solute concentration/kg

51
Q

what is a major factor that affects osmolarity

A

sodium

52
Q

when renal function decreases, urine osmolality ______ and urine specific gravity _______, serum osmolality ________

A

increases; increases; stays the same

53
Q

symptoms of metabolic acidosis related to renal tubule dysfunction

A
  • hyperkalemia
  • hyperventilation
  • cardiac dysrhythmias
54
Q

chronic renal failure (CRF)

A

the irreversible loss of renal function, affecting nearly all organ systems

55
Q

what does chronic renal failure result from

A

primary renal condition (such as polycystic kidney disease, glomerulonephritis) or other diseases that affect the kidneys (diabetes, htn)

56
Q

risk factors for chronic renal failure

A

diabetes mellitus, htn, proteinuria, family history, increasing age

57
Q

in chronic renal failure regulation in GFR =

A

reduction in number of functional nephrons

58
Q

in chronic renal failure kidneys compensate for damage by

A

hyperfiltration

59
Q

hyperfiltration =

A

further loss of function over time

60
Q

in chronic renal failure the kidneys experience generalized

A

wasting (shrinking) and progressive scarring

61
Q

it is usually not until over ___% of kidney function is lost the pts start to experience symptoms

A

70%

62
Q

cardiovascular S&S of chronic renal failure

A
  • htn
  • hf
  • heart disease
  • stroke
  • peripheral vascular disease
  • pericarditis
63
Q

hematologic S&S of chronic renal failure

A
  • anemia
  • reduced erythropoietin
  • GI blood loss
  • iron deficiency
  • thrombocytopenia
64
Q

GI S&S of chronic renal failure

A
  • nausea
  • vomiting
  • anorexia
  • GI bleeding
65
Q

neurologic S&S of chronic renal failure

A
  • sleep disorders
  • memory loss
  • impaired judgement
  • muscle cramps
  • twitching
  • asterixis
  • seizures
  • coma
  • peripheral neuropathy
66
Q

medical treatment for chronic renal failure (CRF) is aimed at maintaining homeostasis by

A
  • reducing fluid volume overload
  • monitoring electrolytes
  • treating acid base imbalances
  • treating and preventing infection
  • metabolic imbalance
  • treating electrolyte excess
67
Q

for chronic renal failure (CRF) fluid overload is avoided by

A
  • fluid restriction
  • diuretics
68
Q

for chronic renal failure (CRF) catabolic processes are avoided by

A

decreased protein intake = decreased protein diet

69
Q

for chronic renal failure (CRF) electrolyte imbalances are avoided by

A

IV solutions with more free water; 0.45% saline or isotonic

70
Q

types of renal replacement therapy (RRT)

A

(1) hemodialysis
(2) peritoneal dialysis
(3) continuous renal replacement therapy

71
Q

how does renal replacement therapy work

A

dissolved particles are transferred across a semipermeable membrane from one fluid compartment to another

72
Q

renal replacement therapy does not correct renal impairment but does correct _____

A

fluid, electrolyte, and acid-base imbalances, and removes waste products

73
Q

hemodialysis

A

allows more gradual removal of excess electrolytes
- used in critical care setting so that ongoing assessment can occur
- uses 5 different methods to clear excess fluids

74
Q

what 5 different methods are used in hemodialysis to clear excess fluids

A

(1) fluids
(2) solutes
(3) electrolytes
(4) creatinine
(5) urea

75
Q

peritoneal dialysis

A

peritoneal cavity is used as the semipermeable membrane to removes wastes, excess fluids, and electrolytes
- a sterile catheter is inserted into the peritoneal cavity through the abdominal wall
- as dialysate solution is instilled through the catheter, waste and excess products cross the semipermeable peritoneal membrane and into the dialysate
- continuous or intermittent

76
Q

peritoneal dialysis depends on

A

diffusion and osmosis

77
Q

in peritoneal dialysis osmosis and a high glucose concentrate in the dialysate allows water to migrate from the ________ and into the

A

the blood and into the peritoneal cavity

78
Q

advantages of peritoneal dialysis

A
  • can be performed on a regular basis so that fluid and electrolyte shift is less dramatic
  • can be performed in pt home
  • ambulatory pts may work or do other activities while dialysis occurs
  • if hemodynamically unstable there is a less dramatic alteration in fluid balance
79
Q

disadvantages of peritoneal dialysis

A
  • considerable infection risk
  • respiratory distress associated with the volume of fluid and “dwelling”
  • significant protein depletion
80
Q

when a pt is on dialysis it is important to monitor and assess _________

A

monitor and maintain fistula and assess for bruit

Med-Surg (15 decks)

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