Acute Kidney Injury

Question 1

oliguria

Answer 1

reduced urine output <30ml per hour

Question 2

azotemia

Answer 2

high levels of nitrogen in urine

Question 3

BUN

Answer 3

normal 5-25

Question 4

creatine

Answer 4

0.5-1.5

Question 5

AKI

Answer 5

rapid onset hours to days
effects: increased metabolic wastes, fluid volume excess, decreased UOP
will progress to chronic renal failure is not treated

Question 6

3 types of renal failure

Answer 6

pre-renal- before the kidneys
intra-renal- within the kidneys
post-renal- after the kidneys

Question 7

prerenal AKI

Answer 7

decrease in renal perfusion resulting in decreased GFR and kidney function
MAP of 7-75 should be maintained to perfuse kidneys

Question 8

causes of prerenal AKI

Answer 8

excessive fluid loss
decreased renal perfusion
vascular obstruction
medications ( ace-inhibitors, NSAIDS, Cyclosporine)

Question 9

intra renal AKI

Answer 9

most common cause is acute tubular necrosis
permanent injury
impaired renal function the rest of life, could lead to diaylsis

Question 10

causes of intrarenal AKI

Answer 10

renal tubular ischemia
acute tubular necrosis
nephrotoxicity
rhabdomyolysis
intra-tubular obstruction

Question 11

post renal failure

Answer 11

obstruction of the outflow of urine
mechanical causes: renal stones, BPH, strictures, edema, tumors, obstructed catheter
functional causes of post renal failure- diabetic neuropathy, pregnancy, drugs (narcotic PCA), spinal cord injury

Question 12

systemic complications of AKI

Answer 12

decreased alertness, drowsy, seizures, coma
hypertension, dysrhythmias, edema
decreased cough reflex, crackles, infiltrates
weight loss, anorexia, n/v, constipation or diarrhea
anemia, fatigue, weakness , pale, dry, dull, yellow skin, bruising, pruritis, thin hair, brittle nails, disorders related to decreased calcium absorption, fractures.

Question 13

urine labs for aki

Answer 13

protein - increased
creatinine - decreased
urea- decreased

Question 14

excess fluid volume aki management

Answer 14

diuretics
dialysis
fluid restrictions (may allow 1 liter per day)
monitor for imbalanced I&O, edema, pulmonary crackles, hypertension, weight gain

Question 15

catabolic processes for AKI management

Answer 15

protein, sodium, potassium and fluid restricted diet
high card, fat and amino acid diet
dialysis to decrease BUN and creatinine
monitor for and intervene for weight gain, neuro changes, GI dysfunction, decreased serum protein levels

Question 16

electrolyte imbalance AKI management

Answer 16

hyperkalemia
treatment occurs when symptomatic
kayexalate
insulin into vein for quick treatment of hyperkalemia followed by amp of dextrose
metabolic acidosis- serum bicarb or in severe cases dialysate additive
serum sodium- limit oral and IV sodium, diuretics for hypernatremia

Question 17

IHD indications

Answer 17

BUN >1000, LOC, confusion, dialysis
hyperkalemia, drug toxicity, metabolic acidosis, fluid overload, pulmonary edema
serum creatinine >10
symptoms of uremia, pericarditis, GI bleeding, encephalopathy
contraindications to other forms of dialysis
transfusion reactions (filters blood to quickly)

Question 18

contraindications for IHD

Answer 18

hemodynamic instability
coagulopathies- hypercoagulable states
lack of access to circulation
age extremes

Question 19

complications of IHD

Answer 19

hypotension
muscle cramps
blood loss
hepatitis

Question 20

continuous renal replacmenmt therapy

Answer 20

need for fluid volume removal in a hemodynamically unstable client
hypervolemia unresponsive to diuretics
MODS, coagulopathies
Ease of fluid management
PD/HD contraindications

Question 21

contraindications of continuous renal replacement therapy

Answer 21

HCT >45%
lack of arterial/venous access

Question 22

monitoring during dialysis

Answer 22

BP, HR every 5-15 min
PCWP every 1-2 hours
Respiratory pattern, neuro every 1 hour and continuous cardiac monitoring

Question 23

complications of dialysis

Answer 23

hypotension- lower HOB, raise feet, IV volume expanders, vasopressors
dysrhythmias
bleeding