Acute Kidney Injury Flashcards
oliguria
reduced urine output <30ml per hour
azotemia
high levels of nitrogen in urine
BUN
normal 5-25
creatine
0.5-1.5
AKI
rapid onset hours to days
effects: increased metabolic wastes, fluid volume excess, decreased UOP
will progress to chronic renal failure is not treated
3 types of renal failure
pre-renal- before the kidneys
intra-renal- within the kidneys
post-renal- after the kidneys
prerenal AKI
decrease in renal perfusion resulting in decreased GFR and kidney function
MAP of 7-75 should be maintained to perfuse kidneys
causes of prerenal AKI
excessive fluid loss
decreased renal perfusion
vascular obstruction
medications ( ace-inhibitors, NSAIDS, Cyclosporine)
intra renal AKI
most common cause is acute tubular necrosis
permanent injury
impaired renal function the rest of life, could lead to diaylsis
causes of intrarenal AKI
renal tubular ischemia
acute tubular necrosis
nephrotoxicity
rhabdomyolysis
intra-tubular obstruction
post renal failure
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
systemic complications of AKI
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.
urine labs for aki
protein - increased
creatinine - decreased
urea- decreased
excess fluid volume aki management
diuretics
dialysis
fluid restrictions (may allow 1 liter per day)
monitor for imbalanced I&O, edema, pulmonary crackles, hypertension, weight gain
catabolic processes for AKI management
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
electrolyte imbalance AKI management
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
IHD indications
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)
contraindications for IHD
hemodynamic instability
coagulopathies- hypercoagulable states
lack of access to circulation
age extremes
complications of IHD
hypotension
muscle cramps
blood loss
hepatitis
continuous renal replacmenmt therapy
need for fluid volume removal in a hemodynamically unstable client
hypervolemia unresponsive to diuretics
MODS, coagulopathies
Ease of fluid management
PD/HD contraindications
contraindications of continuous renal replacement therapy
HCT >45%
lack of arterial/venous access
monitoring during dialysis
BP, HR every 5-15 min
PCWP every 1-2 hours
Respiratory pattern, neuro every 1 hour and continuous cardiac monitoring
complications of dialysis
hypotension- lower HOB, raise feet, IV volume expanders, vasopressors
dysrhythmias
bleeding
