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NUR 201 Week 8 > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q
  • Loss of kidney function affects ability to maintain normal processes of urinary elimination, fluid & electrolyte balance, & acid-base balance
  • Loss also interrupts activity of every organ system, esp immune, endocrine, skeletal, & cardiovascular
A
  • AKI is most common in acute care setting
  • CKD more likely in community settings or as a co-existing condition in acute care settings
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2
Q
  • Filter wastes & maintain fluid & electrolyte balance, acid-base balance
A
  • Kidneys work together w/many other systems
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3
Q

Assessments: Recognize Cues - Physical Assessment

  • Skin, head, & neck
  • Respiratory, cardiovascular
  • Renal (inc I&O), musculoskeletal
  • Abdominal, CNS, psychosocial
A

Urinalysis

  • Color, odor, turbidity
  • Specific gravity
  • pH
  • Glucose
  • Ketone bodies, protein
  • Leukocyte esterase, nitrites
  • Cells, casts, crystals, bacteria
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4
Q

Other Urine

  • Urine for C&S
  • Composite urine collections
  • Creatinine clearance - best indication of overall kidney function !
  • Urine electrolytes & osmolarity
A

Laboratory Assessment

  • Serum creatinine, BUN, BUN:serum creatinine ratio
  • Blood osmolarity
  • Kidney/urinary
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5
Q

! BUN is not always the best indicator of kidney function because it’s not ALWAYS elevated

No common pathologic condition other than kidney disease increases the serum creatinine level

A

Serum creatinine level doesn’t increase until @ least 50% of kidney function is lost, & therefore any elevation of serum creatinine values is important & should be further assessed

! Creatinine is excreted by the kidneys

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6
Q

What is the BEST indicator of OVERALL kidney function?

A

creatinine clearance (a measure of GFR)

  • Usually done w/a 24 hr urine collection
    ! CC/GFR is NOT accurate during acute & critical illness
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7
Q

?

Is a urine output <400 mL/day

A

Oliguria

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8
Q

?

Is the retention & buildup of nitrogenous wastes in the blood

A

Azotemia

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9
Q

Kidney Failure: Prerenal, Intrarenal, & Postrenal

A
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10
Q

?

Involves cancers such as bladder, cervical, colon, prostate, prostate hypertrophy, obstruction (kidney stones), spinal cord injury/nerve damage/neurogenic bladder, pelvic trauma, blood clots in urinary tract

A

Postrenal failure

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11
Q

?

  • Kidney damage - acute tubular necrosis, renal trauma, severe muscle exertion, genetic conditions, infectious diseases/sepsis, metabolic disorders, glomerulonephritis, renal artery lesions
  • Abx, contrast imaging dyes, ischemia from cardiac/resp arrest
A

Intrarenal

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12
Q

?

! Perfusion reduction - shock, circulating volume depletions, volume shifts, decreased CO, decreased PVR, renal artery obstruction

___ azotemia - renal failure c/b poor blood flow to the kidneys

Most commonly c/b hypovolemic shock & HF, liver failure, NSAID use, burns, dehydration, stenosis

A

Prerenal failure

Prerenal

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13
Q

?

Failure that has a low specific gravity, <1.010

A

Intrarenal

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14
Q

?

Failure that has a normal specific gravity, 1.000 - 1.010

A

Postrenal

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15
Q

?

Failure that has a high specific gravity, >1.030

A

Prerenal

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16
Q

Nephrotoxic Substances: Rx’s

  • Antibiotics/antimicrobials
  • Drugs (NSAIDs)/other drugs
    ! Metformin - If pts get contrast dye while taking this rx they can go into renal failure
A

Nephrotoxic Substances: Other

  • Organic solvents/non-drug chemical agents
  • Heavy metals & ions
17
Q

Comparison of Acute (many systems) vs Chronic (every system)

A
18
Q

AKI - Classifications: RIFLE, KDIGO

R - Risk stage
I - Injury stage
F -Failure stage
L - [Outcome] loss
E - [Outcome] end-stage kidney disease

A

KDIGO - Kidney Disease Improving Global Outcomes

19
Q

Phases of Acute Renal Failure - (4)

A

Onset > Oliguric > Diuretic > Recovery

20
Q

? Phase

  • GFR increases
  • BUN/creatinine plateau & then decrease
  • Improvement may occur in 1-2 weeks but may take up to 12 mos to stabilize
  • Labs return to baseline
A

Recovery

21
Q

? Phase

  • Output between 100-400 mL urine/day
  • Elevation of substances usually excreted by kidneys, i.e., urea, creatinine, uric acid, K, Mg
A

Oliguric

22
Q

? Phase

  • Increase in daily u/o of 1-3 L/day but may be higher
  • Kidneys excrete but are unable to concentrate
A

Diuretic

23
Q

? Phase

  • The time from initial insult until oliguria develops
A

Onset

24
Q

Health Promotion & Maintenance

  • Severe blood volume depletion can lead to renal failure even in people who have no known kidney problems
A
  • Continual assessment of I&O, blood volume depletion, lab values, use of nephrotoxic substances
25
Q

! Decreased urine SG indicates a loss of urine-concentrating ability & is the earliest sign of renal tubular damage

A
  • NSAIDs can cause or increase risk for AKI
  • Obtain peak & trough levels of abx known to be nephrotoxic (i.e., garamycin, vancomycin)
26
Q

Assessment: Recognize Cues

  • History, physical assessment/clinical manifestations
  • Lab assessment
  • Imaging/diagnostic tests
    > urine, labs, xray, US, CT, Nuc Med, Bx
  • Drug therapies
A
  • MAP of 65 mmHg maintained to promote kidney perfusion
  • A clinically significant inc in creatinine, esp if it’s over a few hrs or a few days, is a concern & needs to be reported immediately (may then order 24 hr urine for CC)
27
Q

ARF: Taking Action > Therapies

  • Fluid challenge
    > Prerenal azotemia - fluid challenges & diuretics used to promote renal blood flow (bolus 500-1000 NS over 1 hr) If not FVE. It it’s oliguric RF, fluid challenges & diuretics are d/c’d
  • Diuretic therapy cautiously
A
  • Calcium channel blockers
    > Used to treat AKI resulting from nephrotoxins
    > They prevent movement of calcium into kidney cells, maintain kidney cell integrity, & improve kidney blood flow
    > Are stopped if they don’t improve GFR as est by CC
28
Q
  • Careful observ of I&O, daily weights
  • Frequent serum labs
A
  • Nutrition/diet control, PPN, TPN
    > Specialty tube feedings for kidney pts are lower in Na, K, & P & higher in calories than are standard feedings
  • Dialysis (or RRT)
    Indications -
    > Symptomatic uremia (pericarditis, neuropathy, unexplained decline in cognition)
    > Persistent or rapidly rising high K lvls (>6.5 mEq/L)
    > Severe metabolic acidosis (<7.1)
    > Fluid overload that compromises tissue perfusion
29
Q
  • When AKI is assoc w/drug or alcohol intoxication, RRT can also remove toxins
A

Interventions: Taking Action

> Monitor trends of I&O
Assess VS, daily weights
Evaluate skin turgor, mucous membranes
Monitor lab values, frequent oral care, restrict fluids

30
Q

Interventions: Taking Action cont’d

  • Consult a dietitian
  • Plan meals w/client
  • Provide a pleasant mealtime environment
  • Administer rx’s to reduce nausea
A

> Tailor interventions toward what you find in assessments

31
Q

Gerontologic Considerations: ARF

  • Older adults more susceptible r/t function of nephrons dec w/age

> Dehydration
Hypotension
Diuretic therapy
Aminoglycoside therapy
Obstructive disorders (prostatic hyperplasia)
Surgery, infection, contrast agents

A

Review - goals for care

  • Prevention
  • Find & remove cause of failure
  • Correct fluid, electrolyte, & acid-base imbalances
  • Dialysis may be needed to remove metabolic wastes until kidneys heal
  • Prevent infection
  • Maintain nutritional status

NUR 201 Week 8 (5 decks)

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