Acute Kidney Injury

Question 1

Metabolic acidosis

Answer 1

Build up on toxins and fluid

Question 2

Functions of the KIdneys
AWETBED

Answer 2

acid-base
water removal
erythropoesis
toxin removal
BP
electrolyte
D vitamin activation

Question 3

Renal Failure

Answer 3

The inability of the kidneys to excrete waste products and water from the bloodstream through filtration
AKI or CKD

Question 4

AKI

Answer 4

acute, rapid loss of renal function

Question 5

AKI urias present

Answer 5

oliguria
uremia

Question 6

Time of Recovery for AKI

Answer 6

Will see improvement in few weeks to months and may resolve in months to a year (not always do patient’s kidneys recover)

Question 7

AKI Labs

Answer 7

Increase of Dangerously
Creatinine
BUN
K
Low Output
Azotemia

Question 8

Azotemia

Answer 8

as elevation, or buildup of, nitrogenous products (BUN-usually ranging 7 to 21 mg/dL), creatinine in the blood, and other secondary waste products within the body

Question 9

3 Major Causes

Answer 9

Prerenal
intrarenal
postrenal

Question 10

Prerenal Causes

Answer 10

blood flow decreased to kidneys
Absolute loss of fluid (hemorrhage, vomiting, diarrhea, severe burns)
Relative loss of fluids (Overload, CHF)
Renal Artery Stenosis (embolus)

Question 11

Intrarenal Causes

Answer 11

Nephrotoxic agents cause damage to tubules, glomerulus, and interstitium
acute tubular necrosis - epithelial cells die due to ischemia
GN - antigen and antibodies complex
Interstitial Nephritis

Question 12

Postrenal Causes

Answer 12

Obstructions from outflow
- Compression tumors, BPH, or kidney stones
- trauma prostate CA

Question 13

1 ureter obstructed

Answer 13

unilateral

Question 14

2 ureter obstructed

Answer 14

bilateral

Question 15

The 4 Phases of AKI

Answer 15

Initiating
Oliguric
Diuretic
Recovery

Question 16

Initiating Phase

Answer 16

occurs whenrenal blood flow (RBF) decreases to a level resulting in severe cellular depletionthat in turn leads to acute cell injury and dysfunction. Renal tubular epithelial cell injury

Question 17

Oliguric Phase

Answer 17

decreased urine output (<400/day) – 1st indication
diuretics don’t work
electrolytes (K) increase
 generally, lasts about 10-14 days (but can last up to months Nephrotoxic drugs)

Question 18

Diuretic Phase

Answer 18

output increases to about 1-3L/day (can be up to 5L)
 nephrons are not fully functional even with the increase in output
 lasts about 1-3 weeks
 monitor for large losses of fluid and electrolytes
 values/acid balance stabilizes toward the end
hypovolemia and hypotension
BUN and Creatinine go back down

Question 19

Recovery Phase

Answer 19

lasts about 1-2 weeks, but may take up to 12 months
GFR increases
BUN and Creatinine plateau then down
 some do not recover which leads to ESRD
 some may recover with damage and end up with early-stage CKD

Question 20

If the pt does not meet the recovery phase,

Answer 20

ESRD
with damage

Question 21

Acute on chronic stage 3 =

Answer 21

permanent damage

Question 22

Stages when they are a candidate for dialysis =

Answer 22

ESRD only

Question 23

S/S of AKI GENERAL

Answer 23

Decreased urine output
Swelling of the legs, ankles, and feet (edema) - overload
BLEEDING by low platelets
Shortness of breath (dyspnea)
Fatigue
N/V = Loss of appetite
irregular pulse (arrhythmias and High K)
confusion, lethargic, seizures (toxic build)

Question 24

Plan for AKI

Answer 24

Eliminate cause, prevent complications, and assist recovery
VS, I&O, WT Daily
O2
FLUID BALANCE
position
skin care
Dialysis if GFR builds up and toxins

Question 25

Meds for AKI

Answer 25

Diuretic (Furosemide or challenged bolus)
avoid nephrotoxic and contrast dye
*^Kayexalate** (polystyrene sulfate)
Calcium Channel Blockers (vasodilation)
Dialysis

Question 26

Nutrition of AKI

Answer 26

High-calorie healthy
Low sodium
Low potassium
Lean meats no can, processed, or frozen

Question 27

Elderly considerations with AKI

Answer 27

GFR declines with age
Other organ impairment increases risk for AKI
** CVD or diabetes risk**
Older kidney does not compensate as well for fluid volume, solute load, and cardiac output
Increased risk for dehydration esp diuretic a phase