Acute Kidney Injury Flashcards
Metabolic acidosis
Build up on toxins and fluid
Functions of the KIdneys
AWETBED
acid-base
water removal
erythropoesis
toxin removal
BP
electrolyte
D vitamin activation
Renal Failure
The inability of the kidneys to excrete waste products and water from the bloodstream through filtration
AKI or CKD
AKI
acute, rapid loss of renal function
AKI urias present
oliguria
uremia
Time of Recovery for AKI
Will see improvement in few weeks to months and may resolve in months to a year (not always do patient’s kidneys recover)
AKI Labs
Increase of Dangerously
Creatinine
BUN
K
Low Output
Azotemia
Azotemia
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
3 Major Causes
Prerenal
intrarenal
postrenal
Prerenal Causes
blood flow decreased to kidneys
Absolute loss of fluid (hemorrhage, vomiting, diarrhea, severe burns)
Relative loss of fluids (Overload, CHF)
Renal Artery Stenosis (embolus)
Intrarenal Causes
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
Postrenal Causes
Obstructions from outflow
- Compression tumors, BPH, or kidney stones
- trauma prostate CA
1 ureter obstructed
unilateral
2 ureter obstructed
bilateral
The 4 Phases of AKI
Initiating
Oliguric
Diuretic
Recovery
Initiating Phase
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
Oliguric Phase
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)
Diuretic Phase
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
Recovery Phase
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
If the pt does not meet the recovery phase,
ESRD
with damage
Acute on chronic stage 3 =
permanent damage
Stages when they are a candidate for dialysis =
ESRD only
S/S of AKI GENERAL
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)
Plan for AKI
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
Meds for AKI
Diuretic (Furosemide or challenged bolus)
avoid nephrotoxic and contrast dye
*^Kayexalate** (polystyrene sulfate)
Calcium Channel Blockers (vasodilation)
Dialysis
Nutrition of AKI
High-calorie healthy
Low sodium
Low potassium
Lean meats no can, processed, or frozen
Elderly considerations with AKI
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
