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capstone > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Explain the anatomy of the kidney

A

renal capsule
cortex
medulla
renal pelvis

Nephron
- ascending loop of henle
- descending loop of henle
pertitubular cappilaries
proximal tubule
glomerulus
distal tubule
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2
Q

What are the by products of the kidneys filtration?

A

H+

  • waste product
  • by product of H2O
  • needs to get it out, if it is not excreted metabolic acidosis

Urea

  • waste product
  • By product of protein
  • made in the liver filtered through kidneys
  • high levels of urea means the kidneys are not functioning well
  • Heart failure and dehydration can also cause this

creatinine

  • waste product
  • by product of muscle contraction
  • decrease in kidney function when there is high levels
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3
Q

What is the function of the kidney?

A
  • Keeping the concentrations of various ions and other important substances constant
  • Keeping the volume of water in your body constant
  • Removing wastes from your body
  • Keeping the acid/base concentration of your blood constant
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4
Q

Explain reabsorption?

A

Once inside the lumen of the nephron, small molecules, such as ions, glucose and amino acids, get reabsorbed from the filtrate

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5
Q

Finish this sentence

If it doesn’t go into the potty __________

A

It stays in the body

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6
Q

What are some common kidney disorder?

A
  • Acute Kidney Injury (AKI)
  • Chronic Kidney Disease
  • End-stage Kidney Disease
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7
Q

What is renal insufficiency?

A

Kidneys are unable to remove accumulated metabolites from the blood, leading to altered fluid, electrolyte and acid–base balance

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8
Q

What are the 3 categories of Acute Kidney Injury (AKI)

A

Prerenal
Intrinsic
Postrenal

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9
Q

Explain Pre renal and give an example of something that can affect the body prerenally

A

any condition decreasing renal blood flow, causing subsequent hypo perfusion

Ø Causes are factors external to the kidneys that reduce
renal blood flow: Severe dehydration, heart failure, ↓ CO
Ø Decreases glomerular filtration rate, causes oliguria

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10
Q

Explain Intrinsic (intra renal) and give an example of something that can affect the body intrarenally

A

acute damage to the Kidneys themselves

Ø Conditions causing direct damage to kidney tissue
Ø Results from prolonged ischaemia, nephrotoxins
Ø Acute tubular necrosis (ATN)
• Results from ischaemia, nephrotoxins, or sepsis
• Severe ischaemia causes disruption in basement
membrane
• Nephrotoxic agents cause necrosis of tubular
epithelial cells (CT contrast)
• Potentially reversible

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11
Q

What needs to be done after having CT contrast?

A

Flush it out with lots of fluids

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12
Q

Explain Postrenal and give an example of something that can affect the body post renally

A

Any condition that obstructs the outflow of urine

Ø Causes include:
• Benign prostatic hyperplasia
• Prostate cancer
• Calculi
• Trauma
• Extrarenal tumors
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13
Q

What are the manifestations of AKI?

3 phases, explain each

A

• Oliguric phase
– Waste product accumulation: Elevated BUN and serum creatinine levels
– Neurologic disorders: Fatigue and difficulty concentrating, Seizures, stupor, coma

• Diuretic phase
– Daily urine output is 1 to 3L, may reach 5L or more
– Monitor for hyponatraemia, hypokalaemia, and dehydration

• Recovery phase
– Up to 12 months for kidney function to stabilise

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14
Q

How is AKI classified
(5 classifications)
RIFLE

A 
Risk
injury
failure
loss
end-stage
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15
Q

For the Risk classification what is the serum creatinine/ GFR level and Urine output?

A

Increased creatinine × 1.5 or decrease in GFR > 25%

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16
Q

For the Injury of kidneys what is the serum creatinine/ GFR level and Urine output?

A

Increased creatinine × 2 or decrease GFR > 50%

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17
Q

for the Failure of kidneys what is the serum creatinine/ GFR level and Urine output?

A

increased creatinine × 3 or decrease in GFR > 75%

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18
Q

Loss of functioning happens at how many weeks?

A

Complete loss of kidney function > 4 weeks

19
Q

End - stage kidney disease happens at how many months?

A

End-stage kidney disease > 3 months

20
Q

What diagnostic studies can be done for AKI?

A 
– Thorough history
– Serum creatinine
– Urinalysis
– Kidney ultrasonography 
– Renal scan
– Computed tomography (CT) scan
21
Q

What multidisciplinary care needs to be done for the patient?

A

– Ensure adequate intravascular volume and cardiac output
– Closely monitor fluid intake during oliguric phase
– Hyperkalaemia
– Nutritional therapy

22
Q

What is the treatment for Prerenal, intra renal, postrenal?

A 
Pre-renal
– restoring blood flow to kidneys 
Intra-renal
– treating intrinsic disease e.g. glomerulonephritis
Post-renal
– removing an obstruction
23
Q

What are the 3 ways for renal replacement therapy?

A
  • Haemodialysis
  • Peritoneal dialysis
  • Renal transplantation
24
Q

What is dialysis and why is it used?

A

• Movement of fluid/molecules across a semipermeable membrane from one compartment to another
• Used to correct fluid/electrolyte imbalances and to remove waste products in renal failure
• Treat drug overdoses
• Two methods of dialysis available – Peritoneal dialysis (PD)
– Haemodialysis (HD)

25
Q

When is dialysis done?

A

• Begun when patient’s uraemia can no longer be adequately managed conservatively
• Initiated when GFR (or creatinine clearance) is less than 15 mL/min
• Ultrafiltration
– Water and fluid removal
– Results when there is an osmotic gradient across the membrane

26
Q

Explain Chronic Kidney Disease including early symptoms and late symptoms and GFR

A
  • Slowly and insidiously there is irreversible damage to the kidneys
  • CKD is diagnosed when Glomerular Filtration Rate (GFR) is 90)
  • Early symptoms: NONE, except proteinuria
  • Late symptoms: nocturia, nausea, itch, vomiting, headaches, breathlessness and weight loss
27
Q

what are the 6 stages of CKD

A

1,2,3a,3b,4,5

28
Q

What happens in Stage 1 of CKD?

A

normal or increased GFR >90
Diagnosis and treatment
CVD risk reduction
Slow progression

29
Q

What happens in Stage 2 of CKD?

A

Kidney damage with mild decreased GFR (60-89)

Elimination of progression

30
Q

What happens in Stage 3a of CKD?

A

Moderate decreased GFR (45-59)

Evaluation and treatment of complications

31
Q

What happens in Stage 3b of CKD?

A

Moderate to severe decreased GFR (30-45)
More frequent evaluation
treatment of complications

32
Q

What happens in Stage 4 of CKD?

A

Severe decrease in GFR (15-29)
Preparation for kidney replacement therapy
(dialysis, kidney transplant)

33
Q

What happens in Stage 5 of CKD?

A

Kidney failure
<15 or dialysis
Renal replacement therapy
(if uraemia is present and pt desires treatment)

34
Q

What electrolyte imbalances can occur?

A

• Potassium - Hyperkalaemia (Fatal dysrhythmias)
• Sodium – Elevated
– Because of impaired excretion, sodium is retained
(Water is retained: Oedema, hypertension, CHF)
• Metabolic acidosis
– Inability of kidneys to excrete acid load. Defective reabsorption/regeneration of bicarbonate

35
Q

Give 2 signs and symptoms from the Haemotologic system

A

– Anaemia
– Bleeding tendencies
– Infection

36
Q

Give 2 signs and symptoms from the Cardiovascular system

A

– Hypertension
– Heart failure
– Peripheral oedema
– Dysrhythmias

37
Q

Give 2 signs and symptoms from the Respiratory system

A

– Dyspnea may occur with fluid overload

  • pulmonary oedema
  • respiratory infections
38
Q

Give 2 signs and symptoms from the Gastrointestinal system

A 
– Every part of GI system is affected
• Cause: excessive urea
– Mucosal ulcerations
– GI bleeding
– Anorexia, nausea, vomiting, constipation
39
Q

Give 2 signs and symptoms from the Neurologic system

A

– Altered mental ability
– Seizures
– Coma

40
Q

Give 2 signs and symptoms from the Reproductive system

A

– Infertility
– Decreased libido
– Low sperm counts

41
Q

Give 2 signs and symptoms of Psychologic changes

A

– Personality and behavioural changes
– Withdrawal
– Depression

42
Q

What treatments can be used?

A

Antihypertensive therapy
Dyslipidaemia
Nutritional therapy

43
Q

What nursing managements can be done?

A

• Health promotion
• Acute intervention
– Daily weight and daily BPs
– Identify signs and symptoms of fluid overload and hyperkalaemia
– Strict dietary adherence
– Medication teaching
– Motivate patients in management of their disease
• Ambulatory and home care
– When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options

capstone (19 decks)

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