Acute Kidney Injury Flashcards
Kidney stone diet **
look in blue box on page 2 of the kidney stone diet handout
Acute kidney injury
almost always recoverable - rapid loss of kidney function
elevated serum creatinine
decreased urine output (oliguria)
potentially reversible
azotemia
too much nitrogen in the blood
3 types of kidney injury
pre-renal
inter-renal
post-renal
prerenal causes
caused by: Ischemia- whats causing it? severe dehydration heart failure (or anything that decreases cardiac output) arythmias/tachycardia/ ect anything that decreases CO
ischemia decreases GFR
causes oliguria
autoregulatory mechanisms attempt to prevent blood flow (only as effective as the blood flow)
intrarenal damage
tissue damaged by conditions prolonged ischemia NEPHROTOXINS abx (gentamycin) NSAIDS Hgb released from hemolyzed RBC Myoglobin released from necrotic muscle cells
ATN acute tubular necrosis
results from ischemia, nephrotoxins, or sepsis
potentially reversible
only need about % of one kidney to survive
40%
Post renal causes (5) :
BPH Prostate cancer calculi trauma (ex bike injury on urethra) extrarenal tumors
AKI
RIFLE classification-
how much filtration rate is lost?
Risk for injury? Injury ( start having scant urine) Failure (lost all but 50% GFR) Loss (lost all but 25% GFR) End stage kidney disease
oliguric phase urine output?
urine output <400mL/day
occurs 1-7 days after insult
lasts 10-14 days
oliguric phase UA may show?
UA may show casts, RBC WBC
oliguric phase =fluid retention
sx are-
neck veins distended bounding pulse pulmonary edema HTN anasarca
Kussmaul respiration
lungs try to make pt take deeper breaths faster
trying to maintain acid pH balance in body
hyponatremia can lead to
cerebral edema
anasarca becomes life threatening when:
it spreads to brain tissue-the swelling has no where to go (cerebral edema limits amount of blood that can get into the brain)
33:03
quickest way to die from renal prob?
potassium excess
affects electrocardiac activity of heart= EKG changes
what happens to lab value from waste product accumulation?
Elevated BUN ans serum creatinine levels
Diuretic phase of AKI-
how much urine?
what should you monitor?
daily urine output 1-3L
May reach 5L or more
monitor for hyponatremia, hypokalemia, and dehydration
AKI - diagnostic studies?
UA
serum creatinine
kidney ultrasonography- looking for hydronephrosis fluid buildup in kidney
renal scan-
CT of abdomen with contrast dye (risk to kidneys from dye)
renal biopsy 14G needle apply pressure dressing and keep pt on that side to limit bleeding
therapy for hyperkalemia ( biggest life or death)
Kayexalate med- very sweet pulls K+ from colon thru pooping
combo of IV insulin/ IV dextrose/ Ca Gluconate
47:50
osmotic diuretic
mannitol or albumin
CRRT continuous renal replacement therapy
ICU 1 nurse monitors pt- 1 nurse monitor machine to verify I and O
nutrition therapy for AKI
adequate caloric intake
restrict Na, K
increase dietary fat ( so they still get amino acids)
enteral nutrition
LIMIT protein= causes higher nitrogenous wastes
Assessment for AKI
VS
I and O
examine urine
assess appearance of pt (itching? skin turgor? dehydration?)
observe access site for dialysis
LOC
oral mucosa
lung sounds (crackles? sign of pulonary edema)
heart rythym (irregular = hyper/hypo kalemia)
Nusing DX for AKI
excess fluid volume
risk for infection
fatique
anxiety
1KG water = how much water retained?
1L
chronic kidney disease
****see table 47-6
memorize the TABLE!
progressive irreversible loss of kidney function
SEE TABLE 47-6 stages of kidney disease++
leading cause of ESKD
diabetes
HTN leads to atherosclerosis= succession of blood flow
glomulonephritis
interstitial nephritis
polycystic kidney disease (cysts increase size of kidney/decrease function)
prolonged obstuction of urinary tract
vesicoureter reflux
chronic pyelonepritis (infection leads to inflammation and scarring)
oliguria
scant urine
isothenuria
large qty of very dilute urine
anuria
producing almost no urine
which dialysis is least extreme?
peritoneal dialysis- aka continuous ambulatory dialysis- peritoneum of body is used as a permeable membrane as pt ambulates
peritoneal dialysis is started when-
pt GFR is 15mL or less
begun when pt uremia can no longer be managed conservatively
peritoneal dialysis is done by
inserting a catheter thru the abdominal wall= direct access into inner part of body STERILE TECHNIQUE MANDATORY!
peritoneal dialysis based on pt
weight and BP
Dialysis solutions
1, 2, or 3L bags
concentration of 1.5%, 2.5%, or 4.25% dextrose
must be warmed slowly to BODY TEMP
do not microwave!!!!!!!!
Pt takes BP and dry weight (empty) in the AM to determine fluid deficient 1.5%/ neutral2.5% /overload 4.25%
dialysate should be:
clear (no infection) no strings (fibrin starting to form clotting cascade- dr would give heparin to prevent that from progressing)
dialysate should be:
clear (no infection) no strings (fibrin starting to form clotting cascade- dr would give heparin to prevent that from progressing) allows independence allows travel short training program fewer dietary restrictions greater mobility than with hemodialysis
benefit of peritoneal dialysis
allows freedom of movement , go about life
complications of peritoneal dialysis
exit site infection hernia (walking around with 3KG of fluid in abdomen) peritonitis lower back problem (from the weight of the 3KG of fluid) clog in tubing bleeding pulmonary complications protein loss
hemodialysis complication
Complications: Thrombosis Infection Aneurysm Ischemia – “steal syndrome”
dialyzer
artificial kidney
access sight for hemodialysis
arteriovenous fistula and graft,
temporary vascular access
** risk for infection, clotting
hemodialysis vascular access
fistula - surgically created anastamosis of artery and vein - much less likely to blow like a vein would do (more common- but if poor blood supply or cant use large enough needle)
shunt/graft- same process, but using teflon or dacron but deaing with a foreign substance in the body
Dialyzer/blood lines are primed with saline solution to eliminate air/blood in the line T or F?
TRUE
Fill a thrill means?
turbulance that can be felt at site
hemodialysis complications?
Hypotension Muscle cramps Loss of blood Hepatitis (getting lower) Disequilibrium syndrome
nursing considerations for pt with hemodiallysis:
NEVER use HD catheter without a physician order
NO….. In affected extremity
Blood pressure measurements
Insertion of IVs
Phlebotomy
Palpate for thrills and auscultate for bruits every 4 hours while pt is awake
Assess the patient’s distal pulses and circulation in the arm with the access
Elevate the affected extremity post operatively
Encourage routine range of motion exercises
Check for bleeding at needle insertion sites
Assess for s/s of infection at the needle insertion site.
Instruct pt not to carry heavy loads in the affected arm
Instruct pt not to sleep with the body weight on the affected arm
more nursing considerations for hemodialysis
Monitor vital signs
Monitor laboratory values before, during and after dialysis
Assess the client for fluid overload prior to the procedure
Assess patency of the blood access device
Weigh the client before and after the procedure to determine fluid loss. Know the Patient’s dry weight.
Assess the patient’s LOC
Assess for headache, nausea or vomiting.
MORE nursing considerations for hemodialysis
Hold antihypertensives and other medications that can affect the BP prior to the procedure, as prescribed
Hold medications that could be dialyzed off, such as water-soluble vitamins and certain antibiotics
Monitor for shock and hypovolemia during the procedure
Provide adequate nutrition (client may eat prior to the procedure)
