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6200 Adult /Older Adult II > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Acute Kidney Injury manifestations?

A

increased creatinine and decreased UO

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2
Q

How to approximate minimal normal uring output in an adult?

A

30cc/hr or 0.5mL/kg/hr

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3
Q

types of AKI

A

prerenal, intrarenal, postrenal

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4
Q

What is a normal MAP?

A

70-105

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5
Q

At what MAP will kidney profusion problems occur?

A

60 or below

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6
Q

Kidney damage occurs how long after hypoperfusion begins?

A
  • > 30 minutes

- < 30, no damage, reversible

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7
Q

Causes of prerenal ACI?

A
  • Hypovolemia (dehydration/bleeding)
  • decreased cardiac output (MI or HF)
  • decreased peripheral vascular
  • decreased renal blood flow
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8
Q

Causes of Intrarenal ACI?

A

Acute Tubular Necrosis
Hemoglobin
Myoglobin
Interstitial nephritis

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9
Q

Causes of Acute Tubular Necrosis

A
  • Nephrotoxic Injury (drugs)
  • Prolonged ischemia
  • Sepsis
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10
Q

In which type of acute kidney injury is there direct kidney injury?

A

intrarenal

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11
Q

Causes of Postrenal acute kidney injury?

A

mechanical obstruction causes urine to flow back into the kidney (enlarged prostate)

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12
Q

Acute Kidney Injury RIFLE stands for?

A 
Risk
Injury
Failure
Loss
End-stage disease
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13
Q

Acute Kidney Injury RIFLE Classification is base on?

A

creatinine or GFR

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14
Q

Acute Kidney Injury Phases?

A

Oliguric , Diuretic , Recovery

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15
Q

Acute Kidney Injury Oliguric Phase

A
  • ↓ Urine output to < 400 cc/day (50% of cases)

- geriatric patients at increased risk of increased UO

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16
Q

What is increased in Acute Kidney Injury Oliguric Phase?

A

Vascular fluid volume, BUN, Creatinine, Potassium, Phosphate

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17
Q

What lab values are decreased in the Oliguric phase of an Acute Kidney Injury?

A
  • pH = metabolic acidosis
  • Calcium
  • Na may be normal or low
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18
Q

Acute Kidney Injury Diuretic Phase?

A
  • Kidneys recover ability to excrete but not concentrate urine
  • Urine output 1-5 Liter/day, 2-3 weeks
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19
Q

Acute Kidney Injury Oliguric Phase begins?

A
  • < 7 days after event

- if last > 10-14 days = worse prognosis

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20
Q

UO during the Oliguric phase of AKI?

A
  • < 400 mL in 50%
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21
Q

Acute Kidney Injury Diuretic Phase labs?

A
  • ↑ BUN and serum creatinine
  • ↓ creatinine clearance
  • Near end of phase - normalization of lab values
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22
Q

UO during the Diuretic phase of AKI?

A

1-5 Liter/day, 2-3 weeks

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23
Q

Acute Kidney Injury Recovery Phase Labs?

A

↓ BUN and serum creatinine

24
Q

Acute Kidney Injury Recovery Phase lasts?

A

1-2 wks, up to 12 mo

25
Q

Acute Kidney Injury Recovery Phase begins?

A
  • when GFR increases
  • some permanent loss of renal failure
  • enough renal function to maintain healthy life
26
Q

Prerenal Acute Kidney Injury Diagnostics - Urinalysis

A
  • ↑urine spec. gravity (>1.015)
  • Urine osmolality >500mOsm/kg
  • ↓urine sodium concentration (<20 mEq/L)
27
Q

Intrarenal Acute Kidney Injury Diagnostics - Urinalysis

A
  • Urine spec. gravity fixed at 1.010
  • Urine osmolality <400mOsm/kg
  • ↑sodium in urine (>40mEq/L)
28
Q

Intrarenal Acute Kidney Injury Diagnostics - Urinalysis

A

Casts - cells that have taken on the shape of the renal tubules

29
Q

Acute Kidney Injury Diagnostics ALL?

A
  • Labs
    • serum creatinine, BUN
    • BUN : Creatinine ratio
    • creatinine clearance
    • Electrolytes
  • Kidney Ultrasound
  • CT/MRI
  • Kidney biopsy
30
Q

Primary goals of AKI care?

A

manage fluids and hypokalemia

31
Q

1st step of ACI tx?

A
  • Diuretics
  • Volume expanders
  • Dialysis
32
Q

How to calculate fluid replacement in ACI?

A

use past 24hr record and add 600 mL

33
Q

Hyperkalemia tx for patient with ACI?

A
  • Regular insulin IV (and glucose)
  • Sodium bicarb
  • Calcium gluconate IV
  • Hemodialysis
  • Sodium polystyrene sulfonate (Kayexalate)
  • Dietary restriction (K restricted to 40 mEq/day)
34
Q

Why are insulin and glucose given to treat hyperkalemia?

A

insulin increase k into the cells and glucose to prevent hypoglycemia

35
Q

What does Sodium polystyrene sulfonate (Kayexalate) do?

A
  • increases k out the bowels an Na in

- diarrhea and/or soft bowels occur

36
Q

Which medication increases k out and Na retention in the bowels?

A

Sodium polystyrene sulfonate (Kayexalate)

37
Q

Dietary restriction for hyperkalemic patient?

A

40 mEq/day

38
Q

When do you initiate dialysis in an ACI?

A
  • Volume overload
  • Compromised cardiac or pulmonary status
  • Hyperkalemia with EKG changes
  • Metabolic Acidosis (serum bicarb <15mEq/L)
  • BUN >120
  • Significant mental status changes
  • Pericarditis, pericardial effusion, cardiac tamponade
39
Q

Acute Kidney Injury Nursing Interventions to maintain homeostasis/monitor renal function?

A
  • Identify and monitor high-risk clients
  • Assess fluid balance
  • Assess electrolytes and renal parameters
  • Evaluate postural hypotension
  • Support involved body systems-cardiac, pulmonary
  • Balance activity/rest
40
Q

Acute Kidney Injury Nursing Interventions to Maintain fluid/electrolyte balance?

A

Monitor:
- Daily weight, I’s & O’s
- Metabolic acidosis
- Uremia
- Hyperkalemia
Management:
- Fluid replacement
- Dialysis
- Continuous Renal
- Replacement Therapy
~~~

41
Q

Acute Kidney Injury Nursing Interventions to maintain nutrition?

A
  • Calories from carbohydrates and fats
  • Dietary restrictions (low Na, k and/or phosphorous)
  • Small frequent feedings, limit fluids
42
Q

Acute Kidney Injury Nursing Interventions to monitor for infection?

A 
Prevent
  - Avoid indwelling catheter
Assess 
  - For UTI
  - Wounds
  - Lines
  - WBC
43
Q

Acute Kidney Injury Nursing Interventions to prevent skin breakdown

A
  • Positioning
  • Prevent pressure areas
  • ROM
44
Q

Manifestations of ACI - Urinary System?

A
  • decreased UO, specific gravity and osmolality
  • increased urinary Na
  • proteinuria
  • casts
45
Q

Manifestations of ACI CV System?

A
  • volume overoad
  • HF
  • hypotension (early)
  • HTN after FVO
  • pericarditis
  • pericardial effusion
  • dysrhythmias r/t electrolyte imbalances
46
Q

Manifestations of ACI - Respiratory System?

A
  • pulmonary edema
  • pleural effusions
  • kussmaul resps
47
Q

Manifestations of ACI - GI System?

A
  • N/V
  • anorexia
  • stomatitis
  • bleeding
  • diarrhea
  • constipation
48
Q

Manifestations of ACI - Hematologic?

A
  • anemia (within 48hrs)
  • increased risk of infection
  • leukocytosis
  • clotting problems
49
Q

Manifestations of ACI - Neurologic?

A
  • lethargy
  • seizures
  • asterixis
  • memory impairment
50
Q

What lab values are indicative of an Acute Kidney Injury (AKI)?

A

decreased:
- Na, pH, bicarb, Ca
increased:
- BUN, creatinine, k, phosphate

51
Q

What are the causes of AKI in older adults?

A

dehydration, hypotension, diuretic therapy, aminoglycoside therapy, prostatic hyperplasia, surgery, infection, and contrast media

52
Q

Increases in serum creatinine occur after what percentage of kidney function loss?

A

> 50%

53
Q

What are the most common complications with peritoneal dialysis?

A

infection at the site, peritonitis, pain, hernias, low back pain, protein loss, bleeding, atelectasis, pneumonia, bronchitis

54
Q

What are the most common complications with hemodialysis?

A

hypotension, muscle cramps and blood loss

55
Q

What type of therapy is used for a hemodynamically unstable patient in place of HD or PD?

A

Continuous Renal Replacement Therapy (CRRT)

6200 Adult /Older Adult II (17 decks)

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