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

Acute Kidney Injury Flashcards

(55 cards)

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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?

Study These Flashcards
A

↓ BUN and serum creatinine

24
Q

Acute Kidney Injury Recovery Phase lasts?

Study These Flashcards
A

1-2 wks, up to 12 mo

25
Acute Kidney Injury Recovery Phase begins?
- when GFR increases - some permanent loss of renal failure - enough renal function to maintain healthy life
26
Prerenal Acute Kidney Injury Diagnostics - Urinalysis
- ↑urine spec. gravity (>1.015) - Urine osmolality >500mOsm/kg - ↓urine sodium concentration (<20 mEq/L)
27
Intrarenal Acute Kidney Injury Diagnostics - Urinalysis
- Urine spec. gravity fixed at 1.010 - Urine osmolality <400mOsm/kg - ↑sodium in urine (>40mEq/L)
28
Intrarenal Acute Kidney Injury Diagnostics - Urinalysis
Casts - cells that have taken on the shape of the renal tubules
29
Acute Kidney Injury Diagnostics ALL?
- Labs - serum creatinine, BUN - BUN : Creatinine ratio - creatinine clearance - Electrolytes - Kidney Ultrasound - CT/MRI - Kidney biopsy
30
Primary goals of AKI care?
manage fluids and hypokalemia
31
1st step of ACI tx?
- Diuretics - Volume expanders - Dialysis
32
How to calculate fluid replacement in ACI?
use past 24hr record and add 600 mL
33
Hyperkalemia tx for patient with ACI?
- Regular insulin IV (and glucose) - Sodium bicarb - Calcium gluconate IV - Hemodialysis - Sodium polystyrene sulfonate (Kayexalate) - Dietary restriction (K restricted to 40 mEq/day)
34
Why are insulin and glucose given to treat hyperkalemia?
insulin increase k into the cells and glucose to prevent hypoglycemia
35
What does Sodium polystyrene sulfonate (Kayexalate) do?
- increases k out the bowels an Na in | - diarrhea and/or soft bowels occur
36
Which medication increases k out and Na retention in the bowels?
Sodium polystyrene sulfonate (Kayexalate)
37
Dietary restriction for hyperkalemic patient?
40 mEq/day
38
When do you initiate dialysis in an ACI?
- 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
Acute Kidney Injury Nursing Interventions to maintain homeostasis/monitor renal function?
- 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
Acute Kidney Injury Nursing Interventions to Maintain fluid/electrolyte balance?
Monitor: - Daily weight, I’s & O’s - Metabolic acidosis - Uremia - Hyperkalemia Management: - Fluid replacement - Dialysis - Continuous Renal - Replacement Therapy ```
41
Acute Kidney Injury Nursing Interventions to maintain nutrition?
- Calories from carbohydrates and fats - Dietary restrictions (low Na, k and/or phosphorous) - Small frequent feedings, limit fluids
42
Acute Kidney Injury Nursing Interventions to monitor for infection?
``` Prevent - Avoid indwelling catheter Assess - For UTI - Wounds - Lines - WBC ```
43
Acute Kidney Injury Nursing Interventions to prevent skin breakdown
- Positioning - Prevent pressure areas - ROM
44
Manifestations of ACI - Urinary System?
- decreased UO, specific gravity and osmolality - increased urinary Na - proteinuria - casts
45
Manifestations of ACI CV System?
- volume overoad - HF - hypotension (early) - HTN after FVO - pericarditis - pericardial effusion - dysrhythmias r/t electrolyte imbalances
46
Manifestations of ACI - Respiratory System?
- pulmonary edema - pleural effusions - kussmaul resps
47
Manifestations of ACI - GI System?
- N/V - anorexia - stomatitis - bleeding - diarrhea - constipation
48
Manifestations of ACI - Hematologic?
- anemia (within 48hrs) - increased risk of infection - leukocytosis - clotting problems
49
Manifestations of ACI - Neurologic?
- lethargy - seizures - asterixis - memory impairment
50
What lab values are indicative of an Acute Kidney Injury (AKI)?
decreased: - Na, pH, bicarb, Ca increased: - BUN, creatinine, k, phosphate
51
What are the causes of AKI in older adults?
dehydration, hypotension, diuretic therapy, aminoglycoside therapy, prostatic hyperplasia, surgery, infection, and contrast media
52
Increases in serum creatinine occur after what percentage of kidney function loss?
> 50%
53
What are the most common complications with peritoneal dialysis?
infection at the site, peritonitis, pain, hernias, low back pain, protein loss, bleeding, atelectasis, pneumonia, bronchitis
54
What are the most common complications with hemodialysis?
hypotension, muscle cramps and blood loss
55
What type of therapy is used for a hemodynamically unstable patient in place of HD or PD?
Continuous Renal Replacement Therapy (CRRT)

6200 Adult /Older Adult II (17 decks)

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