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Exam 4 > Acute Kidney injury/Acute Renal failure > Flashcards

Acute Kidney injury/Acute Renal failure Flashcards

1
Q

When the kidneys are unable to remove the metabolites from the blood, it results in…

A

Renal failure

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2
Q

Increased nitrogenous waste in the blood is known as…

A

Azotemia

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3
Q

A rapid decline in renal fx., particularly in GFR due to reduced excretion fx. of kidneys that leads to increased creatinine, and urea levels is called…

A

Acute Kidney Injury (AKI)

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4
Q

Two common causes of AKI are..

A
  • -ischemia (insufficient blood supply)

- -nephrotoxins

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5
Q

Exposure to this can cause direct damage to the renal tissue.

A

Nephrotoxins

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6
Q

The acronym RIFLE defines the severity of AKI. RIFLE stands for…

A
  • -Risk for injury
  • -Injury
  • -Failure
  • -Loss of fx.
  • -End stage renal failure
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7
Q

There are 3 stages to AKI, Prerenal, Intrarenal, and post renal. Prerenal is classified when kidney fx. is at what percent?

A

55%

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8
Q

In the prerenal stage, reduced blood flow can lead to AKI w/o directly affecting integrity of kidney tissue. This results from conditions that happen BEFORE the kidneys are affected such as:

A
  • -Hypovolemia
  • -reduced CO
  • -altered vascular resistance
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9
Q

Some prerenal causes of AKI are:

A
  • -dehydration
  • -shock
  • -Vomiting, Diarrhea
  • -Surgery
  • -Cardiac failure
  • -Diuretics, NSAIDS, ACE inhibitors
  • -Liver failure
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10
Q

Prerenal AKI is rapidly reversed when…

A

blood flow is restored, and renal parenchyma remains undamaged.

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11
Q

Intrarenal (intrinsic) AKI is when the kidney functions at ___%

A

40%

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12
Q

In intrarenal stage there is direct damage to kidney tissue, acute damage to parenchyma and nephrons. the most common cause is due to…

A

Acute tubular necrosis

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13
Q

What are common causes of Intrarenal AKI?

A
  • -Acute Glomerulonephritis/pyelonephritis
  • -Aminoglycoside antibiotics
  • -Sepsis
  • -Aneurysms
  • -Cholesterol embolus
  • -radiation
  • -intratubular obstruction
  • -nephrotic drugs
  • -Diabetic Neuropathy
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14
Q

Acute tubular necrosis can be caused by:

A
  • **ischemia (primary cause)
  • -toxins (drugs)
  • -heavy metals
  • -hemolysis
  • -rhabdomyolysis
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15
Q

Post-renal AKI is when the kidney is functioning at ___%

A

5%

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16
Q

The precipitating factor associated with postrenal AKI is..

A

Urethral/Ureteral obstruction

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17
Q

Ureteral obstructions can be caused by…

A
  • *Calculi

* *Cancer

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18
Q

Urethral obstructions can be caused by…

A
  • **BPH (most common)
  • *Enlarged prostate
  • *Calculi
  • *cancer
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19
Q

The destruction of tubular epithelial cells with an abrupt progressive decline of renal function is known as…

A

Acute Tubular necrosis

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20
Q

Ischemia lasting longer than ___ hours can cause severe, irreversible damage to kidney tubules causing necrosis and sloughing.

A

2 hours

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21
Q

Common neurotoxins associated with acute tubular necrosis is…

A
  • *aminoglycoside antibiotics (“cin” meds)
  • -contrast media
  • -NSAIDS
  • -chemotherapy
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22
Q

The two most common causes of hospital acquired AKI are:

A
  • -decreased renal perfusion

- -nephrotoxic meds

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23
Q

The 3rd most common cause of hospital acquired AKI is:

A

–contrast (want to reduce number of tests done with dye)

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24
Q

What are some ways to prevent AKI?

A
  • -take BP meds (counteract vasoconstriction)
  • -enhance blood flow to kidneys
  • -reduce antibiotic, NSAID use
25
There are 3 stages when it comes to clinical manifestations of AKI. they are the initiation, maintenance, and recovery phase. The initiation phase can last ___ to ____. It begins at ____________ and ends when _____ ____ occurs. It is usually asymptomatic.
- -hours to days - -time of event (injury) - -tubular injury occurs
26
Maintenance phase is when there is a significant fail in GFR. Urine may be produced but, kidney cannot eliminate metabolic waste, water, electrolytes, and acids properly which leads to a manifestation of...
oliguria
27
In the maintenance phase the patient will present with...
- -azotemia - -fluid retention - -metabolic acidosis - -edema - -hyperkalemia, hyperphosphatemia, hypocalcemia - -anemia (b/c of suppressed erythropoietin secretion)
28
When waste and fluids aren't filtered and stay in the blood this can cause what syndrome?
Uremic syndrome
29
The recovery phase is when the tubule cells repair and return GFR to normal. the patient may lose large amounts of urine which is called...
Diuresis
30
In the recovery phase renal function starts to improve rapidly. How long could it take for the kidneys stabilize?
up to 1 year
31
Diagnostic tests associated with AKI are:
- -UA (specific gravity of 1.010) - -BUN * *creatinine (most definitive to dx. renal issues) - -electrolytes (hyperkalemia, hyponatremia) - -ABG's (metabolic acidosis) - -CBC (anemia) - -Renal ultrasound (obstruction?) - -Renal biopsy (acute or chronic?)
32
Pharm therapy for AKI include:
- -IV fluids (perfusion) - -Dopamine IV (increases renal blood flow) - -Furosemide (manages salt and water retention)
33
- -The patient can also be given this med which will excrete sodium, potassium in poop. - -The med can be given with___ to prevent constipation
* *Kayexalate | - -sorbitol
34
Once volume and renal perfusion is restored the patient will be put on a ____ _____.
Fluid restriction
35
To calculate fluids the nurse must allow for how many mL of insensible loss?
500 mL
36
How is fluid restriction calculated?
Take 500 mL of insensible loss and add amount excreted in urine from prior shift. Example: A patient had 275 mL output from previous shift. 500 mL + 275 mL = 775 fluid restriction for next day
37
- -Proteins must be limited _______/day to minimize azotemia. - - The nurse should instruct the pt. to eat high value proteins such as: - -The pt. should be on a high ___ diet to provide adequate calories.
- -0.6g/kg per day - -eggs, fish, protein shakes - -Carb
38
Parenteral nutrition can be used if the pt. cant have PO nutrition. the disadvantages to this is the risk for...
- -fluid volume overload (increased volume of fluid needed) | - -infection (venous line)
39
- -Continuous arteriovenous hemofiltration (CAVH) is used to remove... - -It works by circulating blood through a ____ then returning it to the pt. The ultrafiltrates are collected in a drainage bag.
- -Fluid and some solutes | - -hemofilter
40
Continuous arteriovenous hemodialysis (CAVHD) is done by removing.... Arterial blood circulates through hemofilter surrounded by____, then returns to client.
- -fluid and waste products | - -Dialysate
41
Continuous venovenous hemodialysis (CVVHD) is used to remove.... Venous blood circulates through hemofilter surrounded by dialysate then returns to client through....
- -Fluid and waste products | - -double lumen venous catheter
42
when a person does hemodialysis they will have a ___ or ____ in their arm.
AV graft or fistula
43
A person on dialysis will do it ____ times weekly, for about ___ hours each session.
- - 3 to 4 times | - - 3 to 4 hours
44
Complications of hemodialysis are:
* *hypotension (most frequent) - -bleeding - -infection
45
Prior to dialysis the nurse should monitor VS and hold what meds?
-hold BP meds
46
If a patient is anemic a ____ injection can be given prior to dialysis tx.
erythropoietin
47
- -due to having to access the graft regularly the patient is at risk for_______. - -Other risks are... - -They are most commonly caused by...
- -Infection - -HIV/AIDS, Hep. B/C - -Healthcare workers (poor hand hygiene, cross contamination, contaminated equipment)
48
What therapy functions closely to our own renal function?
Continuous renal replacement therapy (CRRT)
49
CRRT can last for a period of ___ hours or more. It is a slower process and is done in the ____.
- - 12 hours | - - ICU
50
For HD and CRRT it is done in the subclavian, jugular, or femoral vein with a double lumen catheter. If it is functional the nurse will note...
palpable pulsation, and bruits heard on auscultation
51
when a patient has a graft or fistula in the arm the nurse should put a sign in the patients room that states....
No IV's or BP in that arm
52
Peritoneal dialysis is performed by using...
warmed sterile dialysate
53
where is the catheter placed with peritoneal dialysis?
Peritoneal cavity
54
During peritoneal dialysis fluid is drained by ____ out of peritoneal cavity and into a sterile bag. The fluid in the bag should be ____.
- -gravity | - -clear
55
With peritoneal dialysis the patient is at risk for...
Peritonitis
56
Peritoneal dialysis is contraindicated in pts. with...
- -recent abd. surgery - -lung disease - -peritonitis
57
Three nursing diagnosis for AKI may be...
- -Excess fluid volume - -ineffective renal tissue perfusion - -Risk for altered cardiac perfusion
58
when caring for a pt. with AKI/ARF, the nurse should implement what in to her care plan?
- -Weigh daily - -monitor I & O's - -VS q4h - -Semi fowlers - -Put on cardiac monitor (hyperkalemia) - -Q2 turns if needed - -fluid restrictions (give hard candies or do mouth care)

Exam 4 (10 decks)

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