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Nursing Theory > Acute Kidney Injury and Chronic Kidney Disease > Flashcards

Acute Kidney Injury and Chronic Kidney Disease Flashcards

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1
Q

What is kidney disease?

A
  • kidney disease may cause the partial or complete impairment of kidney function
  • results in an inability to to excrete metabolic waste products and water
  • renal insufficiency impacts all body systems
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2
Q

What is acute kidney disease characterized by?

A

An abrupt decline in kidney function

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3
Q

How long does acute kidney disease occur over?

A

Over hours to days

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4
Q

What does acute kidney disease result in?

A

A build up of waste products in your blood and affects fluid balance

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5
Q

What are pre-renal injuries?

A
  • injuries that occur before the kidney
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6
Q

What is pre-renal ischemia?

A
  • hemorrhage or dehydration
  • decreased cardiac output
  • hypotension from septic shock
  • antihypertensive medications
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7
Q

What are intrarenal injuries?

A
  • conditions that cause direct damage to kidney tissue
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8
Q

What is acute tubular necrosis?

A
  • ischemia and high pressure within the kidney causes death of tubular epithelial cells that form the renal tubules of the kidneys
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9
Q

What is acute glomerulonephritis?

A

An infection

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10
Q

What are some diseases that cause vascular changes?

A
  • diabetes

- hypertension

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11
Q

What are post-renal injuries?

A
  • obstructive problems
  • urinary and renal calculi
  • benign prostatic hypertrophy
  • urethral stricture
  • trauma
  • bladder cancer
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12
Q

What is the oliguric phase of kidney injury?

A
  • urinary output decreased to <400 ml per 24 hours
  • increase in blood urea nitrogen (BUN) and creatinine levels
  • uric acid, potassium, and magnesium levels
  • duration 1-3 weeks
  • metabolic acidosis
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13
Q

What is the diuretic phase of kidney injury?

A
  • often has a sudden onset within 2-6 weeks of oliguric phase
  • diuresis: up to 4-6 L per 24 hours - very dilute
  • hypovolemia and hypotension
  • BUN levels stop increasing
  • urinary creatinine clearance stabilizes
  • monitor for hypokalemia and hyponatremia
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14
Q

What is the recovery phase (convalescent phase) of kidney injury?

A
  • begins when the glomerular filtration rate (GFR) increases and starts to return to normal
  • continue to monitor electrolytes
  • continue to monitor for hypovolemia and hypotension
  • often some permanent loss of kidney function
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15
Q

What are some of the symptoms of acute kidney injury?

A
  • hypotension - will become hypertensive as more fluid builds up
  • irregular heart rhythms (hyperkalemia)
  • SOB (fluid may back up into the lungs)
  • decreased LOC: confusion to coma
  • edema - fluid retention
  • electrolyte imbalances (hyperkalemia and hyponatremia)
  • anemia (low erythropoietin levels) - fatigue and weakness
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16
Q

What is the glomerular filtration rate in acute acute kidney injury?

A
  • 90-120 mL/min/1.73 m2

- as GFR rises, urine output decreases

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17
Q

What diagnostic studies should be done for acute kidney injury?

A
  • ultrasound of kidneys

- CT scan (no contrast)

18
Q

What is the treatment for acute kidney disease?

A
  • focus on determining the cause
  • fluid balance
  • monitor electrolytes (potassium, sodium, phosphate and calcium)
  • maintain serum pH levels (administer bicarbonate)
  • dialysis
19
Q

What are the nursing interventions for acute kidney injury?

A
  • monitor kidney function (BUN and creatinine values)
  • accurate intake and output
  • daily weights (same scale, same time)
  • monitor specific gravity values
  • monitor electrolyte values
  • frequent vital signs (monitor BP, hypotension or hypertension)
20
Q

What nursing interventions should be done in the oliguric phase?

A
  • fluid restrictions
  • hyperkalemia (give insulin and glucose help to drive K+ into the cells, sodium polystyrene sulphurated (kayexalate) - bind potassium)
  • calcium supplements
  • phosphate binders
  • restrict protein, potassium, and sodium intake
  • increased intake of carbohydrates
  • monitor for constipation
21
Q

What nursing interventions need to be done in the diuretic phase?

A
  • administer fluids NS
  • hypokalemia - potassium supplements
  • skin care
  • monitor sodium levels - hyponatremia
  • monitor calcium and phosphate level
  • encourage fluids
  • some potassium, sodium and protein intake, check lab values
  • increased intake of carbohydrates and fats for energy
  • small frequent meals
22
Q

What is chronic kidney disease?

A
  • a progressive irreversible reduction in renal function
  • defines as the presence of kidney disease (pathological abnormalities)
  • nephrons are destroyed = decrease in glomerular filtration rate (GFR)
  • normal GFR = 125ml/min/1.73m3
  • chronic kidney disease GFR <60ml/min/1.73m3 for three months or longer
23
Q

What are the risk factors for chronic kidney disease?

A
  • chronic hypertension
  • diabetes (poorly controlled)
  • chronic glomerulonephritis or pyelonephritis
  • exposure to nephrotoxic medication/chemo
  • systemic lupus erythematous (SLE)
24
Q

What is stage 1 of chronic kidney disease?

A
  • kidney damage with normal GFR
  • GFR >90ml/min/1.73m3
  • diagnosis and treatment
  • evaluation of risk factors, implement strategies to manage
  • slow progression - proper nutrition, fluid management (water), meds, are prescribed
25
Q

What is stage 2 of chronic kidney disease?

A
  • kidney damage with mild decrease in GFR
  • GFR = 60-89 ml/min/1.73m3
  • diagnosis and treatment
  • evaluation of risk factors, implement strategies to manage
  • slow progression - proper nutrition, fluid management (water), meds as prescribed
26
Q

What is stage 3 of chronic kidney disease?

A
  • kidney damage with moderate decrease in GFR
  • GFR = 30-59 ml/min/1.73m3
  • treatments to slow progression - proper nutrition, fluid management (water), meds as prescribed)
  • assess and treat complications
  • example; hypertension, fluid volume overload
27
Q

What is stage 4 of chronic kidney disease?

A
  • kidney damage with severe decrease in GFR
  • GFR = 15-29 ml/min/1.73m3
  • treatments to slow progression - proper nutrition, fluid management (water), meds as prescribed
  • assess and treat complications (DM and hypertension)
  • prepare for kidney replacement therapy
28
Q

What is stage 5 of chronic kidney disease?

A
  • kidney failure
  • GFR = < 15 ml/min/1.73m3
  • dialysis (perineal dialysis or hemodialysis)
  • kidney replacement (transplant)
29
Q

What are the signs and symptoms of chronic kidney disease?

A
  • changes in urine specific gravity
  • urine - proteinuria, presence of casts, pyuria, and hematuria
  • oliguria leads to anuria (<100ml of urine/24 hours)
  • decreasing GFR rates over periods of months
  • increasing BUN and creatinine levels
  • decreasing erythropoietin production (slowly over time)
30
Q

What are the metabolic changes associated with chronic kidney failure?

A
  • accumulations of waste products (nitrogenous) impact GI system
  • nausea and vomiting
  • anorexia
  • insulin is excreted by the kidneys - lack of filtration leads to changes in carbohydrate metabolism (elevated triglyceride levels and decreased lipase levels(breakdown fats)
  • advanced stages lead to gastritis and peptic ulcer disease from metabolic acidosis
31
Q

What are the respiratory systems associated with chronic kidney disease?

A
  • dyspnea, fluid overload
  • pulmonary edema
  • predisposed to respiratory infections
32
Q

What are the endocrine symptoms of chronic kidney disease?

A
  • unable to filter phosphorus (commonly found in foods) = hyperphosphatemia = hypoglycemia
  • demineralizing of the bone: pathological fractures
  • imbalances in electrolytes impact muscle - weakness and fatigue
33
Q

What are the symptoms of the skin caused by chronic kidney disease?

A
  • yellow/gray discoloration
  • pruritis (due to high level of urea)
  • ecchymosis
34
Q

What are the cardiovascular symptoms related to chronic kidney disease?

A
  • hypertension
  • heart failure (can develop)
  • anemia (low erythropoietin production) = poor oxygenation to tissues
  • hyperkalemia leads to cardiac dysrhythmia
35
Q

What are the neurologic symptoms related to chronic kidney disease?

A
  • general nervous system depression
  • peripheral neuropathy
  • sleep disturbances
36
Q

What diagnostic tests can be done for chronic kidney disease?

A
  • urinalysis (sediment for casts, protein, specific gravity)
  • lab (BUN and creatinine levels, GFR, electrolytes, CBC: red blood cells, hemoglobin, and hematocrit values)
  • ultrasound of kidneys
  • CT scan
37
Q

What nutritional therapy needs to be considered for patients with chronic kidney disease?

A
  • limit protein intake to 20-40 grams/day (protein with high biologic value (high in amino acids), beef, fish and eggs)
  • fluid restrictions 1L/day - adjust per urinary output or dialysis
  • restrict sodium, potassium, and phosphate intake
38
Q

What medications might be given for someone with chronic kidney disease?

A

Antihypertensive medications
- beta blockers (carvedilol, metoprolol)
- ACE inhibitors (lisinopril, ramipril)
-calcium channel blockers (amloodipine, nicardipine)
- calcium supplemental vitamin D
- phosphorus binders (calcium acetate, sevelamer)
Diuretic Medications
- loop (furosemide)
- thiazide (hydrochlorothiazide)
- potassium sparing (spironolactone
Erythropoietin (eopgen, procrit) - stimulates red blood cell development
Folic acid and or iron supplement (prevent anemia)

39
Q

What nursing interventions need to be done for patients with chronic kidney disease?

A
  • evaluate fluid balance (determine daily weights, monitor intake and output, fluid restrictions)
  • monitor nutritional intake (limit sodium, phosphorus and potassium)
  • prevent constipation (add bran/fiber to diet, stool softeners)
  • frequent vital signs (monitor hypertension)
  • medication therapy
  • monitor for signs of fluid overload
  • treat complications (dry skin, anemia)
  • care of accesses for dialysis procedures
40
Q

What is dialysis?

A
  • passage of ions from and area of high concentration to low concentration across a semipermeable membrane
    hemodialysis or peritoneal dialysis

Nursing Theory (6 decks)

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