acute renal failure Flashcards
what is not a function of the kidney?
synthesize cholesterol, that’s the liver’s job
Functions of the kidneys
-regulate blood pressure
-secretion of prostaglandins
-release erythropoietin
best approximation of Kidney function?
24 hour urine
is a minor increase in creatinine alarming?
yes
what is CKD
-kidney damage or a decrease in GFR for 3 or more months
-associated with decreased quality of life
-can progress to ESKD
manifestations of CKD
increased creatinine
anemia
fluid retention
electrolyte imbalances
CKD interventions
-keep BP below 130/80
-control cardiac risk factors
-treat hyperglycemia
-manage anemia
-smoking cestation
-weight loss
which lab test is the best approximation of kidney function?
creatinine clearance
which lab value indicates if someone is dehydrated?
specific gravity
Acute Nephritic Syndrome clinical manifestations
-hematuria
-edema
-azotemia
-proteinuria
-cola-colored urine
-HTN
Acute Nephritic Syndrome treatment
-corticosteroids
-manage HTN
-ABX is infection still present
-I&O
-fluids as needed
Nephrotic syndrome
-increased glomerular permeability leading to massive proteinuria
-hypoalbuminemia
-hyperlipidemia
-hypercoagulable state
-edema
Nephrotic syndrome treatment
-diuretics
-ACE-Is
-lipid lowering agents
-sodium restriction
ESKD
-can be mistaken for stroke like symptoms
-uremia develops, the more build up the greater the symptoms
-metabolic acidosis occurs
ESKD complications
-anemia
-calcium - phosphorus imbalance
-hyperkalemia
-HTN
-pericarditis, pericardial effusion, pericardial tamponade
ESKD medications
-calcium & phosphate binders
-antihypertensives
-cardiovascular agents (ion tropics)
-erythropoietin
Hemodialysis goal
extract nitrogenous substances from the blood and to remove excess fluid
HD access
-arteriovenous fistula (preferred, vein to artery)
-arteriovenous graft (synthetic connection vein to artery
-HD catheter (double-lumen catheter that only dialysis can touch
how often do you assess artery/venous graft/fistula?
every 8-12 hours
what complications are you looking for for a patient who received HD?
bleeding at fistula/graft - apply pressure
infection central line
CRRT
-continous HD for patients too unstable for HD
-can be run on a critical care unit by trained critical care RN
Peritoneal Dialysis
-pt has PD catheter inserted on abdomen
-dwells dialysate into peritoneum
-drainage of dialysate into drainage bag
can you manipulate the catheter for peritoneal dialysis?
no
complications of peritoneal dialysis
peritonitis
leakage
bleeding
criteria for AKI
50% of greater increase in serum creatinine above baseline
what is pre-renal AKI?
-volume depletion (severe blood loss)
-impaired cardiac efficiency
-vasodilation
what is a intrarenal AKI?
-physical injury (trauma to kidney)
-hypoxic injury (prolonged ischemia)
-chemical injury (ACE-inhibitors)
-immunologic injury
Post renal AKI?
-urinary obstruction (kidney stone, BPH, tumors, SCI)
AKI stages
-initiation (when urine output starts to slow down)
-oliguria (400 mLs or less in 24 hours)
-diuresis
-recovery (can take months)
AKI complications
-fluid retention (daily weights)
-electrolyte imbalances
-uremia
AKI focused assessment
-dyspnea
-rhonchi
-tachycardia
-JVD
-edema
-decreased urine output
-ekg changes
AKI prevention
-monitor renal function
-monitor vital sign changes
-watch for signs/symptoms of sepsis
-provide & treat infections promptly
-provide adequate hydration to patient at risk for dehydration
Risk factors for kidney disease
-advanced age
-bph
-diabetes
nutritional considerations
-utilize daily weights during the oliguric and diuresis phase to determine appropriate dietary requirements
