Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

medsurg 2 > AKI > Flashcards

AKI Flashcards

1
Q

what is AKI?

A

term used to encompass the entire scope of the syndrome.
ranging from a slight deterioration in kidney function to severe impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is AKI characterized by?

A

a rapid loss of kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the loss of kidney function is accompanied by what?

A

a rise in serum creatinine and/or a reduction in urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AKI can develop over how long? with progressive elevations of what?

A
  • hours or days
  • blood urea nitrogen (BUN), creatinine, and potassium with or without a reduction in urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is azotemia?

A

accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

compare/contrast: onset of AKI vs CKD

A

AKI: sudden
CKD: gradual, often over many years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

compare/contrast: most common cause of AKI vs CKD

A

AKI: acute tubular necrosis (ATN)
CKD: diabetic nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

compare/contrast diagnostic criteria AKI vs CKD

A

AKI: acute reduction in urine output AND/OR elevation in serum creatinine
CKD: GFR <60mL/min for >3 months AND/OR kidney damage >3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

compare/contrast reversibility AKI vs CKD

A

AKI: potentially reversible
CKD: progressive and irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

compare/contrast: primary cause of death AKI vs CKD

A

AKI: infection
CKD: CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are causes of PRERENAL AKI?

A

factors that reduce systemic circulation, causing a reduction in renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

prerenal: the decrease in blood flow leads to decreased what?

A

glomerular perfusion and filtration of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in prerenal oliguria, there is no damage to what?

A

no damage to the kidney tissue (parenchyma).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is prerenal oliguria caused by? what are some examples?

A

a decrease in circulating blood volume (e.g., severe dehydration, HF, decreased CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F: prerenal oligura is reversible

A

TRUE :) with appropriate treatment!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

prerenal: with a decrease in circulating blood volume, what tries to preserve blood flow to essential organs? (4 things)

A

autoregulatory mechanisms that increase angiotensin II, aldosterone, norepinephrine, and antidiuretic hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does prerenal azotemia result in?

A

a reduction in sodium excretion (less than 20mEq/L), increased sodium and water retention, and decreased urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what do prerenal conditions contribute to?

A

intrarenal AKI. if decreased perfusion persists for an extended time, the kidneys lose their ability to compensate and damage to kidney parenchyma occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what causes INTRARENAL AKI?

A

conditions that cause direct damage to the kidney tissue, resulting in impaired nephron function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what does the damage from intrarenal causes result from?

A

prolonged ischemia, nephrotoxins (e.g., aminoglycoside antibiotics, contrast media), hemoglobin released from hemolyzed RBCs, or myoglobin released from necrotic muscle cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

nephrotoxins cause ___ of intrarenal structures by crystallizing or causing damage to the epithelial cells of the tubules?

A

obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

intrarenal: hemoglobin and myoglobin can block the tubules and cause ___ ___

A

renal vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

intrarenal: what kidney diseases cause AKI?

A

acute gomerulonephritis and systemic lupus erythematosus (SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the most common intrarenal cause of AKI in hospitalized pts?

A

acute tubular necrosis (ATN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute tubular necrosis is primarily the result of what?

A

ischemia, nephrotoxin, or sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what % if intrarenal AKI cases are ischemic and nephrotoxic ATN responsible for?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what causes a disruption in the basement membrane and patchy destruction of the tubular epithelium?

A

severe kidney ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what do nephrotoxic agents cause in tubular epithelial cells?

A

necrosis of tubular epithelial cells, which slough off and plug the tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what happens with the flow of urine being obstructed?

A

urine refluxes into the renal pelvis, impairing kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are risks associated with developing ATN while in the hospital? (5 answers)

A

major surgery, shock, blood transfusion reaction, muscle injury from trauma, and prolonged hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

is ATN reversible?

A

ATN is potentially reversible if the basement membrane is not destroyed and the tubular epithelium regenerates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the most common postrenal causes of AKI? (5 answers)

A

benign prostatic hyperplasia (BPH), prostate cancer, stones/calculi, trauma, and external tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the main/broad cause of postrenal AKI?

A

mechanical obstruction in the outflow of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does bilateral ureteral obstruction lead to? resulting in what?

A

hydronephrosis (kidney dilation, increase in hydrostatic pressure, and tubular blockage. resulting in a progressive decline in kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what develops if a pt does not recover from AKI?

A

CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the most common initial manifestation of AKI? when does it usually occur?

A

oliguria = urine output <400mL/day, occurs within 1-7 days of injury to kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

RIFLE classification: GFR criteria and urine output criteria for RISK

A

GFR: Serum creatinine increased × 1.5 OR GFR decreased by 25%
Urine: Urine output <0.5mL/kg/hr for 6hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

RIFLE classification: GFR and Urine criteria for INJURY

A

GFR: Serum creatinine increased × 2 OR GFR decreased by 50%
Urine: Urine output <0.5mL/kg/hr for 12hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

RIFLE classification: GFR and Urine criteria for FAILURE

A

GFR: Serum creatinine increased × 3
OR GFR decreased by 75%
OR Serum creatinine >4 mg/dL with acute rise ≥0.5 mg/dL
Urine: Urine output <0.3mL/kg/hr for 24hr (oliguria) OR Anuria for 12 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

RIFLE classification: GFR and Urine criteria for LOSS

A

GFR: Persistent acute kidney failure. Complete loss of kidney function >4wk
Urine: —

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

RIFLE classification: GFR and Urine criteria for End-stage renal disease

A

GFR: Complete loss of kidney function >3mo
Urine: —

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what makes the initial diagnosis of AKI more difficult?

A

nonoliguric patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what may be present if AKI is related to glomerular membrane dysfunction?

A

proteinuria

41
Q

describe the features and duration of the onset phase of AKI

A
  • common triggering events: significant blood loss, burns, fluid loss, diabetes insipidus
  • renal blood flow 25% of normal
  • tissue oxygenation 25% of normal
  • urine output below 0.5mL/kg/hr
  • duration: hrs to days
42
Q

describe the features and duration of the oliguric (anuric) phase of AKI

A
  • urine output below 400 mL/day, possibly as low as 100 mL/day
  • increases in blood urea nitrogen (BUN) and creatinine levels
  • electrolyte disturbances, acidosis, and fluid overload (from kidneys inability to excrete water)
  • duration: 8 to 14 days (10-14) or longer, depending on the nature of AKI and dialysis initiation
43
Q

describe the features and duration of the diuretic phase of AKI

A
  • occurs when cause of AKI is corrected
  • renal tubule scarring and edema
  • increased GFR
  • daily urine output above 400 mL (usually around 1-3L/day but may reach 5L)
  • possible electrolyte depletion from excretion of more water and osmotic effects of high BUN
  • duration: 7 to 14 days
44
Q

describe the features and duration of the recovery phase of AKI

A
  • decreased edema
  • normalization of fluid and electrolyte balance
  • return of GFR to 70% or 80% of normal
  • duration: several months to 1 yr
45
Q

What should pt be monitored for during the diuresis phase due to large losses of fluid and electrlyes?

A

MONITOR PT FOR HYPONATREMIA, HYPOKALEMIA AND DEHYDRATION

46
Q

consider prerenal causes of AKI when pt has a history of what 3 things?

A

dehydration, hypotension, or blood loss

47
Q

suspect intrarenal causes of AKI if the pt has been exposed to what?

A

potentially nephrotoxic drugs or contrast media used in radiologic study

48
Q

a history of changes in what would suggest postrenal causes?

A

changes in urinary stream, stones, BPH, or bladder or prostate cancer

49
Q

what is one important diagnostic test for AKI?

A

urinalysis

50
Q

urine sediment containing what 3 things suggests intrarenal disorders?

A

abundant cells, casts or proteins

51
Q

what are the 7 diagnostic studies for AKI?

A
  1. obtain a thorough hx
  2. serum creatinine
  3. urinalysis
  4. kidney ultrasonography
  5. renal scan
  6. CT scan
  7. renal biopsy
52
Q

what is often the first diagnostic test done for AKI? why?

A

kidney ultrasound, provides imaging without exposure to potentially nephrotoxic contrast agents. it is useful for evaluating for kidney disease and obstruction of the urinary collection system

53
Q

a renal scan can assess what?

A

abnormalities in kidney blood flow, tubular function and collecting system

54
Q

what can a CT scan identify in the kidneys?

A

lesions, masses, obstructions and vascular anomalies

55
Q

what is the BEST method for confirming intrarenal causes of AKI?

A

renal biopsy

56
Q

what diagnostic test is not advised/contraindicated in patients with kidney failure? why?

A

MRI or magnetic resonance angiography (MRA with the contrast media gadolinium because it can be potentially fatal

57
Q

in pts with normal kidney function, contrast media poses minimal risk. but in pts with kidney disease, _______ can occur when contrast media for diagnostic studies causes nephrotoxocity injury

A

contrast-induced nephropathy (CIN)

58
Q

in AKI, the ___ ___ level increases because the kidney’s normal ability to excrete it is impaired

A

serum potassium

59
Q

the risk for ___ increases if AKI is caused by massive tissue trauma bc the damaged cells release ___ into the ECF

A

hyperkalemia, potassium

60
Q

___ and ___ ____ may cause cellular destruction, releasing more potassium into the ECF

A

bleeding, blood transfusions

61
Q

what signs/changes would be apparent on an ECG from hyperkalemia?

A

peaked T waves, widening of QRS complex, ST segment depression

62
Q

tx for hyperkalemia: this medication is generally used in advanced cardiac toxicity (evidence of hyperkalemic ECG changes) and raises the threshold for excitation, resulting in dysrhythmias.

A

calcium gluconate IV

63
Q

what dietary restriction would be on a pt with hyperkalemia? why?

A

potassium intake is limited to 40mEq/day
primarily used to prevent recurrent elevation, not for acute elevation

64
Q

what is the most effective therapy to remove potassium?

A

hemodialysis, works within a short time

65
Q

oral suspension that binds potassium in GI tract

A

patirometer (Veltassa)
- used to treat pts with CKD
- do not use as emergency drug for life-threatening hyperkalemia!!!!
- has a delayed onset of action
- do not give to a pt with paralytic ileus as bowel necrosis can occur

66
Q

potassium moves into the cells when ___ is given

A

insulin, when effects decrease, potassium moves back out of cells

67
Q

IV ___ given concurrently with regular insulin IV in pt with hyperkalemia to prevent hypoglycemia

A

glucose

68
Q

this can correct acidosis and cause a shift of potassium into cells

A

sodium bicarbonate

69
Q

given by muth or retention enema, produces osmotic diarrhea, allowing for evacuation of potassium-rich stool

A

sodium polystyrene sulfonate (kayexalate)
- when resin is in the bowel, potassium is exchanged for sodium
- remove 1mEq of potassium per 1g of drug
- do not give to pts with a paralytic ileus as bowel necrosis can occur!!

70
Q

bc AKI is potentially reversible, what are the primary goals of tx?

A
  • eliminate cause
  • manage s/s
  • prevent complications while the kidneys recover
71
Q

what is the first step in interprofessional care of AKI?

A

determine if there is adequate intravascular volume and cardiac output to ensure adequate perfusion of the kidneys

72
Q

diuretic therapy may be given and usually includes loop diuretics such as ___ and ___ or an osmotic diuretic such as ___

A

furosemide (Lasix), bumetanide (Bumex), mannitol

73
Q

closely monitor ___ ___ during the oliguric phase of AKI

A

fluid intake

73
Q

if AKI is already established forcing ___ and ___ will not be effective and may be harmful

A

fluids, diuretics

74
Q

if conservative therapy is not effective in treating AKI, then ___ ____ ___ is used

A

renal replacement therapy (RRT)

75
Q

____ is one of the most serious complications in AKI bc it can cause dysrhythmias

A

hyperkalemia

75
Q

what is the general rule for calculating the fluid restriction?

A

add all losses for the previous 24 hrs (e.g., urine, diarrhea, emesis, blood) plus 600 mL for insensible losses (e.g., respiration, diaphoresis)
ex. pt excreted 300 mL of urine on Tuesday with no other losses, the fluid allocation on Wednesday would be 900mL

76
Q

what are the 6 most common indications for RRT?

A
  1. volume overload, resulting in compromised cardiac and/or pulmonary status
  2. high serum K level
  3. metabolic acidosis (serum HCO3 level <15 mEq/L (12 mmol/L)
  4. BUN level >120mg/dL (43mmol/L)
  5. significant change in mental status
  6. pericarditis, pericardial effusion, or cardiac tamponade
77
Q

intermittent __ and continuous ___ ___ ___ have both been used effectively for AKI

A

hemodialysis (HD), renal replacement therapy (CRRT)

78
Q

_ _ _ _ is provided continuously over 24 hrs through cannulation of a vein or catheter placement, and has much slower blood flow rates compares with intermittent HD

A

CRRT

79
Q

_ _ is the method of choice for conservative therapy when changes are needed emergently

A

HD

80
Q

the goal of nutritional management in AKI is to provide adequate ___ to prevent catabolism despite restrictions that prevent electrolyte and fluid problems and azotemia

A

calories

81
Q

nutritional intake must maintain adequate caloric intake, providing _____ of protein per kg of desired body weight to prevent the breakdown of body protein

A

30 to 35 kcal/kg and 0.8 to 1.0 g of protein per kg

82
Q

adequate energy should primarily be from ___ and ___ sources to prevent ketosis from endogenous fat breakdown and gluconeogenesis from muscle protein breakdown

A

carbohydrate, fat

83
Q

sodium is restricted as needed to prevent ___, ___, and __

A

edema, hypertension, HF

84
Q

Dietary fat intake is increased so that the patient receives at least __% to __% of total calories from fat

A

30%-40%

85
Q

If a patient cannot maintain adequate oral intake, ___ ___ is the preferred route for nutritional support

A

enteral nutrition

86
Q

___, ___, ___ are key in essential assessments for developing an interprofessional plan of care

A

daily weights, strict I&O’s, vital signs

87
Q

daily monitoring of a pt’s __ ___ has prognostic implications and is crucial for determining therapy and daily fluid volume replacement

A

urine output

88
Q

examine pt’s urine for what 6 characteristics?

A

color
specific gravity
glucose
protein
blood
sediment

89
Q

assess pt’s general appearance including what? (4 things)

A

skin color
edema
neck vein distention
bruises

90
Q

If a patient is receiving dialysis, observe the access site for ____ and ____

A

inflammation, exudate

91
Q

nursing management: evaluate the pt’s ___ ___ and __

A

mental status, LOC

92
Q

nursing mgmt: assess pt oral mucosa for ___ and ___

A

dryness, inflammation

93
Q

nursing mgmt: auscultate the lungs for ___ and ___ or __ ___ __

A

crackles, wheezes, decreased breath sounds

94
Q

nursing mgmt: monitor the heart for an _ __, ___, or a ___ ___ ___

A

S3 gallop, murmurs, pericardial friction rub

95
Q

the overall goals for pt with AKI are (4)

A
  1. completely recover w/o any loss of kidney function
  2. maintain normal fluid and electrolyte balance
  3. have decreased anxiety
  4. adhere to and understand the need for careful follow up
96
Q

nursing interventions: what are 3 health promotion tactics?

A
  1. identify and monitor high risk populations
  2. control exposure to nephrotoxic drugs and industrial chemicals
  3. preventing prolonged episodes of hypotension and hypovolemia
97
Q

nursing mgmt: carefully monitor pt’s ___, ___’s, and ___ and ___ balance

A

weight, i&o’s, fluid, electrolye

98
Q

nursing mgmt: replace significant ___ losses, provide aggressive __ ___ for fluid overload, and use _____ drugs sparingly

A

fluid, diuretic therapy, nephrotoxic

99
Q

nursing mgmt: regulate __ and ___ intake, follow up care, teaching, and appropriate referrals

A

protein, potassium

100
Q

evaluation: expected outcomes for pt with AKI

A
  1. regain and maintain normal fluid and electrolyte balance
  2. adhere to tx regimen
  3. have no complications
  4. have a complete recovery
101
Q

gerontologic considerations (8)

A
  1. more susceptible to AKI
  2. dehydration: can occur from polypharmacy - diuretics, laxatives, OTC AND acute febrile illness and immobility
  3. hypotension
  4. diuretic therapy
  5. aminoglycoside therapy
  6. obstructive disorders
  7. surgery
  8. infection

medsurg 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions