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54/64 Unit 2 > AKI And CKD > Flashcards

AKI And CKD Flashcards

1
Q

Functions of the kidneys

A

“A WET BED”: Acid-base balance, water balance, electrolyte balance, toxin removal, blood pressure control, erythropoietin, vitamin D metabolism

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2
Q

The _____ kidney sits lower than the _____ due to the location of the liver

A

Right; left

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3
Q

Pain while urinating

A

Dysuria

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4
Q

Excessive urination at night

A

Nocturia

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5
Q

Bloody urine

A

Hematuria

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6
Q

Abnormal amounts of protein in the urine

A

Proteinuria

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7
Q

Urine output <400 mL/day

A

Oliguria

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8
Q

Urine output <50 mL/day

A

Anuria

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9
Q

Normal urinary output

A

1-2 L/day or 30-50 mL/hr

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10
Q

Rate of blood flow through the kidneys

A

Glomerular Filtration Rate (GFR)

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11
Q

Expected GFR

A

90-120 mL/min

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12
Q

Best indicator of kidney function

A

Creatinine

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13
Q

End product of muscle metabolism; solely filtered from the blood via glomerulus

A

Creatinine

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14
Q

Creatinine expected range

A

0.6-1.2 mg/dL

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15
Q

Normal waste product resulting from the breakdown of proteins

A

Blood Urea Nitrogen (BUN)

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16
Q

BUN expected range

A

10-20 mg/dL

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17
Q

Lab that measures the kidney’s ability to excrete or conserve water

A

Urine specific gravity

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18
Q

Urine Specific Gravity expected range

A

1.010-1.030

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19
Q

Dilute urine _____ urine specific gravity, while concentrated urine _____ urine specific gravity

A

Decreases; increases

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20
Q

__________ is caused by inflammation and damage to the glomeruli as a result of formation of antigen-antibody complexes due to untreated strep infection

A

Acute Glomerulonephritis

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21
Q

S/S of glomerulonephritis

A

Hematuria, azotemia (resulting in tea-colored urine), retaining sodium, increased BP, edema (face and eyes)

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22
Q

Excessive nitrogenous waste in the blood

A

Azotemia

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23
Q

Labs associated with glomerulonephritis

A

Hypoalbuminemia, low GFR (oliguria), increased urine specific gravity, increased BUN and creatinine

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24
Q

Diet modifications for glomerulonephritis

A

Fluid and sodium restriction, low protein, high carb (provides energy and stops breakdown of protein)

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25
Q

Sudden renal damage causing a build-up of waste, fluid, and electrolyte imbalance; can be REVERSED

A

Acute Kidney Injury (AKI); aka acute renal failure

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26
Q

Damage before the kidneys

A

Prerenal failure

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27
Q

Decreased volume/perfusion to kidneys due to decreased or impaired CO (MI), vasodilation, hemorrhage (hypovolemia), burns, or GI losses such as V/D causes _____ failure

A

Prerenal

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28
Q

Damage in the kidneys

A

Intrarenal failure

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29
Q

Intrarenal failure results from

A

Prolonged ischemia

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30
Q

Examples of nephrotoxic drugs

A

NSAIDs, antibiotics (aminoglycosides), chemo drugs, contrast dyes

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31
Q

Damage after the kidneys

A

Postrenal failure

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32
Q

Postrenal failure results from

A

Obstruction/blockage in urinary tract (stones, blood clots, tumors, etc)

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33
Q

Phases of Acute Kidney Injury (AKI)

A

“Oh Oh Darn Renal”: onset/initiation, oliguria, diuretic, recovery

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34
Q

Onset/initiation phase of AKI

A

Triggering event (pre-intra-postrenal failure)

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35
Q

Oliguria phase of AKI is characterized by

A

Decreased UO (<400 mL/24 hrs), decreased GFR (d/t glomerulus decreasing ability to filter blood)

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36
Q

Phase of AKI in which the cause of AKI is corrected and UO gradually increases

A

Diuretic

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37
Q

AKI phase characterized by enhanced kidney function

A

Recovery

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38
Q

The recovery phase of AKI may take up to __-__ months

A

6-12

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39
Q

Treatment of the onset/initiation phase of AKI

A

Treat the cause

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40
Q

Interventions of oliguria phase of AKI

A

Diet modifications (low protein and fluid), strict I&O and daily weights, monitor EKG and labs (hyperkalemia), dialysis (until kidney function returns)

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41
Q

Labs associated with oliguria phase of AKI

A

Increased BUN, creatinine, and potassium
Hyponatremia, hypocalcemia

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42
Q

Interventions for diuretic phase of AKI

A

Monitor for dehydration and hypokalemia

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43
Q

Untreated AKI can lead to

A

Chronic Kidney Disease (CKD)

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44
Q

Protein that regulates oncotic pressure and prevents clot formation

A

Albumin

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45
Q

Condition in which kidneys release an excessive amount of protein (albumin) in urine

A

Nephrotic syndrome

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46
Q

S/S of nephrotic syndrome

A

Hypoalbuminemia (edema, fatigue, loss of appetite, hyperlipidemia), proteinuria (>3 g/day)

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47
Q

Interventions for nephrotic syndrome

A

Monitor fluid status (weights, I&O, edema), diet modifications, medications, monitor for signs of infection and blood clots, replace albumin!

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48
Q

Dietary modifications for nephrotic syndrome

A

Low cholesterol/saturated fats, low sodium, moderate protein

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49
Q

Medications for nephrotic syndrome

A

Diuretics, statins, prednisone (for inflammation), immunosuppressants

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50
Q

Progressive and irreversible loss of kidney function that occurs over a long period of time

A

Chronic Kidney Disease (CKD)

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51
Q

Causes of CKD

A

Untreated AKI, DM, HTN, recurrent infections, autoimmune disorders

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52
Q

Stages of CKD are based on

A

GFR (as CKD worsens, GFR decreases)

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53
Q

Stage 1 CKD

54
Q

Stage 2 CKD

55
Q

Stage 3 CKD

56
Q

Stage 4 CKD

57
Q

Stage 5 (end-stage) CKD

58
Q

GU symptoms of CKD

A

Decreased UOP, proteinuria, Hematuria

59
Q

Neurological symptoms of CKD

A

Lethargy, altered LOC/confusion, seizures

60
Q

Cardiac symptoms of CKD

A

Hypertension, hypervolemia, HF

61
Q

GI symptoms of CKD

A

Anorexia, N/V, uremic fetor (ammonia breath), metallic taste

62
Q

Immune symptoms of CKD

A

Impaired immune and inflammatory response

63
Q

Hematologic symptoms of CKD

A

Anemia (d/t decreased erythropoietin), bleeding risk, prolonged bleeding time

64
Q

Reproductive symptoms of CKD

A

Amenorrhea, ED, decreased libido

65
Q

Integumentary symptoms of CKD

A

Uremic frost, pruritus

66
Q

Labs associated with CKD

A

Increased BUN, creatinine, potassium, magnesium, and phosphate
Decreased calcium and sodium

67
Q

Treatment options for CKD

A

Dialysis, Kidney transplant

68
Q

Removal of waste products from the blood in those with kidney dysfunction

69
Q

Most common method of dialysis that uses a dialyzer (artificial kidney) outside the body to remove excess fluids and toxins

A

Hemodialysis

70
Q

Hemodialysis process

A

Blood brought to dialyzer, toxins/waste products are filtered, clean blood brought back to body

71
Q

How often is hemodialysis conducted?

A

3x a week (3-5 hrs/treatment) in the hospital or dialysis clinic

72
Q

Hemodialysis access

A

Vascular access via a fistula or graft

73
Q

Joining an artery to vein

74
Q

Synthetic graft between an artery and a vein

75
Q

Hemodialysis via _____ carries an increased risk for infection due to synthetic material insertion

76
Q

Complications of hemodialysis

A

Hypotension, hemorrhage, air embolus, electrolyte imbalances, disequilibrium syndrome

77
Q

Hemodialysis patient education

A

Avoid compression, blood draws, BP readings, finger sticks (BG monitoring), tight clothing, and sleeping on arm with vascular access

78
Q

Evaluation of patency of hemodialysis access

A

Feel the thrill (palpate fistula) and hear the bruit (heard during auscultation)

79
Q

Dialysis that uses a peritoneum (inside the body) to remove excess fluids and toxins

A

Peritoneal dialysis

80
Q

Process of peritoneal dialysis

A

Warm the solution, infuse dialysate into peritoneal cavity by gravity, close clamp on infusion line, dialysate dwell time, unclamp drain tube, fluid drains from peritoneum by gravity, new container of dialysate infused after drainage is complete, repeat!

81
Q

How often is peritoneal dialysis conducted?

A

7x a week (multiple exchanges per day) at home

82
Q

Peritoneal catheter insertion is performed at

A

Bedside or in OR

83
Q

Complication of peritoneal dialysis

A

Peritonitis

84
Q

S/S of peritonitis

A

Cloudy/bloody drainage, fever, abdominal pain, malaise

85
Q

Patient education for peritoneal dialysis

A

Avoid infection: hand hygiene before AND after dialysis, clean catheter site daily, keep supplies in a clean and dry place

86
Q

Infection within the urinary system caused by either a bacteria (most common — E.Coli), virus, or fungus

A

Urinary Tract Infection (UTI)

87
Q

Causes of UTI

A

Women (d/t shorter urethra, close to rectum), overuse of antibiotics, indwelling catheters, DM, scented products

88
Q

Upper urinary tract infection that affects the kidneys

A

Pyelonephritis

89
Q

UTI education

A

Take entire course of antibiotics, wipe front to back, void after intercourse, avoid bubble baths/scented products, wear non-tight cotton underwear

90
Q

S/S of UTI

A

Smelly urine, chills/fever, dysuria (painful urination), frequency and urgency, Hematuria, costovertebral angle (CVA) tenderness

91
Q

UTI symptoms in elderly patients

A

Confusion, lethargy, new incontinence

92
Q

UTI nursing considerations

A

2-3 L fluid/day, remove catheters ASAP per orders, take urine culture prior to first dose of antibiotics

93
Q

UTI medications

A

Antibiotics, analgesics, phenazopyridine (Pyridium) (may turn urine orange)

94
Q

S/S of renal calculi

A

Flank pain that can radiate to abdomen and groin, discomfort, Hematuria, pyuria (WBCs), N/V, fever

95
Q

Dietary modifications for renal calculi

A

Increase fluids, limit protein, sodium and calcium

96
Q

What can cause oliguria?

A

Dehydration, inadequate kidney perfusion, blockages

97
Q

Normal pH

98
Q

Normal potassium

99
Q

Normal sodium

100
Q

Normal calcium

101
Q

Normal magnesium

102
Q

Key hormone in the adrenal gland for BP control

A

Aldosterone

103
Q

Key hormone in the kidneys for BP control

104
Q

Function of erythropoietin

A

Aids in production of RBCs

105
Q

Glomerulonephritis treatment

A

Antibiotics, hydrate with IV fluids (NS 0.9%), analgesics

106
Q

S/S of pyelonephritis

A

Fever, low back pain, painful urination, CVA tenderness

107
Q

The nurse should weigh the client before AND after dialysis and expect to see weight loss of about ___ lbs post-dialysis

108
Q

Mental status changes associated with hyponatremia

109
Q

Mental status changes associated with hypernatremia

A

Possible seizures

110
Q

T/F: dialysis catheters may be used to administer medications and/or fluids

111
Q

Kidney transplant complications

A

Possible organ rejection, infection

112
Q

Initial sign of organ rejection

113
Q

Kidney transplant post-op education

A

Anti-rejection/immunosupression medications for life (take exactly as prescribed), follow neutropenia precautions (no fresh flowers, fresh fruits, salad, etc.)

114
Q

Pre-op kidney transplant

A

Ensure patient is NPO and that informed consent has been obtained

115
Q

Post-op Kidney transplant nursing care

A

Prevent infection, assess vital signs and volume status, provide extensive education

116
Q

AKI renal diet

A

Yogurt, milk, cheese, vitamin D sources, LOW potassium (no bananas, oranges, etc.), INCREASE fluids

117
Q

Acid-base imbalance associated with kidney disease

A

Metabolic acidosis

118
Q

Metabolic acidosis treatment

A

Sodium bicarbonate

119
Q

Normal bicarb

120
Q

Most common cause of CKD

121
Q

What medications maintain kidney function in patients with HTN?

A

ACE inhibitors

122
Q

ACE inhibitors side effects

A

Angioedema, dry cough, hyperkalemia

123
Q

Medications for BP management for patients with CKD

A

Clonidine and hydralazine

124
Q

CKD findings

A

Fluid build-up, bilateral leg swelling, SOB, low hemoglobin

125
Q

S/S of pulmonary edema

A

Crackles, wheezing (high-pitched, musical sound)

126
Q

CKD diet

A

Low potassium, low protein (reduces risk for uremia), LIMIT fluid

127
Q

Kidney biopsy nursing considerations

A

NPO, risk for bleeding, bed rest, position client on the side of biopsy (ex: lay on right side if biopsy of right kidney; vice versa — you want pressure on the affected side)

128
Q

A condition that causes kidney swelling and urine retention, usually due to a blockage or obstruction

A

Hydronephrosis

129
Q

A genetic disorder in which numerous fluid-filled cysts develop in the kidney that can cause HTN, back pain, headaches, Hematuria, renal calculi, and UTIs

A

Polycystic Kidney Disease

130
Q

Normal Hgb for males and females

A

Males: 14-18 g/dL
Females: 12-16 g/dL

54/64 Unit 2 (8 decks)

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