AKI And CKD Flashcards
(130 cards)
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
2
Q
The _____ kidney sits lower than the _____ due to the location of the liver
A
Right; left
3
Q
Pain while urinating
A
Dysuria
4
Q
Excessive urination at night
A
Nocturia
5
Q
Bloody urine
A
Hematuria
6
Q
Abnormal amounts of protein in the urine
A
Proteinuria
7
Q
Urine output <400 mL/day
A
Oliguria
8
Q
Urine output <50 mL/day
A
Anuria
9
Q
Normal urinary output
A
1-2 L/day or 30-50 mL/hr
10
Q
Rate of blood flow through the kidneys
A
Glomerular Filtration Rate (GFR)
11
Q
Expected GFR
A
90-120 mL/min
12
Q
Best indicator of kidney function
A
Creatinine
13
Q
End product of muscle metabolism; solely filtered from the blood via glomerulus
A
Creatinine
14
Q
Creatinine expected range
A
0.6-1.2 mg/dL
15
Q
Normal waste product resulting from the breakdown of proteins
A
Blood Urea Nitrogen (BUN)
16
Q
BUN expected range
A
10-20 mg/dL
17
Q
Lab that measures the kidney’s ability to excrete or conserve water
A
Urine specific gravity
18
Q
Urine Specific Gravity expected range
A
1.010-1.030
19
Q
Dilute urine _____ urine specific gravity, while concentrated urine _____ urine specific gravity
A
Decreases; increases
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
21
Q
S/S of glomerulonephritis
A
Hematuria, azotemia (resulting in tea-colored urine), retaining sodium, increased BP, edema (face and eyes)
22
Q
Excessive nitrogenous waste in the blood
A
Azotemia
23
Q
Labs associated with glomerulonephritis
A
Hypoalbuminemia, low GFR (oliguria), increased urine specific gravity, increased BUN and creatinine
24
Q
Diet modifications for glomerulonephritis
A
Fluid and sodium restriction, low protein, high carb (provides energy and stops breakdown of protein)
25
Sudden renal damage causing a build-up of waste, fluid, and electrolyte imbalance; can be REVERSED
Acute Kidney Injury (AKI); aka acute renal failure
26
Damage before the kidneys
Prerenal failure
27
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
Prerenal
28
Damage in the kidneys
Intrarenal failure
29
Intrarenal failure results from
Prolonged ischemia
30
Examples of nephrotoxic drugs
NSAIDs, antibiotics (aminoglycosides), chemo drugs, contrast dyes
31
Damage after the kidneys
Postrenal failure
32
Postrenal failure results from
Obstruction/blockage in urinary tract (stones, blood clots, tumors, etc)
33
Phases of Acute Kidney Injury (AKI)
“Oh Oh Darn Renal”: onset/initiation, oliguria, diuretic, recovery
34
Onset/initiation phase of AKI
Triggering event (pre-intra-postrenal failure)
35
Oliguria phase of AKI is characterized by
Decreased UO (<400 mL/24 hrs), decreased GFR (d/t glomerulus decreasing ability to filter blood)
36
Phase of AKI in which the cause of AKI is corrected and UO gradually increases
Diuretic
37
AKI phase characterized by enhanced kidney function
Recovery
38
The recovery phase of AKI may take up to __-__ months
6-12
39
Treatment of the onset/initiation phase of AKI
Treat the cause
40
Interventions of oliguria phase of AKI
Diet modifications (low protein and fluid), strict I&O and daily weights, monitor EKG and labs (hyperkalemia), dialysis (until kidney function returns)
41
Labs associated with oliguria phase of AKI
Increased BUN, creatinine, and potassium
Hyponatremia, hypocalcemia
42
Interventions for diuretic phase of AKI
Monitor for dehydration and hypokalemia
43
Untreated AKI can lead to
Chronic Kidney Disease (CKD)
44
Protein that regulates oncotic pressure and prevents clot formation
Albumin
45
Condition in which kidneys release an excessive amount of protein (albumin) in urine
Nephrotic syndrome
46
S/S of nephrotic syndrome
Hypoalbuminemia (edema, fatigue, loss of appetite, hyperlipidemia), proteinuria (>3 g/day)
47
Interventions for nephrotic syndrome
Monitor fluid status (weights, I&O, edema), diet modifications, medications, monitor for signs of infection and blood clots, replace albumin!
48
Dietary modifications for nephrotic syndrome
Low cholesterol/saturated fats, low sodium, moderate protein
49
Medications for nephrotic syndrome
Diuretics, statins, prednisone (for inflammation), immunosuppressants
50
Progressive and irreversible loss of kidney function that occurs over a long period of time
Chronic Kidney Disease (CKD)
51
Causes of CKD
Untreated AKI, DM, HTN, recurrent infections, autoimmune disorders
52
Stages of CKD are based on
GFR (as CKD worsens, GFR decreases)
53
Stage 1 CKD
GFR > 90
54
Stage 2 CKD
GFR 60-89
55
Stage 3 CKD
GFR 45-59
56
Stage 4 CKD
GFR 15-29
57
Stage 5 (end-stage) CKD
GFR < 15
58
GU symptoms of CKD
Decreased UOP, proteinuria, Hematuria
59
Neurological symptoms of CKD
Lethargy, altered LOC/confusion, seizures
60
Cardiac symptoms of CKD
Hypertension, hypervolemia, HF
61
GI symptoms of CKD
Anorexia, N/V, uremic fetor (ammonia breath), metallic taste
62
Immune symptoms of CKD
Impaired immune and inflammatory response
63
Hematologic symptoms of CKD
Anemia (d/t decreased erythropoietin), bleeding risk, prolonged bleeding time
64
Reproductive symptoms of CKD
Amenorrhea, ED, decreased libido
65
Integumentary symptoms of CKD
Uremic frost, pruritus
66
Labs associated with CKD
Increased BUN, creatinine, potassium, magnesium, and phosphate
Decreased calcium and sodium
67
Treatment options for CKD
Dialysis, Kidney transplant
68
Removal of waste products from the blood in those with kidney dysfunction
Dialysis
69
Most common method of dialysis that uses a dialyzer (artificial kidney) outside the body to remove excess fluids and toxins
Hemodialysis
70
Hemodialysis process
Blood brought to dialyzer, toxins/waste products are filtered, clean blood brought back to body
71
How often is hemodialysis conducted?
3x a week (3-5 hrs/treatment) in the hospital or dialysis clinic
72
Hemodialysis access
Vascular access via a fistula or graft
73
Joining an artery to vein
Fistula
74
Synthetic graft between an artery and a vein
Graft
75
Hemodialysis via _____ carries an increased risk for infection due to synthetic material insertion
Graft
76
Complications of hemodialysis
Hypotension, hemorrhage, air embolus, electrolyte imbalances, disequilibrium syndrome
77
Hemodialysis patient education
Avoid compression, blood draws, BP readings, finger sticks (BG monitoring), tight clothing, and sleeping on arm with vascular access
78
Evaluation of patency of hemodialysis access
Feel the thrill (palpate fistula) and hear the bruit (heard during auscultation)
79
Dialysis that uses a peritoneum (inside the body) to remove excess fluids and toxins
Peritoneal dialysis
80
Process of peritoneal dialysis
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
How often is peritoneal dialysis conducted?
7x a week (multiple exchanges per day) at home
82
Peritoneal catheter insertion is performed at
Bedside or in OR
83
Complication of peritoneal dialysis
Peritonitis
84
S/S of peritonitis
Cloudy/bloody drainage, fever, abdominal pain, malaise
85
Patient education for peritoneal dialysis
Avoid infection: hand hygiene before AND after dialysis, clean catheter site daily, keep supplies in a clean and dry place
86
Infection within the urinary system caused by either a bacteria (most common — E.Coli), virus, or fungus
Urinary Tract Infection (UTI)
87
Causes of UTI
Women (d/t shorter urethra, close to rectum), overuse of antibiotics, indwelling catheters, DM, scented products
88
Upper urinary tract infection that affects the kidneys
Pyelonephritis
89
UTI education
Take entire course of antibiotics, wipe front to back, void after intercourse, avoid bubble baths/scented products, wear non-tight cotton underwear
90
S/S of UTI
Smelly urine, chills/fever, dysuria (painful urination), frequency and urgency, Hematuria, costovertebral angle (CVA) tenderness
91
UTI symptoms in elderly patients
Confusion, lethargy, new incontinence
92
UTI nursing considerations
2-3 L fluid/day, remove catheters ASAP per orders, take urine culture prior to first dose of antibiotics
93
UTI medications
Antibiotics, analgesics, phenazopyridine (Pyridium) (may turn urine orange)
94
S/S of renal calculi
Flank pain that can radiate to abdomen and groin, discomfort, Hematuria, pyuria (WBCs), N/V, fever
95
Dietary modifications for renal calculi
Increase fluids, limit protein, sodium and calcium
96
What can cause oliguria?
Dehydration, inadequate kidney perfusion, blockages
97
Normal pH
7.35-7.45
98
Normal potassium
3.5-5
99
Normal sodium
135-145
100
Normal calcium
9-11
101
Normal magnesium
1.2-2.2
102
Key hormone in the adrenal gland for BP control
Aldosterone
103
Key hormone in the kidneys for BP control
Renin
104
Function of erythropoietin
Aids in production of RBCs
105
Glomerulonephritis treatment
Antibiotics, hydrate with IV fluids (NS 0.9%), analgesics
106
S/S of pyelonephritis
Fever, low back pain, painful urination, CVA tenderness
107
The nurse should weigh the client before AND after dialysis and expect to see weight loss of about ___ lbs post-dialysis
5
108
Mental status changes associated with hyponatremia
Confusion
109
Mental status changes associated with hypernatremia
Possible seizures
110
T/F: dialysis catheters may be used to administer medications and/or fluids
FALSE
111
Kidney transplant complications
Possible organ rejection, infection
112
Initial sign of organ rejection
Oliguria
113
Kidney transplant post-op education
Anti-rejection/immunosupression medications for life (take exactly as prescribed), follow neutropenia precautions (no fresh flowers, fresh fruits, salad, etc.)
114
Pre-op kidney transplant
Ensure patient is NPO and that informed consent has been obtained
115
Post-op Kidney transplant nursing care
Prevent infection, assess vital signs and volume status, provide extensive education
116
AKI renal diet
Yogurt, milk, cheese, vitamin D sources, LOW potassium (no bananas, oranges, etc.), INCREASE fluids
117
Acid-base imbalance associated with kidney disease
Metabolic acidosis
118
Metabolic acidosis treatment
Sodium bicarbonate
119
Normal bicarb
22-28
120
Most common cause of CKD
HTN
121
What medications maintain kidney function in patients with HTN?
ACE inhibitors
122
ACE inhibitors side effects
Angioedema, dry cough, hyperkalemia
123
Medications for BP management for patients with CKD
Clonidine and hydralazine
124
CKD findings
Fluid build-up, bilateral leg swelling, SOB, low hemoglobin
125
S/S of pulmonary edema
Crackles, wheezing (high-pitched, musical sound)
126
CKD diet
Low potassium, low protein (reduces risk for uremia), LIMIT fluid
127
Kidney biopsy nursing considerations
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
A condition that causes kidney swelling and urine retention, usually due to a blockage or obstruction
Hydronephrosis
129
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
Polycystic Kidney Disease
130
Normal Hgb for males and females
Males: 14-18 g/dL
Females: 12-16 g/dL
