AKI & CKD & Dialysis

Question 1

Acute Kidney Injury

Answer 1

Rapid loss of kidney function with rise in serum creatinine, elevated BUN & K, and azotemia

Question 2

Prerenal

Answer 2

Happens ABOVE kidneys
LOW volume/perfusion to kidneys
Cause: hemorrhage, GI losses, decreased CO, and vasodilation

Question 3

Intrarenal

Answer 3

Inside kidneys (most problematic)
Prolonged Ischemia
Causes: nephrotoxins, sepsis, trauma

Question 4

Acute Tubular Necrosis

Answer 4

results from ischemia, nephrotoxins, or sepsis
potentially reversible
dialysis need

Question 5

Postrenal

Answer 5

Happens BELOW kidneys
Obstruction in the urinary tract
Causes: stones, blood clots, BPH, tumors

Question 6

Phases of AKI

Answer 6

Oliguric, Diuretic, Recovery

Question 7

OLiguric Phase

Answer 7

Urinary output less than 400 mL/day
Neck veins distended, bounding pulse, edema, hypertension
Metabolic acidosis
Hyponatremia, Hyperkalemia (peaked T waves, widened QRS, ST depression), hematologic disorders, Increased BUN, neuro disorders

Question 8

Diuretic Phase

Answer 8

1-3 weeks
Daily urine output = up to 5 L a day
Monitor for hypovolemia, hypotension, hyponatremia, hypokalemia, and dehydration

Question 9

Recovery Phase

Answer 9

up to 12 months
Increased GFR, decreased BUN and creatinine
GFR below 15 needs dialysis

Question 10

Normal BUN

Answer 10

5 - 20

Question 11

Normal Creatinine

Answer 11

0.6 - 1.2 mg

Question 12

Normal GFR

Answer 12

90 - 120 mL

Question 13

Normal Phosphorus

Answer 13

2.5 - 4.5 mg

Question 14

Normal Calcium

Answer 14

9 - 11 mg

Question 15

Chronic Kidney Disease

Answer 15

progressive, irreversible loss of kidney function

causes: diabetes & hypertension

Question 16

End Stage Renal Disease (ESRD)

Answer 16

occurs when GFR is less than 15 mL/min. Dialysis is required to maintain life
result of retained substances: urea, creatinine, phenols, electrolytes, water, uremia

Question 17

Symptoms of Uremia

Answer 17

Fatigure, nausea, loss of appetite, metallic taste in mouth, mental confusion, GFR < 15

Question 18

Normal Potassium

Answer 18

3.5 - 5

Question 19

Normal MAgnesium

Answer 19

1.8 - 2.2 mg

Question 20

Peritoneal Dialysis

Answer 20

Catheter inserted through anterior abdominal wall into peritoneal cavity
Once catheter incision site is health the pt may shower and pat dry
Protein loss

Question 21

Hemodialysis sites

Answer 21

Two types of sites:
Arteriorvenous Fistula (AVF
Arteriorvenous Graft

Question 22

Fistula

Answer 22

in forearm with a connection between an artery and vein
should be placed 3 months before starting HD
thrill and bruit for assessment

Question 23

Graft

Answer 23

Synthetic material placed under skin to form a bridge between artery and vein
more likely to get infected

Question 24

Hemodialysis Complications

Answer 24

Hypotension
Muscle cramps (hyponatremia or hypovolemia)
Loss of blood
Hepatitis