AKI, pyelonephritis, and kidney stones Flashcards
Differentiate between pre-renal, intrarenal, and postrenal AKI
PRE: hypoperfusion (sepsis, heart failure, trauma)
INTRA: damage to kidney tissue (ATN, nephrotoxins like contrast/NSAIDs, rhabdomyolysis)
POST: obstruction and urine backflow (kidney stones, BPH, tumors)
What does RIFLE classification measure?
Kidney function based on urinary output and creatinine (GFR)
Describe the three phases AKI can progress through
- Oliguric: UO <400mL/day, fixed urine specific gravity, hyperkalemia, hyponatremia, WBCs/RBCs/casts in urine, high BUN/creatinine, low GFR, metabolic acidosis, fatigue
- Diuretic: peeing a lot, hypokalemia, hypotension, dehydration, BUN/creatinine start to normalize
- Recovery: GFR normalizes, BUN/creatinine continue dropping
A patient presents after a crush injury with fatigue and UO of ~200mL/day. Morning labs show albumin levels of 1.8.
What diagnostics do you predict to be ordered?
They may have AKI.
Labs
-BMP–electrolytes, BUN/creatinine
-ABG–pH, paCO2
-UA–WBCs, RBCs, casts
Imaging
-non-contrast CT
-abdominal XR
-ultrasound to check kidney perfusion
What are the nurse’s priorities when caring for a patient with AKI?
-Watch for: hyperkalemia, infection
-Monitor I/Os closely, urine quality
-Daily weights and vital signs
-Avoid nephrotoxic medications
-Restrict fluid intake
Fluid restriction guidance for patients with AKI:
600mL + #mLs fluid lost in past 24 hours / day
What meds are used to lower K+ levels for patients in the _________ stage of AKI?
-oliguric
Meds (PICKS):
-Patiromer
-Insulin
-Ca gluconate
-Kayalexate
-Sodium bicarbonate
What med is used to treat hyperphosphatemia?
Sevelamar
Why might a patient with AKI receive Tums?
If they had hypocalcemia
Why might a patient with AKI receive oral sodium bicarbonate?
If they had hyperkalemia and/or metabolic acidosis
Why is skin/oral care important for patients with AKI?
AKI = elevated uric acid levels, which is irritating and can cause stomatitis
A patient receiving intermittent hemodialysis presents with confusion, itching, and ulcers on their inner cheek.
What electrolyte imbalance might they have?
Elevated urea/uric acid levels
How much protein should patients with AKI take in each day?
1g/kg/day
Kidney biopsies are done to determine if the cause of AKI is _____renal.
intrarenal
Define azotemia. When might this occur?
Elevated nitrogen levels in the blood–first (oliguric) stage of AKI
Describe the etiology of renal pyelonephritis. What are the risk factors?
Lower UTI –> inflammation of renal parenchyma (medulla/cortex)
Risk factors: pregnancy, BPH, vesicoureteral reflux, renal calculi
An OB patient presents at 27wks with:
-sudden lower right flank pain
-dysuria and urinary urgency
-fever of 102
-malaise and nausea
What might they have?
What diagnostic tests do you expect to be ordered?
What medications?
-Pyelonephritis
-UA, CBC, MRI, ultrasound, CT w/o contrast
-antibiotics (IV, then oral) and NSAIDs/tyelenol
A patient with pyelonephritis should be instructed to _________ their fluid intake.
increase
An ultrasound on a patient with renal calculi shows hydronephrosis. This may be a sign of ____________
pyelonephritis
Name the 5 different types of kidney stones–which is most common? (hint: SUCCC)
-Struvite
-Uric acid
-Cystine
-Ca phosphate
-Ca oxalate–most common
What are the risk factors for developing nephrolithiasis?
-climate–hot temps
-obesity
-sedentary lifestyle
-diet: high sodium, low Ca
-middle age
What medications might be prescribed to a patient with urinary tract calculi?
-NSAIDs–IV ketorolac
-Flomax (dilates ureters)
-antibiotics if infection is co-ocurring
A patient with a history of gout is diagnosed with a kidney stone and is planning to return home.
What education should the nurse provide?
-take NSAIDs for pain
-drink 3L water/day, avoid coffee, tea, soda, alcohol
-avoid sodium rich foods
-collect any kidney stones you pee out
-encourage ambulation
