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Kol- 410 Med Surg II > ARF/CKD > Flashcards

ARF/CKD Flashcards

1
Q

acute renal failure is the same thing as acute kindney injury. the rapid reduction of kidney function occurs over what time frame?

A

hours to days

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2
Q

Ability to regain kidney function is directly related to duration of ? and ?

A

oliguria and anuria

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3
Q

fancy name for build of nitrogenous waste =

A

azotemia

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4
Q

give me some examples of causes of pre-renal AKI

A

Reduced perfusion = PRERENAL
* Shock
* Hypotension
* Anything that blocks blood flow to kidneys (Atherosclerosis)

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5
Q

give me some examples of causes of intra-renal AKI

A

Kidney Damage = INTRARENAL
* Glomerulonephritis
* Lupus
* Drugs that damage to the kidney- drugs, aminoglycosides, IV contrast
* Toxins
* Ischemia

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6
Q

give me some examples of post-renal AKI

A

Obstruction = POSTRENAL
* Bladder Cancer
* Kidney Stones
* Prostate cancer or BPH

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7
Q

most patients in the hospital are at risk of develping what thing with their kidneys?

A

AKI (30% ICU, 10% general admission)

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8
Q

Pre and Post renal AKI compensate in what same 3 ways

A
  • Activating R-A-A system
    –> Increase the BP to increase chanse of perfusion
  • Constricting Kidney Blood Vessels
    –>To raise the pressure and increase chance of perfusion
  • Releasing ADH
    —> Hold onto salt and fluid to increase chance of perfusion
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9
Q

the result of pre and post renal compensation is….

A
  • oliguria/anuria
  • holding onto fluid + nitrogenous waste
  • increasing blood volume and kidney perfusion
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10
Q

oliguria is < ____ ml day

A

400

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11
Q

assessment findings for AKI

A

oliguria
fluid overload/increase BP
N/V (azotemia)
Confusion (azotemia, poor brain perfusion)

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12
Q

AKI labs: elevated or low?

creatinine
BUN
K

A

all elevated!

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13
Q

3 early signs of AKI =

A
  1. low UOP
  2. edema
  3. increase creatinine
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14
Q

for AKI maintain a map > ____

A

65

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15
Q

interventions for AKI (4)

A
  1. central venous pressure monitoring thru superior vena cava
  2. CCB
  3. Nutrition/fluid
  4. dialysis (maybe- not everyone needs it)
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16
Q

how much protein should someone with AKI have?

A

40 g/ day (more if on dialysis )

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17
Q

how do we calculate fluid restrictions for AKI?

A

24 hour UOP + 500 ml

18
Q

AKI need a diet low in which 2 elements?

A

phosphorous and potassium
–> remember these are high b/c their kidneys can’t filter it out

19
Q

AKI need a diet low in which 2 elements?

A

phosphorous and potassium
–> remember these are high b/c their kidneys can’t filter it out

20
Q

Your patient has a history of hypertension and is admitted for hypertensive crisis. He is on a nicardipine drip with parameters to keep the blood pressure below 180/100. Currently, your patient’s blood pressure is 96/58 and the drip is running at 25mg/hr. You notice that your patient’s urinary output is 80 mL over the last four hours. After reducing the rate of the nicardipine drip, what is your next priority action?
A) Check the patency of the foley catheter
B) Call rapid response
C) Call the provider
D) Give the patient a bolus of NS

A

A.) Check the patency of the foley catheter

High BP = interrenal
Bottom out BP –>prolly not enough BP to perfuse kidneys now b/c they live at a high BP, not prerenal

21
Q

2 distinct factors that sepereate AKI from CKD

A

CKD is progressive and irreversible

22
Q

CKD leads to what kind of kidney disease?

A

end stage kidney disease

23
Q

How do we stage CKD?

A

based on GFR

24
Q

This stage has a normal GFR/ Increased risk for kidney damage – with diagnosis like diabetes, lupus, HTN

A

Stage 1 CKD

25
Q

This is the stage where we start treating CKD with fluid restrictions and azotemia is present

A

Stage 3 CKD

26
Q

This is the stage of CKD where we might start dialysis

A

Stage 4 CKD

27
Q

This is ther stage where you def need dialysis or a transplant cuz you’ll die otherwise

A

Stage 5 CKD

28
Q

What are systemic findings with CKD (very broad)

A

Fluid/electrolyte imbalance
HF/HTN
Anemia
GI

29
Q

what metabolist state will someone with CKD be in?

A

metabolic acidosis with resp. compensation (kussmauls)

30
Q

what metabolist state will someone with CKD be in?

A

metabolic acidosis with resp. compensation (kussmauls)

31
Q

whats up with Phosphorous and Ca in CKD?

A

High phsophorous from impaired RAAS
–>Ca bind to Phosphporous and leaches Ca out of bones
–>Brittle bones

32
Q

why do people with CKD have anemia?

A

their kidneys can’t make erythropoeitin like they should so not enough RBC

33
Q

CKD peeps need to be on ___?__ precautions

A

bleeding because of damaged platelets

34
Q

4 skin changes with CKD

A
  • Pruritus
  • Bronzed color
  • Uremic frost
  • Bruises
35
Q

weight gain goals for CKD
overnight
in a week
between dialsyis

A

gain no more than:
2 lb overnight
5 lb / week
3 lb b/w dialysis

36
Q

what drugs are we givving for CKD?

A
  • diuretics
  • antihypertensives
  • CCB
  • antiotensin converting enzyme inhibitors
  • BB
37
Q

what stage should we start ACE inbitiors?

A

stage 1!

38
Q

how do BB help CKD?

A

Help increase cardiac output/ avoid heart failure (reduced perfusion of kidneys –> Accelerated kidney disease)

39
Q

sodium restrcitions for CKD
regular vs dialysis

A

regular 1-3 g/day
dialysis 2-4 g/day

40
Q

build up of protein waste =

A

uremia

41
Q

protein intake for CKD : regular vs dialysis

A

regular = 0.55-0.6 g/kg/day
dialysis = 1-1.2 g/kg/day

Kol- 410 Med Surg II (27 decks)

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