Ch.26 AKI and CKD Flashcards
Metabolic end products are no longer removed from the blood when what happens?
Kidneys Fail.
More waste remains in the blood when what happens?
Kidneys Fail.
Nitrogenous compounds build up in the blood when what happens?
Kidneys Fail.
What nitrogenous compounds build up in the blood when the kidneys fail?
- BUN
- Creatinine
What is renal function approximated by?
Initial creatinine level/current creatinine level
When the kidneys fail, they fail to regulate what?
- Fluid
- Electrolyte balance
- pH balance of extracellular fluids
Can renal failure be acute or chronic?
BOTH
What is abrupt onset of renal failure?
AKI (is reversible if caught early and properly treated)
AKI causes a rapid decline in what?
Renal Function
Progressive Azotemia is the most common indicator of what?
AKI
What is a progressive Azotemia?
An accumilation of nitrogenous wastes in blood.
Progressive Azotemia causes a decrease in what?
GFR
What is an AKI manifested by?
Sharp decrease in urine output.
A disproportionate elevation of BUN in relation to serum creatinine levels signals what?
AKI
What are signs and symptoms of AKI?
Individual appears dehydrated.
What are causes of AKI?
- Decrease in blood flow w/o Ischemic injury (prerenal)
- Ischemic, toxic, or obstructive tubular injury (intrinsic or intrarenal)
- Obstuction of urinary tract outflow (postrenal)
How do you treat an AKI?
Typically with a lot of fluids.
What is the progressive and irreversable destruction of nephrons and the kidney structure?
CKD/CRF.
Kidneys are no longer capable of maintaining an internal environment that is consistent with life during what?
CKD/CRF.
Diabetes is the number one cause of what?
Kidney failure.
When the kidneys can no longer regulate the volume and solute composition of the extracellular fluid, that is called what?
Renal Failure
What is renal failure characterized by?
- Edema
- Metabolic acidosis
- Hyperkalemia
- GFR 15-29 mL/min/1.73 m2
When is treatment with dialysis or transplant necessary for survival?
End-stage renal disease.
What is end stage renal disease characterized by?
- GFR = 15 mL/min/1.73 m2
- Decreased renal capillaries
- Scarring in glomeruli
- atrophy and fibrosis in tubules
- kidney mass decreased
When do the signs and symptoms of CKD typically occur?
Gradually and do not become evident until the disease is too far advanced.
GFR is considered the best measure of what?
kidney function
What abnormal lab values are there with CKD?*
-Decreased: H&H Calcium (hypocalcemia) Vit D pH levels (acidosis)
Increased:
phosphate (hyperphosphatemia)
potassium (hyperkalemia)
CKD means disorders of water, electrolyte, and acid base balance, causing what?
- Fluid overload
- Hyperkalemia
- Sodium imbalance
- metabolic acidosis
CKD alters mineral metabolism causing what?
- Hypocalcemia
- Hyperphosphatemia
CKD alters mineral metabolism causing what disorders?
- Secondary Hypothyroidism
- Renal osteodystrophy
Early CKD disorders are treated how?
Early treatment of Vitamin D and low calcium levels
What hematologic disorders does CKD cause?
Mainly Chronic anemia.
- Chronic blood loss
- hemolysis
- bone marrow supression
What is the treatment for anemia caused by CKD?
erythropoietin (Epogen) injections
What are hematologic complications of CKD?
Anemia left untreated, pt, would have the following S&S’s
- Weakness
- Fatigue
- Depression
- Insomnia
- decreased cognitive function
Iron deficiency and impaired platelet functioning which can cause bleeding are hematologic complications of anemia caused by what?
CKD
Cardiovascular disease is the leading cause of death in patents with what other disease?
CKD
What form of cardiovascular disease is caused in patients with CKD?
Hypertension
What is the treatment for hypertension caused by CKD?
- Salt and water restriction
- antihypertensives
What are common causes of GI disorders in patients with CKD?
- Anorexia
- Nausea and vomiting
- Metallic taste in mouth
- Ulceration and bleeding of GI mucosa
What are neurological disorders caused by CKD?
- Peripheral neuropathy (dialysis is key)
- Encephalopathy
- CNS depression
CKD does what to the immune system?
Causes altered immune function
Infection is a common complication and cause of hospitalization and death in persons with what?
CKD/CRF
Hyperglycemia and malnutrition are common in individuals with what kidney disease?
CKD
People with CKD also experience what complications?
- Skin integrity disorders
- sexual dysfunction
What disease can interfere with absorption, distribution, and elimination of drugs?
CKD/CRF
What are measures to slow down the progression of CKD?
- control of blood sugar and blood pressure
- quit smoking
What type of management is done for renal insufficiency?
Conservative management
What type of management is done for renal failure?
-Renal replacement therapy with dialysis
or
-Transplant
When is dialysis necessary?
When advanced uremia or serious electrolyte imbalances are present.
What types of dialysis are there?
- Peritoneal
- Hemodialysis
The nurse is teaching a new client about complications associated with peritoneal dialysis. The nurse should tell the client to notify the physician immediately if what occurs?
The abdomen is tender and dialysate return is cloudy.
What are problems that can occur during dialysis?
- Hypotension
- Chest pain
- Nausea/vomiting
- Disequilibrium syndrome
- Muscle cramps
- Headache
Blood is taken from where and put back through what in hemodialysis?
Taken from an artery and put back through a vein.
What is heparin used for during dialysis?
Clot prevention
What does a hemodialysis treatment plan look like?
- 3 days a week
- 3-4 hour sessions
A 62 y/o women who has been on hemodialysis for several weeks asks the nurse what substances are being removed by dialysis. The nurse informs the client that one of the substances passing through the membrane is what?
Sodium
Is CKD common in elderly patients?
Yes
What is the relationship of aging and GFR?
Normal to have a decline in GFR
What are elderly individuals are more suspeotible to the detrimental effects of what that compromise renal function?
Nephrotoxic drugs and other conditions that compromise renal function.
What is the dietary management goal with CKD?
optimum nutrition while maintaining tolerable levels of metabolic wastes.
CKD patients with with advanced stage of kidney disease need need to limit what prior to receiving dialysis?
Protein
CKD patients on hemodialysis need to increase what type of intake?
Protein
CKD patients need adequate intake of what to meet energy needs?
Carbs
Fats
Calories
How should CKD patients maintain fluid and electrolytes safely?
- Sodium and fluid restrictions
- Limiting dietary phosphorus (this is high in processed foods)
A client receiving hemodialysis has an order for a diet containing proteins with high biologic value. An example of a protein source with high biologic value is what?
Eggs
The GFR is considered to be the best measure of renal function. What is used to estimate GFR?
Serum creatinine
A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2mEq. What is most important for the nurse to do?
Obtain an ECG strip and notify the practitioner.
