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Quarter 4 > Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease > Flashcards

Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease Flashcards

1
Q

kidney function of urinary ELIMINATION includes

A

excretion of waste, FLUID AND ELECTROLYTE BALANCE, regulation of ACID–BASE BALANCE, and hormone secretion.

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2
Q

Kidney function loss also interrupts the activity of every organ system, particularly:

A

the immune, endocrine, skeletal, and cardiovascular systems.

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3
Q

When kidney function is permanently or persistently impaired, as with end-stage kidney disease (ESKD) what treatment is needed

A

dialysis or kidney transplant is a life-saving approach for urinary ELIMINATION to maintain homeostasis, FLUID AND ELECTROLYTE BALANCE, and ACID–BASE BALANCE.

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4
Q

When kidney function declines gradually:

A

most of the nephrons must be destroyed before kidney injury is obvious.

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5
Q

Acute kidney injury(AKI)

A

is a rapid reduction in kidney function resulting in a failure to maintain FLUID AND ELECTROLYTE BALANCE and ACID–BASE BALANCE.

  • AKI occurs over a few hours or days.
  • During this time of decreased renal function, the patient is at increased risk because of the stress on remaining nephrons.
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6
Q

causes of AKI are

A

reduced PERFUSION to the kidneys, damage to kidney tissue, and obstruction.

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7
Q

(coagulopathy)

A

reduce perfusion, cause inflammation and direct tissue damage, and create obstruction of urinary flow. Thus, coagulopathy is a pre-renal, intrarenal, and post-renal cause of AKI.

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8
Q

When renal decline is sudden, the functioning nephrons:

A

are overworked, and kidney failure may develop with the loss of only 50% of functioning nephrons.

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9
Q

acute effects what vs chronic effects what

A

Acute failure affects many systems, while chronic disease affects every body system.

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10
Q

Pre-renal failure

A

is caused by reduced PERFUSION to the kidneys, such as in hypovolemic shock and heart failure.

oManifestations include hypotension, tachycardia, decreased urine output, decreased cardiac output, decreased central venous pressure, and lethargy.

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11
Q

critical rescue nursing priority AKI

A

Because reduced PERFUSION from volume depletion is a common cause of AKI, prevention of volume depletion and early intervention

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12
Q

Reversal of AKI

A

especially with prompt intervention by correcting blood volume and improving kidney PERFUSION, increasing blood pressure, and improving cardiac output.

fluid challenges often used to promote kidney perfusion

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13
Q

Intrarenal or intrinsic renal failure is caused by

A

inflammation, INFECTION, and damage from toxins that cause intracellular changes of the tubular system in kidney tissue.

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14
Q

Intrarenal or intrinsic renal failure s/s

A

oliguria or anuria, edema, hypertension, tachycardia, shortness of breath, distended neck veins, elevated central venous pressure, weight gain, respiratory crackles, anorexia, nausea, vomiting, lethargy or changes in levels of consciousness, and electrocardiographic changes.

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15
Q

When kidney function declines: first phase

A

the oliguric phases of AKI begin. However, not all patients with AKI experience oliguria.

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16
Q

after the oliguric phase

A

diuretic phase, in which hypovolemia and electrolyte losses are the main problems.

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17
Q

The longer the period oliguria or anuria ___

A

the less likely the patient will return to baseline kidney function

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18
Q

Inflammation causes of AKI can result in

A

polyuria.

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19
Q

The plan of care AKI

A

focuses on fluid and electrolyte replacement and monitoring. Onset of polyuria can be the start of recovery from AKI.

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20
Q

Because kidney function is unstable in AKI, continuously monitor ___

A

intake and output and serum electrolyte levels to determine how the supplementation affects FLUID AND ELECTROLYTE FUNCTION.

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21
Q

Post-renal azotemia develops from ___

A

obstruction to the outflow of formed urine anywhere within the kidney or urinary tract.

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22
Q

azotemia

A

biochemical abnormality, defined as elevation, or buildup of, nitrogenous products

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23
Q

AKI expect to see what labs

A

rising blood urea nitrogen and serum creatinine and abnormal blood electrolyte values.

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24
Q

AKI usually do not have the anemia associated with chronic failure unless

A

there is hemorrhagic blood loss or high blood urea level.

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25
Q

Contrast: Adequate hydration is essential to

A

prevent contrast-induced nephropathy. IV fluids are often given to high risk patients before the procedure to ensure hydration, dilution of the contrast medium, and speed urinary ELIMINATION.

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26
Q

Renal biopsy is performed if

A

the cause is uncertain, immunologic disease is suspected, or the reversibility of the kidney failure needs to be determined.

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27
Q

AKI therapy

A

Drug therapy, diet therapy, and renal replacement therapy, such as peritoneal dialysis, hemodialysis, or hemofiltration, are commonly used for management.

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28
Q

CKD

A

When kidney function declines gradually, it is diagnosed as chronic kidney disease(CKD), also known as chronic renal failure.

progressive, irreversible kidney injury and affects every body system.

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29
Q

acute-on-chronic kidney injury,

A

CKD with AKI can accelerate loss of kidney function. Low numbers of functioning nephrons from CKD contribute to the progression of kidney dysfunction.

30
Q

End stage kidney disease

A

When kidney function cannot sustain life, it becomes ESKD.

31
Q

uremia

A

(azotemia with symptoms)

32
Q

CKD with greatly reduced GFR causes many problems, including

A

abnormal urine production, severe disruption of FLUID AND ELECTROLYTE BALANCE, and metabolic abnormalities.

33
Q

Because healthy nephrons become larger and work harder:

A

urine production and water ELIMINATION are sufficient to maintain essential homeostasis until about three fourths of kidney function is lost.

34
Q

(isosthenuria)

A

As the disease progresses, the ability to produce diluted urine is reduced, resulting in urine with a fixed osmolarity

35
Q

Kidney damage raises systemic blood pressure, which:

A

also increases glomerular pressure and damage to remaining unaffected nephrons.

36
Q

kidney damage increases the workload on the heart as a result of anemia, hypertension, and fluid overload.

A

heart failure may occur

Cardiac disease is the leading cause of death in patients with end-stage failure.

37
Q

urine changes in CKD

A

The amount and composition of the urine change as kidney function decreases.

oThe actual urine output varies according to remaining kidney function.

oOliguria is usually seen with severe CKD or ESKD, but some patients can produce 1 L or more daily.

oDaily urine volume usually changes again after dialysis is started.

oA long duration of oliguria is an indication that recovery of kidney function is not to be expected.

38
Q

urine changes in CKD

A

The amount and composition of the urine change as kidney function decreases.

oThe actual urine output varies according to remaining kidney function.

oOliguria is usually seen with severe CKD or ESKD, but some patients can produce 1 L or more daily.

oDaily urine volume usually changes again after dialysis is started.

oA long duration of oliguria is an indication that recovery of kidney function is not to be expected.

39
Q

Long-standing hypertension

A

is a risk for CKD and rapid progression of kidney failure once CKD occurs. Therefore blood pressure control is essential in preserving kidney function.

40
Q

CKD causes extreme changes in laboratory values, including

A

creatinine, blood urea nitrogen, sodium, potassium, calcium, phosphate, bicarbonate, hemoglobin, and hematocrit.

urinalysis is performed and 24-hour urine specimen is sent.

41
Q

Injury prevention strategies are needed because

A

patients may have brittle, fragile bones that fracture easily and cause minimal pain

42
Q

Problems with calcium and phosphorus levels can result in

A

renal osteodystrophy, metastatic calcifications, and cardiovascular disease.

43
Q

renal osteodystrophy

A

currently defined as an alteration of bone morphology in patients with chronic kidney disease (CKD)

44
Q

metastatic calcifications

A

the pathological process whereby calcium salts accumulate in previously healthy tissues

45
Q

Drug therapy with diuretics is prescribed for

A

patients with some kidney impairment to manage fluid retention or help control blood pressure.

46
Q

Protein

A

is restricted on the basis of reduced glomerular filtration rate (GFR) and the severity of the symptoms.

47
Q

uremia which can result in severe pruritus (itching) is caused by?

A

Buildup of waste products from protein breakdown.

48
Q

Uremic frost,

A

a layer of urea crystals from evaporated sweat, may appear on the face, eyebrows, axillae, and groin in patients with advanced uremic syndrome.

49
Q

When patients cannot be managed with conservative therapies, such as diet, drugs, and fluid restriction:

A

dialysis is indicated

50
Q

Daily weight

A

Instruct patients to weigh themselves daily, keep a daily log, and report any daily weight gain of 2 pounds or more immediately to the health care provider.

In addition to fluid balance, weight is affected by the inability to ingest, digest, or absorb food and nutrients

51
Q

Neurologic symptoms of CKD and uremic syndrome vary and if untreated:

A

encephalopathy can lead to seizures and coma

Dialysis is used emergently when neurologic problems result from CKD

Depression may compound cognitive and neurologic problems

52
Q

Candidates for transplantation must be

A

free of medical problems that might increase the risks from the procedure

53
Q

Kidney donors

A

may be living donors related or unrelated to the patient, non-heart-beating donors, and cadaveric donors.

  • Organs from living related donors have the highest rates of kidney graft survival—90%.
  • Physical criteria for donors include absence of systemic disease and infection and adequate kidney function as determined by diagnostic studies
54
Q

complications that are possible after transplantation

A

including rejection, acute tubular necrosis, thrombosis of the major blood vessels, vascular leakage or thrombosis (both of which require emergency nephrectomy), and wound problems, such as hematomas, abscesses, lymphoceles, and infection.

•Teach patients on immunosuppressive therapy to assess themselves daily for fever, general malaise, and nausea or vomiting.

55
Q

Renal replacement therapy (RRT)

A

will remove nitrogenous wastes and re-establish FLUID AND ELECTROLYTE BALANCE, as well as restore ACID–BASE BALANCE.

56
Q

Immediate RRT is indicated for

A

fluid overload (compromising tissue PERFUSION) not responding to diuretics (including fluid overload with pericarditis), symptomatic hyperkalemia,calciphylaxis, and symptomatic toxin ingestion, such as drug overdose or alcohol poisoning that is dialyzable

57
Q

or CKD, RRT is needed when

A

the pathologic changes of stage 4 and stage 5 CKD are life threatening or pose continuing discomfort.

58
Q

hemodialysis for CKD is started when:

A

uremic manifestations, such as nausea and vomiting, decreased attention span, decreased cognition, and pruritus, are present.

59
Q

fatigue

A

common and often profound problem among patients with CKD, particularly among patients receiving dialysis.

60
Q

fistula or graft

A

Avoid taking blood pressure measurements or drawing blood from an arm with an arteriovenous (AV) fistula or graft, and do not use the AV fistula or graft site to give IV fluids or draw blood.

61
Q

heparinization during the hemodialysis procedure

A

can increase the risk for bleeding, teach the patient to avoid all invasive procedures within 4 to 6 hours after hemodialysis. Monitor for signs of hemorrhage.

62
Q

The patient is at risk for infection due to

A

skin breakdown, IMMUNITY-related kidney dysfunction, or malnutrition.

63
Q

dialysis and antihypertensives

A

Use caution when giving an antihypertensive before a scheduled dialysis treatment; some short-acting antihypertensives can contribute to hypotension during dialysis.

64
Q

access site complications

A

thrombosis or stenosis, infection, aneurysm formation, ischemia, and heart failure.

65
Q

peritoneal dialysis PD

A

allows exchanges of wastes, fluids, and electrolytes to occur in the peritoneal cavity, but is slower than hemodialysis.

66
Q

Automated peritoneal dialysis (APD)

A

may be used in the acute care setting, the outpatient dialysis center, or the patient’s home. APD uses a cycling machine for dialysate inflow, dwell, and outflow according to preset times and volumes.

67
Q

Continuous-cycle peritoneal dialysis (CCPD)

A

is a form of automated dialysis that uses an automated cycling machine. Exchanges occur at night while the patient sleeps. The final exchange of the night is left to dwell through the day and is drained the next evening as the process is repeated. CCPD offers the advantage of 24-hour dialysis, as in APD, but the sterile catheter system is opened less often

68
Q

PD complications

A

Peritonitis, or infection and inflammation of the peritoneal cavity, is the major complication, commonly from connection site contamination.

bleeding, which is expected when the catheter is first placed, and bowel perforation, which is serious

69
Q

critically ill patients tx

A

Continuous renal replacement therapies in the form of hemofiltration are often better tolerated than hemodialysis for critically ill patients because this method avoids rapid shifts of fluids and electrolytes.

70
Q

acute failure dialysis type

A

Continuous AV hemofiltration and continuous AV hemodialysis and filtration

71
Q

type of dialysis for patients who have fluid volume overload, are resistant to diuretics, and have unstable blood pressures and output

A

Continuous AV hemofiltration

72
Q

Post-dialysis care includes

A

closely monitoring the patient for hypotension, headache, nausea, vomiting, dizziness, and muscle cramps.

Quarter 4 (6 decks)

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