Exam 1 Material : Renal AKI and CKD Flashcards
What lab values should a nurse look for in AKI?
Elevated creatinine
Elevated BUN
Elevated Potassium
Decreased urine output
True or false? AKI is potentially reversible
True
Why are older adults more susceptible to AKI?
Dehydration, diuretics, hypotension, CV, DM
What are the three different types of causes for AKI?
Prerenal, Intrarenal, and Postrenal.
What causes of AKI are considered as Prerenal?
Hypovolemia (can be caused by dehydration, hemorrhage, low albumin or burns)
Decreased Cardiac Output (can be caused by HF, MI, Cardiogenic shock, dysrhythmias)
Decreased Peripheral Vascular resistance (can be caused by anaphylaxis, neurologic injury or septic shock)
Decreased Renovascular Flow (can be caused by Renal Thrombosis or Hepatorenal syndrome)
What causes of AKI are considered as Intrarenal?
Nephrotoxic injury (can be caused by antibiotic medications such as Vancomycin and Gentamycin, antifungal medications such as amphotericin B and contrast dye and crush injury)
Interstitial Nephritis (Can be caused by Bacterial pyelonephritis, CMV, or candidiasis)
Other causes includes: Prolonged prerenal ischemia Acute glomerulonephritis Eclampsia Malignant HTN Systemic Lupus Erythematosus (Lupus Nephritis)
What causes of AKI are considered as Postrenal?
BPH
Prostate and Bladder Cancer
Renal Calculi
Trauma
Ureteral strictures
Spinal Cord injury
What is hydronephrosis?
Swelling in one or both kidneys with urine pooling. Caused by an obstruction which causes urine to flow back towards the kidneys
True or false? Prerenal can lead into intrarenal AKI if left untreated?
True
What is the most common complication for Intrarenal AKI?
ATN (acute tubular necrosis) due to ischemia, sepsis or nephrotoxicity. Can also occur due to long term hypotension, dehydration or hemorrhage.
With AKI, which type of AKI (pre, intra or postrenal) causes kidney damage and causes clinical manifestations to appear?
Intrarenal
What are the three Clinical manifestation phases of AKI?
Oliguric Phase
Diuretic Phase
Recovery Phase
What are the nursing considerations for the Oliguric Phase?
Oliguric Phase = decreased urine output.
Urine output <400 mL/day
UA should be done to monitor for casts, RBCs, WBCs, and proteinuria
Metabolic acidosis can occur due to impaired kidney function of eliminating metabolic wastes
Kussmaul breathing
Decreased Na, Hgb, HCT and calcium levels
Elevated K, BUT, Creatinine, phosphate and WBC
Fatigue, seizures, coma and possible cerebral edema due to decreased serum Na levels.
What are the nursing considerations for the Diuretic Phase?
Urine Output of 1-3 L/day.
Osmotic diuresis = no concentrated urine
Large volumes of diluted urine
Hypovolemia, hypotension, hyponatremia and hypokalemia are possible.
May last 1-3 weeks
What are the nursing considerations for the Recovery Phase?
GFR increases
BUN and Creatinine levels decrease to normal levels
Significant improvement in 1-2 weeks. Can take up to 12 months to fully recover.
Some patients do not recover at all and can progress to chronic renal failure.
Older adults have a lower likelihood of recovery from AKI
What medications should be avoided for AKI patients?
Ace inhibitors, NSAIDS and Vancomycin
What diagnostic tests can be done for AKI?
BUN
CR
Electrolytes
UA
Renal Ultrasound
CT
Renal Biopsy
If potassium levels are elevated, what treatments can be done for those AKI patients?
Regular insulin IV w/ glucose with it. (drives potassium into the cells)
Sodium bicarbonate
Sodium polystyrene sulfonate (Kayexalate) (binds free K+ and excrete them with stool)
Hemodialysis
What does the Renal diet restrict?
Reduce potassium and phosphate intake.
Make sure to have adequate protein intake, just not too much.
Take calcium supplements and phosphate binders.
What is Chronic Kidney Disease? (CKD)
Progressive loss of kidney function; Irreversible
High mortality rate
May be asymptomatic until advanced.
Prognosis depends on stage
May be eligible for Medicare
What are the causes of CKD?
DM
HTN
Increased Age
Obesity
Glomerulonephritis
Polycystic Kidney Disease
Urologic disease
Unresolved AKI
What are the clinical manifestations of CKD?
May be asymptomatic in early stages
Increased BUN and CR which can cause N/V, lethargy and impaired thought process
Decreased CR clearance and GFR (most accurate indicator for CKD)
Altered carbohydrate and lipid metabolism which leads to hyperglycemia, hyperinsulinemia, elevated Triglycerides and LDL, and Decreased HDL
Metabolic acidosis
Decreased Ca
Increased phosphate levels due to decreased phosphate excretion
Decreased HbG and HCT due to decreased erythropoietin production from kidneys
CV development
Increased risk for infection
Fluid overload, pulmonary edema, pneumonia, dyspnea, kussmaul breathing
Anxiety/depression
Infertility, decreased libido
Increased risk for fractures.
What diagnostic tests can be done for CKD?
BUN,
Cr,
creatinine clearance,
electrolytes,
UA,
CBC,
lipid profile,
Renal UltraSound,
CT,
renal biopsy
What non-pharm care can be done for CKD patients?
Address fluid and electrolyte imbalances
Renal diet/ Fluid restriction
Maintain potassium at normal levels
Manage DM, HTN, & HLD if present
Erythropoietin therapy- epoetin alfa (Epogen)
Calcium supplement and phosphate binders
Adjust medication dosing according to renal function
True or false? Phosphate binders should be given with food?
True
What is the goal of CKD care?
Provide comfort, preserve renal functions and decrease risk for developing CVD
What high potassium foods should be avoided for CKD and AKI patients?
Salt substitutes w/ potassium in them
Avocado, banana, cantaloupe, oranges and orange juice, prunes, raisins
Beans, broccoli, potatoes, carrots, tomatoes
Bran products, chocolate, granola, milk, nuts and seeds, peanut butter, yogurt
Aside from medical treatment, there are three different procedures that can be done. What are they?
Dialysis
Hemodiaylsis
Kidney Transplant
What does dialysis do and what are the two different types of dialysis?
Dialysis = Filters out metabolic waste from the blood.
Peritoneal Dialysis = Can be done at home, less restrictive diet. Maintenance = sterile procedure
Automatic Peritoneal Dialysis = Done during the night while sleeping.
Hemodialysis can have three different procedures. What are they?
HD catheter - Inserting a catheter into a large vein in the neck
AV fistula = Joining an artery and vein in the arm
Av graft = Using a soft tube to join an artery and vein in the arm.
When assessing the AV fistula or graft, what should the nurse be looking for?
Auscultating graft or fistula should be hearing Bruit.
Should be feeling for thrill on the graft/fistula
Should be assessing distal pulses to fistula/graft
True or false. We can draw blood, insert medication and insert IV on the extremities with AV fistula or graft.
FALSE.
NEVER DRAW BLOOD. PUT MEDICATION, INSERT IV OR MEASURE BP ON THE EXTREMITIES WITH AV FISTULA or GRAFT
Can a regular Med-surg floor nurse change the dressing on a HD catheter?
No. Call dialysis nurse. HD catheter usage and care is strictly for dialysis only.
What should a nurse be aware of with Dialysis patients?
Dialysis can cause a decrease in BP due to losing fluids during dialysis.
So collaborate with dialysis nurse to see what med to give and to withhold prior to dialysis s
Patients before dialysis can be fatigued or confused. When they come back, assess their VS, LOC, and site. Treat them as a priority patient.
Always do daily weights
What should a kidney transplant patient be taught?
S&S of electrolyte imbalance, especially high K+
Immediately report any of these signs:
Weight gain > 4 lbs ,
Increased BP, SOB, Edema,
Increasing fatigue,
Confusion.
Alternative ways of reducing thirst such as sucking on ice cubes, lemons or hard candy.
