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Nurs 343 Adult Health 1 > Exam 1 Material : Renal AKI and CKD > Flashcards

Exam 1 Material : Renal AKI and CKD Flashcards

1
Q

What lab values should a nurse look for in AKI?

A

Elevated creatinine

Elevated BUN

Elevated Potassium

Decreased urine output

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2
Q

True or false? AKI is potentially reversible

A

True

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3
Q

Why are older adults more susceptible to AKI?

A

Dehydration, diuretics, hypotension, CV, DM

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4
Q

What are the three different types of causes for AKI?

A

Prerenal, Intrarenal, and Postrenal.

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5
Q

What causes of AKI are considered as Prerenal?

A

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)

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6
Q

What causes of AKI are considered as Intrarenal?

A

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)
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7
Q

What causes of AKI are considered as Postrenal?

A

BPH

Prostate and Bladder Cancer

Renal Calculi

Trauma

Ureteral strictures

Spinal Cord injury

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8
Q

What is hydronephrosis?

A

Swelling in one or both kidneys with urine pooling. Caused by an obstruction which causes urine to flow back towards the kidneys

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9
Q

True or false? Prerenal can lead into intrarenal AKI if left untreated?

A

True

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10
Q

What is the most common complication for Intrarenal AKI?

A

ATN (acute tubular necrosis) due to ischemia, sepsis or nephrotoxicity. Can also occur due to long term hypotension, dehydration or hemorrhage.

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11
Q

With AKI, which type of AKI (pre, intra or postrenal) causes kidney damage and causes clinical manifestations to appear?

A

Intrarenal

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12
Q

What are the three Clinical manifestation phases of AKI?

A

Oliguric Phase

Diuretic Phase

Recovery Phase

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13
Q

What are the nursing considerations for the Oliguric Phase?

A

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.

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14
Q

What are the nursing considerations for the Diuretic Phase?

A

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

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15
Q

What are the nursing considerations for the Recovery Phase?

A

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

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16
Q

What medications should be avoided for AKI patients?

A

Ace inhibitors, NSAIDS and Vancomycin

17
Q

What diagnostic tests can be done for AKI?

A

BUN

CR

Electrolytes

UA

Renal Ultrasound

CT

Renal Biopsy

18
Q

If potassium levels are elevated, what treatments can be done for those AKI patients?

A

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

19
Q

What does the Renal diet restrict?

A

Reduce potassium and phosphate intake.

Make sure to have adequate protein intake, just not too much.

Take calcium supplements and phosphate binders.

20
Q

What is Chronic Kidney Disease? (CKD)

A

Progressive loss of kidney function; Irreversible

High mortality rate

May be asymptomatic until advanced.

Prognosis depends on stage

May be eligible for Medicare

21
Q

What are the causes of CKD?

A

DM

HTN

Increased Age

Obesity

Glomerulonephritis

Polycystic Kidney Disease

Urologic disease

Unresolved AKI

22
Q

What are the clinical manifestations of CKD?

A

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.

23
Q

What diagnostic tests can be done for CKD?

A

BUN,

Cr,

creatinine clearance,

electrolytes,

UA,

CBC,

lipid profile,

Renal UltraSound,

CT,

renal biopsy

24
Q

What non-pharm care can be done for CKD patients?

A

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

25
Q

True or false? Phosphate binders should be given with food?

A

True

26
Q

What is the goal of CKD care?

A

Provide comfort, preserve renal functions and decrease risk for developing CVD

27
Q

What high potassium foods should be avoided for CKD and AKI patients?

A

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

28
Q

Aside from medical treatment, there are three different procedures that can be done. What are they?

A

Dialysis

Hemodiaylsis

Kidney Transplant

29
Q

What does dialysis do and what are the two different types of dialysis?

A

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.

30
Q

Hemodialysis can have three different procedures. What are they?

A

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.

31
Q

When assessing the AV fistula or graft, what should the nurse be looking for?

A

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

32
Q

True or false. We can draw blood, insert medication and insert IV on the extremities with AV fistula or graft.

A

FALSE.

NEVER DRAW BLOOD. PUT MEDICATION, INSERT IV OR MEASURE BP ON THE EXTREMITIES WITH AV FISTULA or GRAFT

33
Q

Can a regular Med-surg floor nurse change the dressing on a HD catheter?

A

No. Call dialysis nurse. HD catheter usage and care is strictly for dialysis only.

34
Q

What should a nurse be aware of with Dialysis patients?

A

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

35
Q

What should a kidney transplant patient be taught?

A

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.

Nurs 343 Adult Health 1 (14 decks)

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