Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 425 > Exam #1 Study Guide: Acute Kidney Injury And Renal Transplant > Flashcards

Exam #1 Study Guide: Acute Kidney Injury And Renal Transplant Flashcards

1
Q

Acute Kidney Injury vs. Chronic Kidney Disease: Onset

A

AKI: Sudden
CKD: Gradual, often over many years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Kidney Injury versus Chronic Kidney Disease: Most common cause

A

AKI: Acute Tubular Necrosis
CKD: Diabetic Nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Kidney Injury versus Chronic Kidney Disease: Diagnostic Criteria

A

AKI: Acute reduction in urine output and/or Elevation in serum creatinine
CKD: GFR <60 mL/min/1.73 m2 for >3 mo and/or Kidney Damage >3 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute Kidney Injury versus Chronic Kidney Disease: Reversibility

A

AKI: Potentially
CKD: Progressive and Irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute Kidney Injury versus Chronic Kidney Disease: Primary cause of death

A

AKI: Infection
CKD: Cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute Kidney Injury: Prerenal etiology and Pathophysiology

A
  • Factors that reduce systemic circulation -> reduction in renal blood flow. (Ex. Severe dehydration, HF, decreased CO)
  • Decreases GFR -> causes oliguria
  • Autoregulatory mechanisms attempt to preserve blood flow to essential organs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prerenal conditions can contribute to intrarenal disease if

A
  • Renal ischemia is prolonged.
  • If decreased perfusion persists for an extended time, the kidneys lose their ability to compensate and damage to the kidney parenchyma occurs (intrarenal damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prerenal Azotemia results in

A

A reduction in the excretion of sodium (less than 20 mEq/L), increased salt and water retention and decreased UO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute Kidney Injury: Intrarenal Etiology and Pathophysiology

A
  • Causes include conditions that cause direct damage to kidney tissue (i.e prolonged ischemia, nephrotoxins, Hgb released from hemolyzed RBC’s, myoglobin released from necrotic muscle cells.)
  • Acute tubular necrosis (most common cause)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can nephrotoxins cause intrarenal acute kidney injury?

A

Can cause obstruction of intrarenal structures by crystallization or by causing damage to the epithelial cells of the tubules.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does hemoglobin and myoglobin cause intrarenal AKI?

A

Can block the tubules and cause renal vasoconstriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intrarenal AKI: Acute Tubular Necrosis Pathophysiology and Etiology

A
  • Results from ischemia, nephrotoxins, or sepsis
  • Severe ischemia causes disruption in basement membrane
  • Nephrotoxic agents cause necrosis of tubular epithelial cells
  • Potentially reversible if the basement membrane is not destroyed and the tubular epithelium regenerates.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AKI Postrenal: Etiology and Pathophysiology

A 
-Causes include mechanical obstruction of outflow:
Benign prostatic hyperplasia
Prostate cancer
Calculi
Trauma
Extrarenal tumors
Bilateral ureteral obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AKI: Progresses through phases

A
  1. Oliguric
  2. Diuretic
  3. Recovery

*When a patient does not recover from AKI, then CKD may develop.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RIFLE Classification

A 
Used to describe stages of AKI
(R)is is the first stage of AKI
(I) Injury is the second stage
(F) Failure
(L) Loss
(E) End-stage renal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AKI Oliguric Phase: Clinical Manifestation

A
  • Oliguria (UO < 400 mL/day)
  • Urinalysis may show casts, RBCs and WBCs
  • Hypovolemia
  • Fluid retention (d/t decreased UO): Distended neck veins, bounding pulse, edema, HTN
  • Metabolic acidosis
  • Hyponatremia
  • Hyperkalemia
  • Neurologic disorders: Fatigue, difficulty concentration, seizures, stupor and coma (occur as waste products accumulate in the brain and other nervous tissue)
  • Hematologic Disorders: Leukocytosis (increased risk for infection)
  • Waste product accumulation (elevated BUN and serum creatinine levels)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urine Output Requirement

A

0.5 mL/kg/hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How long does the oliguric phase last?

A

Occurs within 1-7 days after injury and lasts 10-14 days (the longer the oliguric phase lasts, the poorer the prognosis for complete recovery of kidney function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prerenal: Specific Gravity

A

High because urine is concentrated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fluid retention during the oliguric phase of AKI can lead to

A

HF, pulmonary edema and pericardial and pleural effusions (d/t fluid overload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is metabolic acidosis a clinical manifestation of the oliguric phase of AKI?

A
  • Impaired kidney cannot excrete hydrogen ions
  • Serum bicarbonate production is decreased
  • Severe acidosis develops -> Kussmaul respirations

*Read notes for more information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical Manifestations of the Oliguric Phase of AKI: Sodium Balance

A
  • There is an increased excretion of sodium

- Hyponatremia can lead to cerebral edema (puts them at risk for seizure activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical Manifestations of the Oliguric Phase of AKI: Potassium Excess

A
  • Impaired ability of kidneys to excrete potassium
  • Increased risk with massive tissue trauma
  • Usually asymptomatic
  • ECG changes

*Read notes for more info

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat high potassium in oliguric phase of AKI?

A
  • Regular insulin

* May be more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diuretic Phase of AKI

A
  • Daily UO is 1-3 L (may reach 5 L or more) (caused by the inability of the tubules to concentrate urine)
  • Monitor for hyponatremia, hypokalemia and dehydration (hypovolemia)
  • Near the end of this phase, acid-base, electrolyte and waste product values may stabilize.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Recovery Phase of AKI

A

-May take up to 12 months for kidney functions to stabilize.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

AKI: Diagnostic Studies

A
  • Thorough history
  • Serum creatinine
  • Urinalysis
  • Kidney ultrasonography
  • Renal scan
  • CT scan
  • Renal biopsy

*Add notes in to this from slide 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

AKI Diagnostic Studies: Contraindications

A
  • MRI with gadolinium contrast medium
  • Magnetic resonance angiography (MRA) with gadolinium contrast medium: Nephrogenic systemic fibrosis and Contrast-induced nephropathy (CIN)

*Add notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

AKI: Primary Goals

A
  • Eliminate cause
  • Manage signs and symptoms
  • Prevent complications (i.e infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

AKI Interprofessional Care Includes

A
  1. Ensure adequate intravascular volume and CO: Force fluids, loop diuretics and osmotic diuretics
  2. Closely monitor fluid intake during oliguric phase
  3. Treat hyperkalemia
  4. Renal replacement therapy
  5. Nutritional Therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the general rule for calculating the fluid restriction?

A

Add all loses for previous 24 hours plus 600 mL for insensible losses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How to treat hyperkalemia associated with AKI?

A
  • Insulin and sodium bicarbonate
  • Calcium carbonate
  • Sodium polystyrene sulfonate (Kayexalate)

*Add notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

AKI: What are indications for renal replacement therapy?

A
  • Volume overload
  • Elevated serum potassium level
  • Metabolic acidosis
  • BUN level > 120 mg/dL (43mmol/L)
  • Significant change in mental status
  • Pericarditis, pericardial effusion, or cardiac tamponade

*Add notes

34
Q

AKI: Types of Renal Replacement Therapy

A
  1. Intermittent hemodialysis (method of choice when rapid changes are required in a short period of time)
  2. Continuous renal replacement therapy: involves cannulation of artery and vein
35
Q

AKI Interprofessional Care: Nutritional Therapy

A
  • Maintain adequate caloric intake: Primarily carbohydrates and fat; limited protein (to prevent further breakdown of body protein for energy purposes)
  • Restrict sodium
  • Increase dietary fat
  • Enteral nutrition

*Add more info from notes

36
Q

AKI: Nursing Assessment includes

A
  • Measure vital signs
  • Measure fluid intake and output
  • Examine urine for color, SG, glucose, protein, blood and sediment.
  • Assess general appearance (i.e color, edema, neck vein distention)
  • Observe dialysis access site for inflammation and exudate
  • Mental status/level of consciousness
  • Oral mucosa for dryness and inflammation
  • Lung sounds
  • Heart rhythm
  • Laboratory values and diagnostic test results.
37
Q

AKI: Nursing Diagnoses and Collaborative Problem

A
  • Excess fluid volume RT kidney failure and fluid retention
  • Risk for infection RT invasive lines, uremic toxins and altered immune response secondary to kidney failure
  • Fatigue RT anemia, metabolic acidosis and uremic toxins
  • Anxiety RT disease processes, therapeutic interventions and uncertainty of prognosis
  • Potential complication: dysrhythmia RT electrolyte imbalances
38
Q

AKI Planning: The patient with AKI will

A
  • Completely recover without any loss of kidney function
  • Maintain normal fluid and electrolyte balance
  • Have decreased anxiety
  • Adhere to and understand need for careful follow-up care
39
Q

AKI Nursing Implementation: Health Promotion

A
  • Identify and monitor populations at high risk
  • Control exposure to nephrotoxic drugs and industrial chemicals
  • Prevent prolonged episodes of hypotension and hypovolemia
40
Q

Slide 28

A

??

41
Q

AKI: Acute Care

A
  • Accurate intake and output
  • Daily weights
  • Assess for signs of hypervolemia or hypovolemia
  • Assess for potassium and sodium disturbances
  • Meticulous aseptic technique
  • Careful use of nephrotoxic drugs
  • Skin care measures/mouth care

*Read notes

42
Q

AKI: Ambulatory Care

A
  • Regulate protein and potassium intake
  • Follow-up care
  • Teaching
  • Appropriate referrals

*Add notes

43
Q

AKI Evaluation: The expected outcomes are that the patient with AKI wil

A
  • Regain and maintain normal fluid and electrolyte balance
  • Adhere to the treatment regimen
  • Experience no complications
  • Have complete recovery
44
Q

AKI: Vascular Access

A

Uses vascular access catheter

45
Q

During Hemodialysis, what is added to prevent clotting?

A

Heparin is added to prevent clotting.

46
Q

Hemodialysis Complications

A
  • Risk for bleeding/Blood loss (d/t heparin)
  • Risk for anemia (RBC can get stuck in filter?)
  • Hypotension
  • Muscle cramps (d/t electrolyte loss)
  • Hepatitis

*Read notes

47
Q

Hemodialysis Effectiveness

A
  • Cannot fully replace normal functions of kidneys
  • Can ease many of symptoms
  • Can prevent certain complications
48
Q

Continual Renal Replacement Therapy

A
  • Method for treating AKI
  • Means by which uremic toxins and fluids are removed
  • Acid-base status/electrolyte are adjusted slowly and continuously
  • For those not cardiogenic stable (i.e BP, heart rhythm, etc.)
  • Anticoagulants needed to prevent blood clotting (Higher risk for filter to clot)
49
Q

Continual Renal Replacement Therapy Contraindication

A

Patient has life-threatening manifestations of uremia that require rapid treatment

50
Q

CRRT versus HD

A
  • Continuous rather than intermittent
  • Fluid volume can be removed over days versus hours
  • Solute removal by convection (no dialysate required) in addition to osmosis and diffusion
  • Less hemodynamic instability
  • Does not require constant monitoring by HD nurse
  • Does not require complicated HD equipment
51
Q

CRRT Infusion of replacement fluid is determined by

A

Degree of fluid and electrolyte imbalance

52
Q

CRRT can be continued as long as

A

30-40 days

53
Q

How often should the CRRT hemofilter be changed?

A

24-48 hours

54
Q

What should the ultrafiltrate color be for CRRT?

A

Clear yellow (If the ultrafiltrate becomes bloody or blood tinged, suspect a possible rupture in the filter membrane Treatment needs to be terminated to prevent blood loss)

55
Q

CRRT Specific Nursing Interventions

A
  • Obtain weights
  • Monitor and document laboratory values daily
  • Assess hourly: Intake and output, vital signs, hemodynamic status
  • Care for site to prevent infection
56
Q

Kidney Transplant Recipient Selection

A
  • Candidacy determined by a variety of medical and psychosocial factors that vary among transplant centers
  • Preemptive transplant (before dialysis is required) is possible if recipient has a living donor

*Read notes

57
Q

Contraindications to kidney transplant

A
  • Disseminated malignancies
  • Refractory/untreated cardiac disease
  • Chronic respiratory failure
  • Extensive vascular disease (not being able to perfuse the kidney)
  • Chronic infection
  • Unresolved psychosocial disorders (may not be compliant with medications)
58
Q

Surgical Procedures required before kidney transplant

A
  • Coronary artery bypass or coronary angioplasty
  • Cholecystectomy
  • Bilateral nephrectomy
59
Q

Kidney Transplant Incompatibility Studies

A

Purpose of testing is to identify HLA antigens for both donors and potential recipients

60
Q

Kidney Transplant Donor Sources

A
  • Deceased donors with compatible blood type
  • Blood relatives
  • Emotionally related living donors
  • Altruistic living donors
  • Paired organ donation
61
Q

Kidney Transplant Donor Sources: Live donor needs

A
  • Extensive interprofessional evaluation

- Crossmatches

62
Q

Kidney Transplant Donor Sources: Advantages of Live Donors

A
  • Better patient and graft survival rates
  • Immediate organ availability
  • Immediate function/minimal cold time
  • Opportunity to have recipient in best possible medical condition
63
Q

Kidney Transplant Donor Sources: Live Donor Lab Studies

A
  • 24-hour urine: Creatinine clearance and total protein
  • Complete blood count
  • Chemistry and electrolyte profiles
  • Hepatitis B and C, HIV, CMV testing
64
Q

Kidney Transplant Donor Sources: Deceased Donor

A
  • Deceased (cadaver) kidney donors are relatively healthy individuals
  • Have suffered an irreversible brain injury and are declared brain dead

*Read notes

65
Q

Kidney Transplant Donor Sources: Deceased Donor Data includes

A
  • ABO group
  • HLA typing
  • Age
  • Antibody level
  • Length of time waiting

*Read notes

66
Q

Kidney Transplant Management: Postoperative Care for Live Donor

A
  • Care is similar to that for open or laparoscopic nephrectomy
  • Closely monitor renal function
  • Closely monitor hematocrit
  • Donors usually experience more pain than recipient
67
Q

Kidney Transplant Nursing Management: Postoperative Care for the Recipient

A
  • Maintenance of fluid and electrolyte balance is first priority
  • UO may be as high as 1L/hr and gradually decreases as the BUN and serum creatinine levels return toward normal.
  • Urine output is replaced with fluids milliliter for milliliter hourly for the first 12 to 24 hours.
  • Dehydration must be avoided
  • Assess for hyponatremia/ hypokalemia
  • Acute tubular necrosis can occur
  • Dialysis is required
  • Maintain catheter patency

*Check notes

68
Q

Large volumes of urine may be produced soon after transplanted kidney is placed due to

A
  • New kidney’s ability to filter BUN
  • Abundance of fluids during operation
  • Initial renal tubular dysfunction
69
Q

Kidney Transplant Immunosuppressive Therapy Goals

A
  • Adequately suppress immune response

- Maintain sufficient immunity to prevent overwhelming infection

70
Q

Kidney Transplant Complications: Types of rejection

A
  1. Hyperacute
  2. Acute
  3. chronic
71
Q

Hyperacute (antibody-mediated humoral) Rejection

A

Occurs minutes to hours after transplant

72
Q

Acute rejection

A

Occurs days to months after transplant

73
Q

Chronic Rejection

A
  • Process occurs over months or years and is irreversible.

- Looks the same as chronic liver failure.

74
Q

Kidney Transplant Complications include

A
  • Infection
  • Cardiovascular Disease
  • Malignancies
  • Recurrence of original kidney disease
  • Corticosteroid related complications
75
Q

Kidney Transplant Complications: Most common infections observed in the first month include

A
  • Pneumonia
  • Wound infections
  • IV line and drain infections
  • UTI’s
76
Q

Kidney Transplant Complications: Fungal Infections

A

Candida
Cryptococcus
Aspergillus
Pneumocystis jiroveci

These are difficult to treat, necessitate prolonged treatment periods and involve the administration of nephrotoxic drugs.

77
Q

Kidney Transplant Complications: Viral Infections include

A
  • CMV: One of most common
  • Epstein-Barr virus
  • Herpes simplex virus (HSV)
  • Varicella-zoster virus
  • Polyomavirus (e.g., BK virus)

*Check notes

78
Q

Kidney Transplant Complications: Cardiovascular Disease

A
  • Transplant recipients have increased incidence of atherosclerotic vascular disease
  • Immunosuppressants can worsen hypertension and hyperlipidemia
  • Patients need to adhere to antihypertensive regimen

*Check notes

79
Q

Kidney Transplant Complications: Malignancies

A
  • Primary cause is immunosuppressive therapy

- Regular screening is important

80
Q

Kidney Transplant Complciations: Malignancies Preventive Care

A
  • Protective clothing
  • Sunscreen
  • check notes
81
Q

Kidney Transplant Complciations: Recurrence of original kidney disease

A
  • Glomerulonephritis
  • IgA nephropathy
  • Diabetic nephropathy
  • Focal segmental sclerosis
82
Q

Kidney Transplant Complciations: Corticosteroid-related complications include

A
  • Aseptic necrosis of hips, knees, and other joints
  • Peptic ulcer disease
  • Glucose intolerance and diabetes
  • Dyslipidemia
  • Cataracts
  • Infection
  • Malignancies

*Check notes from last two slides

NURS 425 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions