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Nur 326 > Exam 2 - Acute Kidney injury and chronic kidney disease > Flashcards

Exam 2 - Acute Kidney injury and chronic kidney disease Flashcards

1
Q

Kidney Function

A

maintain fluid and electrolyte homeostasis
rid the body of water soluble wastes via urine

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2
Q

three important endocrine function of kidney

A

produce erythropoietin - stimulate RBC production
activates vitamin D
Produces renin, which helps regulate BP

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3
Q

Kidney injury

A

Kidneys are needy - lots of blood flow
Kidney injury can happen suddenly and progress rapidly, but it is reversible.
Renal insufficiency - 25% of normal GFR - indicator of kidney injury is less than 90.

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4
Q

Acute Kidney Injury
Usually result
Common cause
Kidney function

A

usually the result of ischemic injury related to loss of volume - decreased perfusion.
Toxins or sepsis common causes

Kidney function can be mildly affected to severe

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5
Q

AKI classifications - 3

A

depends on WHERE
pre-renal - volume loss related
intrarenal - acute tubular necrosis (chemical and kidney cell death)
post-renal - not as common, obstruction causes cell death

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6
Q

AKI Clinical manifestations

A

Oligurial - less than 400 ml/24H
Begins one day after hypotensive event and lasts 1-3 weeks
Fluid volume excess (edema)
Metabolic acidosis
Hyponatremia
Hypokalemia
Waste product accumulate
Neurologic disorders

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7
Q

Stage 1 Kidney Disease

A

Asymptomatic

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8
Q

Stage 2 Kidney Disease

A

Asymptomatic, possible HTN

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9
Q

Kidney failure

A

Uremic - urea in blood

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10
Q

Best way to treat Kidney injury?

A

Prevent!

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11
Q

Causes of ESRD

A

Diabetes 50%
Glomerulo-nephritis 10%
HTN 30%
Other 10%

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12
Q

Risk factors for CKD - 8

A

Family History
Increasing age >60
Male
Black
HTN, DM, smoking
Overweight/obesity

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13
Q

Renal Injury

A

Cyclical Problem
Biggest indicator is proteinuria at nephron level.
Also Increase in Angiotensin 2

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14
Q

CKD Cardiovascular Manifestations

A

Hypertension
Heart failure
Coronary artery disease
Pericarditis
Peripheral artery disease

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15
Q

CDK Gi manifestations

A

Anorexia
nausea
vomiting
gi bleeding
gastritis

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16
Q

CKI neurologic manifestations

A

fatigue
headache
sleep disturbances
encephalopathy

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17
Q

CKI integument manifestations

A

pruritus
ecchymosis
Dry, scaly skin

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18
Q

CKI pulmonary manifestations

A

PULMONARY EDEMA!!
uremic pleuritis
pneumonia

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19
Q

If Kidneys no longer maintain F & E homeostasis then

A

Edema, hyperkalemia, hyperphosphatemia, hypermagnesemia, metabolic acidosis

20
Q

If kidneys no longer rid the body of wastes via urine then

A

ANOREXIA, malnutrition, itching, CNS changes

21
Q

If kidneys decrease production of erythropoietin

A

Anemia (5-6)

22
Q

If kidneys decrease activation of vitamin D

A

renal osteodystrophy (weakened bone)

23
Q

Slowing the progression of CKD

A

Blood pressure control (110-130) – ACE or ARBs
Lipid control – statins

24
Q

For volume overload

A

Loop Diuretic with low salt diet

25
Q

For hyperkalemia

A

multiple drugs addressed with hemodialysis in ESRD

26
Q

for metabolic acidosis

A

sodium bicarbonate, an alkaline agent

27
Q

for hyperphosphatemia

A

calcium carbonate, a phosphate binder

28
Q

for renal osteodystrophy

A

calcitriol, an activated vitamin D

29
Q

for anemia

A

erythropoietin ** black box warning

30
Q

Sodium bicarbonate

A

treats metabolic acidosis

31
Q

goal of sodium bicarbonate

Slow
Prevent
Improve

A

slow progression of SKD
prevent bone loss
improve nutritional status

32
Q

how is sodium bicarbonate given

A

PO

33
Q

When do you give sodium bicarbonate

A

When HCO3 is less than 15 mEq/mL – goal is 18-20

34
Q

side effect of sodium bicarbonate

A

bloating

35
Q

Calcium carbonate

A

to treat hyperphosphatemia

36
Q

Moa of calcium carbonate

A

binds to phosphate

37
Q

goal of calcium carbonate

A

keep normal phosphate levels, decrease mortality

38
Q

how to take calcium carbonate

A

take with meals

39
Q

adverse effect of calcium carbonate

A

hypercalcemia – monitor calcium

40
Q

calcitriol

A

vitamin D

41
Q

what does calcitriol do

A

treat renal osteodystrophy

42
Q

moa of calcitriol

A

activated form of vitamin D. stimulates intestinal absorption of calcium/phosphate and bone mineralization

43
Q

adverse effects of calcitriol

A

hypercalcemia, hyperphosphatemia

44
Q

complications of drug therapy

A

drugs are excreted through kidneys. Monitor drug levels because they may need to be changed.

45
Q

Drugs of particular concern

A

Digoxin
Diabetic agents (glyburide, metformin)
Antibiotics (vancomycin)
Opioids (morphine) ** opioids especially because of respiratory depression.

Nur 326 (6 decks)

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