Exam 2: Fluid and Electrolytes Flashcards
Acute Kidney Failure
Sudden reduction in kidney function:
Decreased GFR ( normal is 90-120 )
GFR decreased leads to retention of nitro waste
Increased creatinine and BUN
Decreased urine output
Acute Kidney Failure
Urine Output
Normal: 30 ml/hour
Oliguria: Less than 0.5
Anuria: Absence
Polyuria: Excess
Uremia: Waste
Acute Kidney Failure
Causes
Reduced perfusion to kidneys
Damage to kidney tissue
Obstruction
Acute Kidney Failure
Assessment
Assess for:
Urinary output –> decreased
Azotemia
Fluid status –> fluid overload and weight gain can lead to heart failure
Dehydration reduces perfusion
Evaluate vital signs to recognize hypo-perfusion and hypoxemia
-MAP below 65
-Hypotension
-Tachycardia
-Thready pulse
-SPO2 below 88%
Acute Kidney Failure
Labs
- Increased serum creatinine and BUN
- Decreased GFR
- Decreased calcium
- Metabolic acidosis
- Abnormal blood electrolytes
- Hyperkalemia: D/t impaired ability of kidneys to excrete potassium
- ECG changes –> peaked t waves, widened QRS, ST depression
Acute Kidney Failure
Interventions
- Identify and correct cause!
- Optimize cardiac output and renal blood flow –> maintain adequate BP
- Fluid Overload: Fluid restriction, diuretics, dialysis
- Nutritional support due to catabolism protein breakdown
- Prevent further injury –> avoid nephrotoxic agents
: NSAIDS and contrast NO!
Acute Kidney Failure
Interventions
- Hyperkalemia: Limit K+ intake, meds: sodium polystyrene, insulin plus D50, biocarbonate
- Sodium imbalances: Fluid restrict, diuretics
- Metabolic acidosis: Biocarbonate, diaylsis
- AKI can be reversed!
Stage 5 CKD Diet
- Protein restriction
- Fluid restriction
- Low sodium
- Limit phosphate and potassium
- Inc vit d and calcium `
Stage 5 CKD
Complications
- Anemia
- Bone health
- Cardiovascular issues
- Vit D deficiency
- Electro imbalances
- Fluid overload
- GERD
- Hypoalbuminemia
