exam 3 - renal Flashcards
AKI occurs very quickly, occurs over…
hours-days = failure to maintain waste elimination, fluid/electrolyte balance, acid base balance
renal failure results when
the kidneys cannot remove metabolic waste/perform regular functions
AKI diagnostic definition?
increase in Cr by 0.3 in 48 hrs
or
increase in Cr 1.5x baseline 7 days prior
or
urine volume, <0.5ml/kg/hr for 6hrs
ARF and AKI is usually a ______ issue
secondary issues
risk factors for AKI?
shock, cardiac surgery, hypotension, prolonged mechanical ventilation and sepsis, old age and DM
AKI categories?
pre renal, intra renal and post renal
define pre renal AKI
what is it caused by?
most common, reduced blood flow to kidneys
caused by: hypo-perfusiom, hypovolemia, hypotension, burns and sepsis
define intra renal
what is it caused by?
issue within kidney affecting renal cortex/medulla
caused by: allergic disorders, embolism, thrombosis of renal vessels, nephrotoxic drugs (NSAIDs), gentamicin/vanc
define post renal
what causes it?
urine flow obstruction
caused by calculi, tumors, or urethral obstruction
what does body do during pre/post renal to try to fix issue? what does this lead to?
tries to compensate which improves perfusion but reduces urine output and builds up waste in the blood
what causes AKI? what is AKI? what happens if you dont try to tx underlying conditions?
usually caused by an underlying condition = reduced cardiac output or causes obstruction of kidney
blood flow reduced to kidneys, leading to impaired function
if underlying conditions are not tx = renal failure
what is phase 1 of AKI
initiation: begins w/initial result = oliguria
what is phase 2 of AKI
oliguria (small amount of urine produced), accompanied by increase in serum concentration of substance usually excreted by kidneys
what is phase 3 of AKI?
diuesis: gradual increase in UOA which = glomerular filtration is recovering
what is phase 4 of AKI?
recovery: signs of improvement, may take 3-12 m
all phases of AKI, exhibits increase in what lab value
creatinine
what are the manifestations of AKI
lethargy (waste accumulation)
dehydration (dry skin/mucous membranes)
CNS changes (drowsy, ha, muscle twitching, seizures)
GI: n/v, decreased peristalsis
Cardiac: htn, HF, MI, edema
Hema: bleeding, thrombosis, anemia
if AKI isnt treated what can it lead to
CKD
if Bun/Cr ratio is above 20, what does that mean?
pre renal cause: dehydration, hypovolemia, MI, burns, HF
what does it mean if Bun/Cr ratio is less than 10
intrinsic renal cause: acute tubular necrosis, liver disease, malnutrition, SIADH, rhabdomyolosis
objective of tx for AKI
restore normal chemical balance/prevent complications until repair of renal tissue/restoration of renal function can occur
treatment of AKI
treat underlying cause
continuous kidney replacement therapy (hemo/peritoneal dialysis)
describe hemodialysis
Intermittent KRT
Delivered over 4-6 hrs
Performed 3x a week
Describe continuous kidney replacement Therapy
- 24hr prescription
- different approaches lo o rear particles from blood
Only in ICU
Described acute tubular necrosis
Most common type of AKI
Cell death = lack of oxygen + blood flow to kidneys = damage
Slow recovery, takes months, may never fully heal
AKI management
VS (BP)
Weigh pt daily
Assess heart/ lung sounds
Monitor loc/ mental status
Assess edema
Review labs ( potassium)
Insert foley; monitor 1/0’s
Elevate hob
Diuretics
Fluid restriction
↓ na and ↓ k+ diet (no banana, orange.or tomatoes)
What to monitor in AKI
Urine output, weigh, BUN/CR, dryness, itchiness, rails, K+ levels, EKG
Early s/sx of AKI
↓ UOA
Not adequately hydrating
Check weight
Early s/sx of AKI
↓ UOA
Not adequately hydrating
Check weight
Goals for AKI
Restore kidney function
Good BUN/CR ratio
Good hydration
Good weight with no edema
Alert in normal mental status
To avoid AKI . all healthy adult should drink how much water a day
2 -3L
Avoid dehydration, which reduces perfusion and leads to a AKI
Health teachings for AKI
Low, sodium and low potassium diet
Ambulate and do not smoke
Avoid NSAIDs
Get blood work done regularly and control blood pressure
Take meds as prescribed
If short of breath or non-passing urine, return to the emergency room
