exam 3 - renal

Question 1

AKI occurs very quickly, occurs over…

Answer 1

hours-days = failure to maintain waste elimination, fluid/electrolyte balance, acid base balance

Question 2

renal failure results when

Answer 2

the kidneys cannot remove metabolic waste/perform regular functions

Question 3

AKI diagnostic definition?

Answer 3

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

Question 4

ARF and AKI is usually a ______ issue

Answer 4

secondary issues

Question 5

risk factors for AKI?

Answer 5

shock, cardiac surgery, hypotension, prolonged mechanical ventilation and sepsis, old age and DM

Question 6

AKI categories?

Answer 6

pre renal, intra renal and post renal

Question 7

define pre renal AKI
what is it caused by?

Answer 7

most common, reduced blood flow to kidneys

caused by: hypo-perfusiom, hypovolemia, hypotension, burns and sepsis

Question 8

define intra renal
what is it caused by?

Answer 8

issue within kidney affecting renal cortex/medulla

caused by: allergic disorders, embolism, thrombosis of renal vessels, nephrotoxic drugs (NSAIDs), gentamicin/vanc

Question 9

define post renal
what causes it?

Answer 9

urine flow obstruction

caused by calculi, tumors, or urethral obstruction

Question 10

what does body do during pre/post renal to try to fix issue? what does this lead to?

Answer 10

tries to compensate which improves perfusion but reduces urine output and builds up waste in the blood

Question 11

what causes AKI? what is AKI? what happens if you dont try to tx underlying conditions?

Answer 11

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

Question 12

what is phase 1 of AKI

Answer 12

initiation: begins w/initial result = oliguria

Question 13

what is phase 2 of AKI

Answer 13

oliguria (small amount of urine produced), accompanied by increase in serum concentration of substance usually excreted by kidneys

Question 14

what is phase 3 of AKI?

Answer 14

diuesis: gradual increase in UOA which = glomerular filtration is recovering

Question 15

what is phase 4 of AKI?

Answer 15

recovery: signs of improvement, may take 3-12 m

Question 16

all phases of AKI, exhibits increase in what lab value

Answer 16

creatinine

Question 17

what are the manifestations of AKI

Answer 17

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

Question 18

if AKI isnt treated what can it lead to

Answer 18

CKD

Question 19

if Bun/Cr ratio is above 20, what does that mean?

Answer 19

pre renal cause: dehydration, hypovolemia, MI, burns, HF

Question 20

what does it mean if Bun/Cr ratio is less than 10

Answer 20

intrinsic renal cause: acute tubular necrosis, liver disease, malnutrition, SIADH, rhabdomyolosis

Question 21

objective of tx for AKI

Answer 21

restore normal chemical balance/prevent complications until repair of renal tissue/restoration of renal function can occur

Question 22

treatment of AKI

Answer 22

treat underlying cause

continuous kidney replacement therapy (hemo/peritoneal dialysis)

Question 22

describe hemodialysis

Answer 22

Intermittent KRT
Delivered over 4-6 hrs
Performed 3x a week

Question 23

Describe continuous kidney replacement Therapy

Answer 23

• 24hr prescription
• different approaches lo o rear particles from blood
  Only in ICU

Question 24

Described acute tubular necrosis

Answer 24

Most common type of AKI
Cell death = lack of oxygen + blood flow to kidneys = damage
Slow recovery, takes months, may never fully heal

Question 25

AKI management

Answer 25

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)

Question 26

What to monitor in AKI

Answer 26

Urine output, weigh, BUN/CR, dryness, itchiness, rails, K+ levels, EKG

Question 27

Early s/sx of AKI

Answer 27

↓ UOA
Not adequately hydrating
Check weight

Question 28

Early s/sx of AKI

Answer 28

↓ UOA
Not adequately hydrating
Check weight

Question 29

Goals for AKI

Answer 29

Restore kidney function
Good BUN/CR ratio
Good hydration
Good weight with no edema
Alert in normal mental status

Question 30

To avoid AKI . all healthy adult should drink how much water a day

Answer 30

2 -3L
Avoid dehydration, which reduces perfusion and leads to a AKI

Question 31

Health teachings for AKI

Answer 31

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