Final study guide: AKI

Question 1

AKI: what

Answer 1

is an abrupt (within 48 hrs) reduction in kidney function

Question 2

AKI: defined as (3)

Answer 2

*absolute increase in serum cr level of >/= 0.3
*a % increase in serum cr of >/= 50%
*a reduction in UO (<0.5 ml/kg/hr for more than 6hrs)

Question 3

Prerenal AKI s/s(4)

Answer 3

*prolonged HoTN
*prolonged low CO
*Prolonged vol depletion
*renovascular thrombosis

Question 4

Intrarenal AKI s/s (4)

Answer 4

*kidney ischemia
*endogenous toxins
*exogenous toxins
*infection

Question 5

Postrenal AKI s/s (2)

Answer 5

*Obstruction
*rare as a cause of AKI in critical care

Question 6

2 types of intrarenal AKI

Answer 6

ischemic and toxic

Question 7

Ischemic AKI: cause

(three)

Answer 7

prolonged HoTN or low CO d/t HoTN and sepsis

Question 8

Toxic AKI: cause (2)

Answer 8

injury r/t…
*meds that are administered to tx coexisting conditions
*radiopaque dye

Question 9

AKI phases (4)

Answer 9

*onset
*oliguric/anuric
*diuretic
*recovery

Question 10

Phases of ATN: Onset (5)

Answer 10

 The period of time from when an insult occurs until there is cell injury
 This phase lasts from hours to days
 Decreased GFR due to impaired blood flow to the kidney and decreased glomerular ultrafiltration pressure
 Decreased GFR disrupts the integrity of the tubular epithelium
 If treatment initiated now irreversible damage may be alleviated

Question 11

What is GFR

Answer 11

The glomerular filtration rate (GFR) shows how well the kidneys are filtering.

Question 12

AKI phases: Oliguric/Anuric phase (6)

Answer 12

 This phase lasts 5 – 8 days in the nonoliguric patient and 10 – 16 days in the oliguric patient
 Urine output is often less than 400 ml/24 hour period
 Necrotic cellular debris blocks the flow of urine causing damage to the tubular wall and basement
membrane
 This causes glomerular filtrate to flow passively into kidney tissue instead of through the ureters
 GFR is greatly reduced—BUN and Cr rise
 Dialysis is usually started during this phase

Question 13

Oliguric

Answer 13

Only a little pee (<400 ml/day or <20ml/hr)

Question 14

Anuric

Answer 14

Absolutely no pee

Question 15

AKI: Diuretic phase (5)

Answer 15

 Characterized by urine output as high as
2 – 4 L/day
 Polyuria will not be evident due to dialysis
 Obstruction has passed but edema and scarring remain
 Kidneys can clear volume but not solutes
 This phase lasts about 7 – 14 days

Question 16

AKI: recovery phase (1)

Answer 16

During this stage, renal function slow returns to normal or near-normal

Question 17

Medical/RN management (7)

Answer 17

*recognize risk factors
*prevent infection complications
*optimize fluid balance
*avoiding electrolyte imbalance
*prevent anemia
*medications
*education

Question 18

Medical/RN management: recognize risk factors (7)

Answer 18

*elderly (decreased GFR)
*HF or RF
*sepsis
*trauma and rhabdo
*dehydration (hypoperfusion to kidneys)
*pts undergoing radiologic procedures (contrast dye)
*NSAIDS

Question 19

Medical/RN management: prevent infection complications (s/s: 3)

watch for these sgns

Answer 19

 Increased WBC count
 Redness at wound or IV site
 Increased temp

Question 20

Medical/RN management: prevent infection complications (what type of invasive line surveillance (2)

Answer 20

*FC: straight cath Qdaily
*Endotracheal tubes: suctioning and frequent oral care

Question 21

Medical/RN management: optimize fluid balance (3)

What types of fluids are we giving and not giving

Answer 21

*CRYSTALLOIDS: balanced salt solutions (NS and LR)
*LR: should be avoided (too much K)
*COLLOIDS: expand intravascular volume (albumin, hetastarch, and Dextran)

Question 22

Medical/RN management: fluid restrictions (3)

two reasons and how much limited to

Answer 22

 Prevent circulatory overload
 Prevent interstitial edema
 1000 ml/day

Question 23

Medical/RN management: fluid removal (3)

Answer 23

 Diuretics can stimulate fluid removal
 Dialysis is the treatment of choice
 Measuring urine output—nurses are very strict

Question 24

Medical/RN management: avoiding electrolyte imbalance (POTASSIUM) (5)

Answer 24

 Often reach levels > 6
 Stop all supplements
 If producing urine, give diuretics
 IV glucose and IV insulin: forces K out with stool
 Kayexalate: binds with K and sends out with stool

Question 25

Medical/RN management: avoiding electrolyte imbalance (Na) (2)

Answer 25

 Usually dilutional
 Tx: Fluid restriction over a couple of days and Manipulate the amount of sodium in the dialysate

Question 26

Medical/RN management: avoiding electrolyte imbalance (Phos) (5)

Answer 26

*low Ca and high Po4 d/t bad PTH reabsorption of Ca and excretion of Po4
*will come back up
*check albumin
*give Po4 binders: Phos-Lo or Renagel
*high Po4 levels causes itching

Question 27

Medical/RN management: avoiding electrolyte imbalance (Ca) (2)

Answer 27

*low Ca and high Po4 d/t bad PTH reabsorption of Ca and excretion of Po4
*if low give Ca supplements and Vit D

Question 28

Medical/RN management: prevent anemia (one)

Answer 28

 Treat with Epogen or Procrit

Question 29

Medical/RN management: medications (2)

Answer 29

*Low-dose Dopamine
*Acetylcysteine

Question 30

Low-dose Dopamine (3)

Answer 30

 Stimulates blood flow to the kidneys
 Effective short-term
 Develop tolerance

Question 31

Acetylcysteine (2)

Answer 31

 Used before procedures involving radiopaque contrast dye
 Works directly on the kidneys to vasodilate the tubule and scavenge oxygen-free radicals

Question 32

Medical/RN management: education (four)

Answer 32

 Challenging—Increased BUN/Cr alter LOC
 Sleep disturbances
*emotional anxiety
 Encourage patient/family to voice concerns
 Allow patient to control some personal aspect of the environment