Fluid and Electroytes lecture Flashcards
F/E, AKI, CKD
Acronym for maintaining Homeostasis in the body
- A: Acid-Base Balance
- W: Water removal: regulate fluid, ADH (Vasopressin)
- E: Erythropoiesis: Production of RBC’s
- T: Toxin Removal: waste products, urea, renal clearance
- B: Blood pressure regulation: renin
- E: Electrolyte Balance
- D: Vitamin D activation
A WET BED
Where does ADH come from and what is the purpose of ADH?
posterior pituitary gland; tells kidneys to hold on to more water
What elevated labs can be indicitive of unhealthy kidneys?
- Urea
- Creatinine
- Potassium
Urine production <100 mL/24hr
Anuria
What is anuria?
Urine production <100 mL/24hr
Urine Production < 400 mL/24hr
Oliguria
What is oliguria
Urine Production < 400 mL/24hr
- Excessive urine production
- Producing > 2,000/24mL hr
Polyuria
What is polyuria
- Excessive urine production
- Producing > 2,000/24mL hr
Infection of the kidney’s medulla or cortex
Pyelonephritis
Inflammation of the glomerular capillary wals, causing impaired filtration
Glomerulonephritis
Medications used to manage renal failure patients
- Angiotension-converting enzyme or ACE Inhibitors
- Angiotension Receptor Blockers or ARB’s
- Inotropic agents
- Diuretics
- Regular insulin and Dextrose
- Epoetin Alfa
- Iron supplements
- Magnesium base antacids
Enalapril is an example of what type of medication?
ACE Inhibitor
Angiotension Converting enzyme inhibitor
Losartan is an example of what kind of medication?
ARB
Angiotension Receptor Blocker
Medications that can reduce proteinuria and slow progression of kidney disease in diabetics
ACE Inhibitors & ARB’s
Medications that can manage heart failure and pulmonary edema
Inotropic agents and diuretics
Medications that can increase H&H
Epoetin alfa & Iron
Patients with poor kidney function should avoid what OTC medication and why?
Magnesium based antacids due to high risk of toxicity
Abrupt decline in renal function
Acute Kidney Injury or AKI
Classifications of AKI causes
- Pre-renal
- Intra-renal
- Post-renal
What classifaction of AKI cause is this:
Sudden and severe drop in BP, shock, or interruption of blood flow to the kindeys from severe injury or illness
- Pre-renal
What classifaction of AKI cause is this:
Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
- Intra-renal
What classifaction of AKI cause is this:
Sudden obstruction of the urine flow due to enlarged prostate, kidney stones, bladder tumor or injury
- Post-renal
Is AKI reversible?
YES
List some nephrotoxic medications
- Amnioglycosides
- Digoxin
- Phenytoin
- ACE Inhibitors
- Magnesium-containing agents
- NSAIDs
- Contrast Dye
- Metformin
Nephrotoxic medications require _______ based on ____________?
adjustment, kidney clearance and function
Gentamycin and vancomycin are examples of what?
Amnioglycosides
Name the phases of AKI
- Initiation
- Oliguria
- Diuresis
- Recovery
What phase of AKI is this?
Urine output is still normal, pt usually does not know they are sick
Initiation or Non-oliguric
What phase of AKI is this?
- Urine output minimun approximately 400mL/24 hrs or 0.5mL/kg/hr
- Increase uremic symptoms
- Hyperkalemia
Oliguria
What phase of AKI is this?
Gradual increase in urine output and lab values begin to decrease but renal functions still abnormal
Diuresis
What phase of AKI is this?
- Can last 3-12 months
- Labs begin returning to normal
Recovery
What is the term used when urea, nitrogen, creatinine wase in blood?
Azteimia
What is Azotemia?
Urea, nitrogen, creatinine waste in blood
Expected electrolyte imbalances in AKI pt’s
- Increased K
- Increased Phos
- Decreased Ca
- Decreased Na
What is the term used to describe excess urea in blood causing renal decline and involving multiple body systems?
Uremia
What is uremia
Excess urea in blood causing renal decline and involving multiple body systems
Clinical manifestations of AKI
- Azotemia
- Increased BUN and Creatinine
- May or may not have oliguria
- FVO
- Electrolyte imbalances
- Metabolic acidosis
- Edema
- Anemia
- Uremia
- Anorexia
- N/V/D
- Confusion
- Lethargy
- Seizures
Expected BUN and Creatinine for AKI patients
Elevated
What is a waste product of protein metabolism?
Urea
If AKI is found to be severe what may be required?
emergency or temporary dialysis
Diet required for AKI patients
- Adequate protein
- Increased carbs
- Low Na
- Low K
- Fluid restriction
What is the Goal when treating AKI?
eliminate cause and prevent complications!
During treatment for AKI, after the initial fluid replacement what is done?
Fluids are restricted
Management of AKI
- Monitor BP, HR, Temp, Strict I/O, skin color, and respiratory status
- Eliminate cause and prevent complications
- Monitor fluid balance by daily weights and serum Na
- Avoid K in IV fluids an restrit in diet to avoid hyperkalemia
- Diet with adequate protein, increased carbs, low Na
- May require emergency/temporary dialysis if severe
ECG Peaked/Tall ‘T’ waves can indicate what?
Hyperkalemia
Medications used to treat AKI
- Diuretics
- Sodium polystryrene sulfonate or Kayexalate
- Calcium chloride/calcium gluconate
- Sodium Bicarbonate, insulin, and glucose
Examples of diuretics
- Lasix or Furosemide
- Mannitol
- Bumex or Bumetanide
This medication is used to treat AKI
Can be given PO or enema
Exchanges Na or K to treat hyperkalemia
Sodium polystryene sulfonate or Kayexalate
Medications given to AKI pt’s that help enhance reuptake of K into cell
- Sodium Bicarbonate
- Insulin
- Glucose
Expected findings in children with AKI
- Oliguria w/ sudden return to normal O/P
- Drowsiness
- Gross hematuria
- Edema
- FVO
- Tachypnea
- CNS manifestations
- Cardiac arrythmias
These are clinical manifestations of AKI in what age group?
- Oliguria w/ sudden return to normal O/P
- Drowsiness
- Gross hematuria
- Edema
- FVO
- Tachypnea
- CNS manifestations
- Cardiac arrythmias
Children
Clinical manifestation of AKI in older adults
- Oliguria may not be present
- At greater risk for AKI
- Structural changes
Progressive, irreversible loss of kidney function with decreased GFR lasting for 3 months or more
Chronic Kidney Disease or CKD
Risk factors for CKD
- Diabetes
- HTN
- CV disease
- Obesity
- Glomerulonephritis
- Pyelonephritis
- Polycystic kidney
Genetic growth of cysts in kidneys which replace normal structures and functions
Polycystic Kidney disease or PKD
What stage of CKD is this?
- GFR > 90
- Kidney damage with GFR WNL or increasing
- DX/RX of underlying condition and comorbidities
Stage 1
What stage of CKD is this?
- GFR 60-89
- Mild
- Estimate the rate of progression
Stage 2
What stage of CKD is this?
- GFR 30-59
- Moderate
- Evaluate and treat complications
Stage 3
What stage of CKD is this?
- GFR 15-29
- Severe
- Preparing for renal replacement therapy
Stage 4
What stage of CKD is this?
- GFR <15
- Kidney Failure
- Dialysis or transplantation of uremic
Stage 5
also called end-stage renal disease or ESRD
Prevention methods for CKD
- Aggressive management of chronic diseases
- Low Na diet
- Regular exercise and manage weight
- Avoidance of smoking
- Limiting ingestion of alcohol
- Limit OTC NSAIDs
Low Na can be corrected with what?
Oral or IV supplumentation
Pt with reduced production of ADH can cause ________ and can be treated by administering ________
Hypernatremia or high Na, ADH
Low K can be caused by what medication class
Diuretics
How to treat Hyperkalemia
- Calcium Chloride or Calcium gluconate and sodium bicarb
- Glucose and insulin
- Kayexalate
- Medications that correct hyperkalemia
- Given initally to treat Acute Renal Failure
Calcium Chloride or Calcium gluconate and Sodium Bicarb
- Medications used to correct hyperkalemia
- Can help drive K back into cell where elevates levels will create less risk
Glucose and insulin
What electrolyte can help treat hyperkalemia and assist in reducing the irritability of the heart
Calcium
If calcium is low phosporus is ___
high
Calcium Chloride or Calcium Gluconate are administered with phosphate binders and sevelamer hydrochloride to treat what?
Low calcium
High Phos
How is Hypermagnesmia corrected?
Oral or IV supplumentation
Fluids and diuretics in RF patients or dialysis are used to get rid of excess what?
Potassium and
Magnesium
Elevated BUN and Creatinine is indicitive of what?
Renal failure
Creatinine >50-80
Mild renal failure
Creatinine 30-50
Moderate renal failure
Creatinine < 30
Severe renal failure
Normal pH
7.35-7.45
Normal HCO3
22-26
Normal PaCO2
45-35
S/S of Metabolic Acidosis
- Headache
- Decreased BP
- Hyperkalemia
- LOC Changes (Confusion, Lethargy)
- Kussmaul Respirations
- Muscle twitching
- Warm flushed skin (vasodilation)
- N/V/D
The following are S/S of what?
- Headache
- Decreased BP
- Hyperkalemia
- LOC Changes (Confusion, Lethargy)
- Kussmaul Respirations
- Muscle twitching
- Warm flushed skin (vasodilation)
- N/V/D
Metabolic acidosis
Causes of Metabolic Acidosis
- DKA
- Severe diarrhea
- Renal failure
- Shock
The followinf are clinical manifestations of what?
- Decreased Na, Ca, GFR, urine specific gravity, hgb/hct (chronic anemia)
- BUN/Creatinine increased steadily
- Increased K, Phos, Mg
- Fluid excess
- Hematuria
- Proteinuria
CKD
Clinical Manifestations of CKD
- Decreased Na, Ca, GFR, urine specific gravity, hgb/hct (chronic anemia)
BUN/Creatinine increased steadily - Increased K, Phos, Mg
- Fluid excess
- Hematuria
- Proteinuria
CKD Treatment
- Support remaining function of kidneys
- Limit protein intake 0.6-0.8 g/k, increase carbs, restrict Na and K to 2-4 g/day, restrict phos
- Limit fluid intake to 1-2 L/day
- Monitor daily weight (1-3 kg between dialysis
- Renal Replacement therapy/dialysis
- Renal transplant
Protein intake for a CKD pt
0.6-0.8g/kg
Amount of Na and K a CKD pt can have per day
2-4 g/day
Examples of foods that should be restricted for CKD patients
- Bananas
- citrus fruits
- juices
- coffee
Daily fluid intake for CKD patients
1-2 L/day
Diet for CKD patients
- Increase carbs
- Restrict Na, K, Phos, Protein
Nursing assessment for CKD patient
- Monitor VS, weight, urine OP
- Assess dialysis site
- Assess skin
- Monitor labs
- Encourage client and family to discuss fears if new to starting dialysis to provide emotional support
Education for CKD patients
- Importance of keeping dialysis appointments
- Dietary restrictions
- Smoking cecession
- Clinical manifestations of CKD and complications
- Avoid nephrotoxic substances
- Daily weights
- Medication compliance
- Support groups available
A client with CKD IV asks what type of diet they should follow. Which diet will the nurse explain to the client?
A. low protein, low sodium, low potassium, low phospate diet
B. High protein, low sodium, low potassium, high phosphate diet
C. low protein, high sodium, high potassium, high posphate diet
D. low protein, low sodium, low potassium, high phosphate diet
A. Low protein, low sodium, low potassium, low phosphate
The nurse is reviewinf laboratory results on a client with acute renal failure. Which lab result would be reported immediately?
A. Blood urea nitrogen 50 mg/dl
B. Hgb 10.3 mg/dl
C. Venus blood pH 7.30
D Serum potassium 6 mEq/L
D. Serum Potassium 6 mEq/L
Which S/S indicate ESRD? SATA
A. Puritis
B. GFR of 30 mL/min
C. Uremia
D. BUN 18
E. Serum Phos 2.2 mEq/dL
F. Chronic anemia
A, C, F
Kidney enlargement caused by urine backing up from the bladder into the kidney or inability of urine to drain from the kidney into the bladder; excessive reflux stretches the kidney, causing functional damage to it
Hydronephritis
