Fluid and Electroytes lecture Flashcards
F/E, AKI, CKD
1
Q
Acronym for maintaining Homeostasis in the body
A
- 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
2
Q
Where does ADH come from and what is the purpose of ADH?
A
posterior pituitary gland; tells kidneys to hold on to more water
3
Q
What elevated labs can be indicitive of unhealthy kidneys?
A
- Urea
- Creatinine
- Potassium
4
Q
Urine production <100 mL/24hr
A
Anuria
5
Q
What is anuria?
A
Urine production <100 mL/24hr
6
Q
Urine Production < 400 mL/24hr
A
Oliguria
7
Q
What is oliguria
A
Urine Production < 400 mL/24hr
8
Q
- Excessive urine production
- Producing > 2,000/24mL hr
A
Polyuria
9
Q
What is polyuria
A
- Excessive urine production
- Producing > 2,000/24mL hr
10
Q
Infection of the kidney’s medulla or cortex
A
Pyelonephritis
11
Q
Inflammation of the glomerular capillary wals, causing impaired filtration
A
Glomerulonephritis
12
Q
Medications used to manage renal failure patients
A
- 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
13
Q
Enalapril is an example of what type of medication?
A
ACE Inhibitor
Angiotension Converting enzyme inhibitor
14
Q
Losartan is an example of what kind of medication?
A
ARB
Angiotension Receptor Blocker
15
Q
Medications that can reduce proteinuria and slow progression of kidney disease in diabetics
A
ACE Inhibitors & ARB’s
16
Q
Medications that can manage heart failure and pulmonary edema
A
Inotropic agents and diuretics
17
Q
Medications that can increase H&H
A
Epoetin alfa & Iron
18
Q
Patients with poor kidney function should avoid what OTC medication and why?
A
Magnesium based antacids due to high risk of toxicity
19
Q
Abrupt decline in renal function
A
Acute Kidney Injury or AKI
20
Q
Classifications of AKI causes
A
- Pre-renal
- Intra-renal
- Post-renal
21
Q
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
A
- Pre-renal
22
Q
What classifaction of AKI cause is this:
Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
A
- Intra-renal
23
Q
What classifaction of AKI cause is this:
Sudden obstruction of the urine flow due to enlarged prostate, kidney stones, bladder tumor or injury
A
- Post-renal
24
Q
Is AKI reversible?
A
YES
25
List some nephrotoxic medications
* Amnioglycosides
* Digoxin
* Phenytoin
* ACE Inhibitors
* Magnesium-containing agents
* NSAIDs
* Contrast Dye
* Metformin
26
Nephrotoxic medications require _______ based on ____________?
adjustment, kidney clearance and function
27
Gentamycin and vancomycin are examples of what?
Amnioglycosides
28
Name the phases of AKI
1. Initiation
2. Oliguria
3. Diuresis
4. Recovery
29
# What phase of AKI is this?
Urine output is still normal, pt usually does not know they are sick
Initiation or Non-oliguric
30
# What phase of AKI is this?
* Urine output minimun approximately 400mL/24 hrs or 0.5mL/kg/hr
* Increase uremic symptoms
* Hyperkalemia
Oliguria
31
# What phase of AKI is this?
Gradual increase in urine output and lab values begin to decrease but renal functions still abnormal
Diuresis
32
# What phase of AKI is this?
* Can last 3-12 months
* Labs begin returning to normal
Recovery
33
What is the term used when urea, nitrogen, creatinine wase in blood?
Azotemia
34
What is Azotemia?
Urea, nitrogen, creatinine waste in blood
35
Expected electrolyte imbalances in AKI pt's
* Increased K
* Increased Phos
* Decreased Ca
* Decreased Na
36
What is uremia
Excess urea in blood causing renal decline and involving multiple body systems
37
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
38
Expected BUN and Creatinine for AKI patients
Elevated
39
What is a waste product of protein metabolism?
Urea
40
If AKI is found to be severe what may be required?
emergency or temporary dialysis
41
Diet required for AKI patients
* Adequate protein
* Increased carbs
* Low Na
* Low K
* Fluid restriction
42
What is the Goal when treating AKI?
eliminate cause and prevent complications!
43
During treatment for AKI, after the initial fluid replacement what is done?
Fluids are restricted
44
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
45
ECG Peaked/Tall 'T' waves can indicate what?
Hyperkalemia
46
Medications used to treat AKI
* Diuretics
* Sodium polystryrene sulfonate or Kayexalate
* Calcium chloride/calcium gluconate
* Sodium Bicarbonate, insulin, and glucose
47
Examples of diuretics
* Lasix or Furosemide
* Mannitol
* Bumex or Bumetanide
48
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
49
Medications given to AKI pt's that help enhance reuptake of K into cell
* Sodium Bicarbonate
* Insulin
* Glucose
50
Expected findings in children with AKI
* Oliguria w/ sudden return to normal O/P
* Drowsiness
* Gross hematuria
* Edema
* FVO
* Tachypnea
* CNS manifestations
* Cardiac arrythmias
51
# 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
52
Clinical manifestation of AKI in older adults
* Oliguria may not be present
* At greater risk for AKI
* Structural changes
53
Progressive, irreversible loss of kidney function with decreased GFR lasting for 3 months or more
Chronic Kidney Disease or CKD
54
Risk factors for CKD
* Diabetes
* HTN
* CV disease
* Obesity
* Glomerulonephritis
* Pyelonephritis
* Polycystic kidney
55
Genetic growth of cysts in kidneys which replace normal structures and functions
Polycystic Kidney disease or PKD
56
# What stage of CKD is this?
* GFR > 90
* Kidney damage with GFR WNL or increasing
* DX/RX of underlying condition and comorbidities
Stage 1
57
# What stage of CKD is this?
* GFR 60-89
* Mild
* Estimate the rate of progression
Stage 2
58
# What stage of CKD is this?
* GFR 30-59
* Moderate
* Evaluate and treat complications
Stage 3
59
# What stage of CKD is this?
* GFR 15-29
* Severe
* Preparing for renal replacement therapy
Stage 4
60
# 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
61
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
62
Low Na can be corrected with what?
Oral or IV supplementation
63
Pt with reduced production of ADH can cause ________ and can be treated by administering ________
Hypernatremia or high Na, ADH
64
Low K can be caused by what medication class
Diuretics
65
How to treat Hyperkalemia
* Calcium Chloride or Calcium gluconate and sodium bicarb
* Glucose and insulin
* Kayexalate
66
* Medications that correct hyperkalemia
* Given initally to treat Acute Renal Failure
Calcium Chloride or Calcium gluconate and Sodium Bicarb
67
* Medications used to correct hyperkalemia
* Can help drive K back into cell where elevates levels will create less risk
Glucose and insulin
68
What electrolyte can help treat hyperkalemia and assist in reducing the irritability of the heart
Calcium
69
If calcium is low phosporus is ___
high
70
Calcium Chloride or Calcium Gluconate are administered with phosphate binders and sevelamer hydrochloride to treat what?
Low calcium
High Phos
71
Fluids and diuretics in RF patients or dialysis are used to get rid of excess what?
Potassium and
Magnesium
72
Elevated BUN and Creatinine is indicitive of what?
Renal failure
73
Creatinine >50-80
Mild renal failure
74
Creatinine 30-50
Moderate renal failure
75
Creatinine < 30
Severe renal failure
76
Normal pH
7.35-7.45
77
Normal HCO3
22-26
78
Normal PaCO2
45-35
79
S/S of Metabolic Acidosis
* Headache
* Decreased BP
* Hyperkalemia
* LOC Changes (Confusion, Lethargy)
* Kussmaul Respirations
* Muscle twitching
* Warm flushed skin (vasodilation)
* N/V/D
80
# 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
81
Causes of Metabolic Acidosis
* DKA
* Severe diarrhea
* Renal failure
* Shock
82
# 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
83
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
84
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
85
Protein intake for a CKD pt
0.6-0.8g/kg
86
Amount of Na and K a CKD pt can have per day
2-4 g/day
87
Examples of foods that should be restricted for CKD patients
* Bananas
* citrus fruits
* juices
* coffee
88
Daily fluid intake for CKD patients
1-2 L/day
89
Diet for CKD patients
* Increase carbs
* Restrict Na, K, Phos, Protein
90
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
91
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
92
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
93
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
94
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
95
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
96
97
How is Hypermagnesmia corrected?
Oral or IV supplumentation
98
What is the term used to describe excess urea in blood causing renal decline and involving multiple body systems?
Uremia
