Guided Notes Flashcards
What is Acute Kidney Injury (AKI)?
The term used to encompass the entire scope of the syndrome, ranging from a slight deterioration in kidney function to a severe impairment.
What is Acute tubular necrosis (ATN)?
The most common intra-renal cause of AKI in hospitalized patients.
Primarily result of ischemia, nephrotoxins, or sepsis.
What is Acute tubular necrosis (ATN)?
The most common intra-renal cause of AKI in hospitalized patients.
Primarily result of ischemia, nephrotoxins, or sepsis.
What is Anuria?
No urine output, often seen with urinary tract obstructions.
What is Azotemia?
An accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood.
What is Azotemia?
An accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood.
What is Chronic Kidney Disease (CKD)?
This involves progressive, irreversible loss of kidney function.
What is diuresis?
Increased or excessive production of urine.
What is Extracellular fluid (ECF)?
Fluid found outside of the cell.
What is Glomerular filtration rate (GFR)?
The amount of blood filtered each minute by the glomeruli.
Normal is about 125mL/min
What does hypertonic mean?
Higher osmolality than blood.
What IV fluids are hypertonic?
D5NS
D51/2NS
D10W
3%NaCl
What are hypertonic fluids used for?
To move fluid from cells and interstitial spaces to the vascular space (blood stream).
What does hypotonic mean?
Lower osmolality than blood.
What type of IV fluids are Hypotonic?
0.45% NS
What are Hypotonic fluids used for?
“Blows up cells”
Used to treat cellular dehydration (DKA)
What does isotonic mean?
Same osmolality as blood
What type of fluids are isotonic?
0.9% NS
Lactated Ringers
What are isotonic fluids used for?
Used to expand vascular space.
Used for dehydration, hypovolemia, shock.
What is hypovolemia?
Loss of body fluids, inadequate fluid intake, or plasma to interstitial fluid shift
- Dehydration - Loss of water without loss of sodium.
How do we treat hypovolemia?
Correct the underlying cause and replace water and electrolytes with oral fluids, blood products, or proper IV solutions.
What is hypervolemia?
Excess intake of fluids, abnormal retention of fluids, or interstitial to plasma fluid shift.
What is a symptom of hypervolemia?
Weight gain is most common.
How do we treat hypervolemia?
Remove fluid without changing electrolyte composition or osmolality of ECF.
Diuretics, Fluid restrictions, Sodium restriction, Removal of fluid to treat ascites or pleural effusion.
What is Oliguria?
A reduction in urine output of less than 400mL/day
Is the most common initial manifestation of AKI.
What is Paresthesia?
Tickling or pins and needles caused by pressure on or damage to peripheral nerves.
What is tonicity?
The capability of a solution to modify the volume of cells by altering their water content.
What is Uremia?
A condition involving high levels of waste product in the blood. Likely occurs in final stage of CKD.
What is Diffusion?
Movement of molecules through a semipermeable membrane from a higher concentration area to a lower concentration.
What is Active Transport?
The process in which molecules move against the concentration gradient. External energy is needed for this process.
What is Omosis?
The movement of water down a concentration gradient from a region of low solute to one of high solute.
What is osmotic pressure?
The pressure needed to prevent osmosis?
What is hydrostatic pressure?
The force of fluid in a compartment pushing against a cell membrane or vessel wall.
What is oncotic pressure?
The osmotic pressure caused by plasma colloids in solution.
What major colloids contribute to oncotic pressure?
Proteins such as albumin.
What is a normal sodium level?
135-145mEq/L
A salty burger at lunch time 1:35-1:45”
What is a normal Potassium level?
3.5-5
“I only really want to buy 3.5-5 bananas at time”
What is a normal Calcium level?
9-10.5mg/dL
“Call 911!” - this worked better with the range being 9-11 but these are Hajari’s
numbers
What is a normal Phosphorus level?
3-4.5mg/dL
What is a normal Chloride level?
95-105mEq/L
“95-105 degrees is perfect swimming pool (chlorine sounds like chloride)
weather”
What is a normal Magnesium level?
1.3-2.1mEq/L
“You should stop drinking after 1.3-2.1 beers” because hypomagnesemia can
occur with excessive drinking
What is a normal BUN level?
10-20
10-20 hamburger BUNS for a party
What is a normal GFR?
90-120
‘If your kidneys work really well you’ll be peeing every 90-120mins”
What is a normal creatinine?
0.6-1.3
A CREATure would only get a 0.6-1.3 at a beauty pageant’
What is a normal specific gravity?
1.005-1.030
I have to do a urine test between 10:05-10:30’
What is fluid spacing?
The term used to describe the distribution of body water.
What does first spacing mean?
Normal distribution of fluid in ICF and ECF compartments.
What does second spacing mean?
Refers to an abnormal accumulation of interstitial fluid.
What does third spacing mean?
Third spacing occurs when excess fluid collects in the nonfunctional area between the cells.
What is hypernatremia?
Serum sodium above 145
Critical red flag above 160
What are causes of hypernatremia?
Inadequate water intake
Excess water loss
or rarely sodium gain
What are manifestations of Hypernatremia?
Restlessness
Lethargy
Seizures
Coma
How do we treat a patient with hypernatremia?
If the cause is water deficit , replace orally or with IV isotonic solutions such as 0.9%NaCl
If the problem is sodium excess, dilute with sodium free IV solutions and promote excretion with diuretics.
What is hyponatremia?
A loss of sodium-containing fluids, water excess in relation to the amount of sodium, or a combination of both.
Serum less than 135
Critical red flag less than 120
What are common causes of hypnatremia?
Diarrhea
Draining wounds
Vomiting
Primary adrenal insufficiency
Can also be caused when giving too many fluids to a patient with kidney disease.
What are manifestations of Hyponatremia?
Headache
Irritability
Difficulty concentrating
More severe is confusion, vomiting, seizures, and coma.
How do we treat hyponatremia?
Sodium containing IV fluids
Lactated ringers
NS 0.9% or 3%
What should we monitor with hyponatremia?
Electrolytes
Vitals
Neuro
Mental status
Headaches
Is&Os
Weights daily
CHF monitor
Musculoskeletal
What should we monitor for with hypernatremia?
Electrolytes
Vitals
Mental status
Weights
Is&Os
Seizure precautions
What is hypokalemia?
Serum potassium less than 3.5mEq/L
Critical red flag less than 2.5
What are causes of hypokalemia?
Inadequate potassium intake
ETOH Abuse
CHF/HTN
GI loss
Renal loss
Diuretics-Loop
Furosemide
Bumex
How do we treat hypokalemia?
Oral or parenteral potassium
Diets high in K+
Balanced electrolyte solutions
Pedialyte
Sports drinks
What are common manifestations of hypokalemia?
Changes in cardiac and muscle function.
What should we monitor with hypokalemia?
Electrolytes
Vital signs - Low BP
Cardiac responses
Heart rhythm
What is hyperkalemia?
Serum potassium greater than 5
Critical red flag greater than 6
What are causes of hyperkalemia?
Renal failure - Most common
Metabolic acidosis
Dehydration
Excess intake of potassium
Potassium sparing diuretics
Tissue damage
How do we treat hyperkalemia?
Insulin - Moves K+ into the cell
D50 - Prevents hyperglycemia caused by insulin
IV calcium gluconate to counteract cardiac effects of potassium
Sodium bicarbonate to treat the acidosis causes when K+ moves into the cell
What are manifestations of Hyperkalemia?
Fatigue
Confusion
Tetany
Muscle cramps
Paresthesia’s
Weakness
What should we monitor for with hyperkalemia?
Think electricity
Electrolytes
Cardiac
Musculoskeletal
Peaked t wave/wide qrs
Neuro
Heart rates and rhythms
How do we administer IV Potassium?
ALWAYS DILUTE and do not give in concentrate amounts.
Never give via IV push or as a bolus
Invert IV bags several times to insure even distribution
Do not add to a hang iv bag
What is hypercalcemia?
Serum calcium greater than 10.6
Critical red flag 12
What are causes of Hypercalcemia?
Prolonged immobilization
Dehydration
Cancer
Excess antacid intake
How do we treat Hypercalcemia?
Eliminate calcium through kidneys via IV fluids
Loop diuretics to promote elimination of calcium
What should we monitor with hypercalcemia?
THINK MUSCLE RESPONSE
Monitor electrolytes
Vitals
Hypertension
GI N&V
Dysrhythmias
What is hypocalcemia?
Serum calcium less than 8.2
Critical red flag less than 7
What are causes of hypocalcemia?
ETOH Abuse
Pancreatitis
Chronic Renal failure
Low vitamin D intake
Lack of weight bearing
Loop diuretics
Hypomagnesemia
How do we treat hypocalcemia?
Oral calcium carbonate/gluconate
Calcium chloride
What should we monitor for with hypocalcemia?
THINK MUSCLE RESPONSE
Electrolytes
Vitals
Cardiac output decrease
Hypotension
Dysrhythmias
Neuro
