HYHO AKI Flashcards
What lab values indicate Acute Kidney Injury?
Increase in serum creatinine of > 0.3mg/dL within 48 hours or within 7 days OR urine output of <0.5mL/kg/hr for >6hrs
Define Cardiorenal Syndrome
A condition in which therapy to relieve congestive symptoms of HF is limited by a decline in renal function as manifested by reduction in GFR
What data is important in diagnosing Cardiorenal Syndrome?
- BUN/Creatinine levels
- Ejection Fraction (on Echocardiogram)
- BNP levels
- CXR
Define anasarca
severe generalized edema that extends from the lower extremity proximally. It can
cause ascites as well as subcutaneous edema; associated with heart failure, cirrhosis, severe
malnutrition and renal failure
The skin on the forehead of a dehydrated patient, when pinched, will remain elevated rather than springing back to its original position. This is known as?
Skin Tenting
What is a positive fluid test, and what does it show.
-Fluid wave detects large volumes of free intrabdominal fluid. It has a specificity of 80-90%; a positive finding rules in ascites.
Where are the Kidney Chapman Points
Anterior: One inch lateral and one inch superior to the umbilicus
Posterior: between the transverse process of T12 and L1
In a 5 Model Approach to treating AKI, what is the Biomechanical aspect of the treatment?
Diagnosing
SD of OA, AA
SD of thoracic spine at viscerosomatic levels (T10-11)
SD of the psoas muscles
In a 5 Model Approach to treating AKI, what is the Respiratory/Circulatory aspect of the treatment?
O2 via mask/nasal canula
Lymphatics:
o Thoracic inlet MFR
o Diaphragms (thoracolumbar, pelvic)
o Thoracic area: pectoral traction, doming the diaphragm, thoracic pump
o Abdominal area: abdominal pump, sacral rocking, pelvic diaphragm
o Extremities: effleurage, petrissage, pedal pump
o Rib raising
In a 5 Model Approach to treating AKI, what is the Neurologic aspect of the treatment?
Kidney o Sympathetics: T10-11 o Parasympathetic – vagus nerve Ureters – upper o Sympathetics: T10-11 o Parasympathetics: vagus nerve Ureters – lower o Sympathetics: T12-L2 o Parasympathetics: pelvic splanchnic nerve Bladder o Sympathetics: T12-L2 o Parasympathetics: pelvic splanchnic nerve o Kidney Chapman Points Rib raising treatment
In a 5 Model Approach to treating AKI, what is the Metabolic/Energetic/Immune aspect of the treatment?
Loop diuretics Fluid restriction Remove offending agents like NSAIDs, PPI Adjust meds based on renal function Monitor I/O’s, weights
In a 5 Model Approach to treating AKI, what is the Behavioral aspect of the treatment?
Exercise
Diet – restrict fluids
Avoid offending agents
Better management of CHF (inciting cause)
Long-term management of AKI consists of?
- Discussion with patient regarding personal wishes regarding Dialysis, as well as other end of life matters such as Living Will and DPAHC
- Avoid nephrotoxic drugs, including OTC preparations such as NSAIDs, PPI, etc
- Regular monitoring of electrolytes, patient weight, fluid status, etc.
List the initial treatment steps for AKI.
- Remove offending agents: NSAIDS, PPI, etc.
- Judicious use of loop diuretics (furosemide)
- Adjust medication dosing based on renal function
- Supportive care: oxygen
- Monitor weight, I’s & O’s
- Fluid restriction
- Monitor electrolytes (Na+
, K
+
, Ca+
, Mg+
, etc.) - Case management/manager
- Dietary consult
Why is a Living Will (LW) or Durable Power of Attorney for Healthcare (DPAHC) important in the care of a patient?
-Living Will: summarizes choices about future medical care; typically addresses resuscitation and life support, but may include other preferences about treatments (feeding tube, dialysis,
intubation/ventilator support).
-Durable Power of Attorney for Healthcare (DPAHC) authorizes another person (or surrogate) to make decisions on the patient’s behalf.
How many stages exist in the KDIGO criteria for Acute Kidney Injury?
3.
-Stage 1 indicates risk of AKI, whereas Stage 3 indicates kidney failure
What criteria are use in KDIGO to differentiate between stages?
Changes in the increase of serum creatinine, change in urine output, and initiation of RRT for Stage 3
