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PCM 3 Exam 1 > [HYHO] HPS Session 2 AKI > Flashcards

[HYHO] HPS Session 2 AKI Flashcards

1
Q

What is the definition of acute kidney injury?

A

Increase in serum creatinine of greater than or equal to 0.3mg/dL within 48 hours

OR

Urine output of <0.5mL/kg/hour for >6 hours

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2
Q

What is cardiorenal syndrome?

A

A condition which therapy to relieve congestive symptoms of HF is LIMITED by a decline in renal funciton

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3
Q

How is GFR calculated?

A

Using creatinine

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4
Q

What is an issue with using creatinine to measure GFR?

A

Can UNDERESTIMATE the degree of dysfunction

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5
Q

What are the 3 potential causes for AKI?

A

Prerenal

Intrinsic

Postrenal

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6
Q

What are the potential causes of prerenal AKI?

A

Hypovolemia

Decreased cardiac output

Decreased effetive circulating volume

Impaired renal autoregulation

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7
Q

What are the causes of intrinsic AKI?

A

Glomerular

Tubules/Interstitum

Vascular

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8
Q

What are the causes of postrenal AKI?

A

OBSTRUCTION

(e.g. bladder outlet obstruction, pelvourethral obstruction)

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9
Q

What is key to determining the source of an AKI?

A

Careful history taking

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10
Q

What is a common example of an event in the hx. of a patient that can present with AKI?

A

Exposure to IV contrast

Typically increases serum creatinine (25-50%) after administration

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11
Q

Describe what the symptom correlates with:

Blue toes

A

Possible cholesterol emboli

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12
Q

Describe what the symptom correlates with:

Appearance of ‘drug rash’

A

Acute Interstitial Nephritis (AIN)

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13
Q

Describe what the symptom correlates with:

Signs of volume contraction (tachycardia, skin tenting, dry oral mucosa, etc…)

A

Dehydration

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14
Q

Describe what the symptom correlates with:

Jaundice and ascites

A

Liver disease with portal hypertension

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15
Q

What are the symptoms/signs associated with AKI?

A

Decreased urine output

Worsening dyspea

Orthopnea

Paroxysmal nocturnal dyspnea

Worsening edema

S3 gallop

Hypotension

JVD

Liver distention

Distended abdomen (fluid wave)

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16
Q

Where is skin testing best evaluated?

A

Skin of the forehead

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17
Q

What is paroxysmal nocturnal dyspnea (PND)?

A

Episodes of sudden dyspnea and orthopnea that awaken patient from sleep,

prompting patient to sit up or stand up

18
Q

What is anasarca?

A

Severe generalized edema that extrends from the lower extremity proximally

19
Q

What is a fluid wave?

A

Detects large volumes of free abdominal fluid

20
Q

How would you perform a fluid wave exam?

A
  1. Patient places ulnar surface of their hand along the abdominal vertical midline
  2. Physician places one hands on one flank and taps gently on the opposite flank
  3. ( + ) sign = physician feels a fluid wave emanating into the contralateral side
21
Q

What is puddle sign?

A

Lower sensitivity than fluid wave detection, also…it’s really awkward.

Literally. Look at the image. You make your patient assume the position.

This is an auscultatory percussion sign, pt. holds this position on their hands and knees for 5 min. The physician then listens with stethescope while flicking a finger over a localized flank area of the abdomen.

(+) sign= increase in intensity and clarity of sound

22
Q

Osteopathic structural exam (OSE)

Levels: Kidney

Sympathetic?

Parasympathetic?

A

Sympathetic = T10-T11

Parasympathetic = Vagus nerve

23
Q

Osteopathic structural exam (OSE)

Levels: Upper ureters

Sympathetic?

Parasympathetic?

A

Sympathetic = T10-11

Parasympathetic = Vagus nerve

24
Q

Osteopathic structural exam (OSE)

Levels: Lower ureters

Sympathetic?

Parasympathetic?

A

Sympathetic = T12-L2

Parasympathetics= Pelvic splanchnic nerve

25
Q

Osteopathic structural exam (OSE)

Levels: Bladder

Sympathetic?

Parasympathetic?

A

Sympathetic = T12 - L2

Parasympathetics = Pelvic splanchnic nerve

26
Q

Where are the (dare I say) chapman points for the kidney?

Anterior/posterior?

A

Anterior = One inch lateral and one inch superior to the umbilicus

Posterior = Between the transverse process of T12 and L1

27
Q

5 model approach

What are the considerations you would make for AKI with…

Biomechanical?

A

SD of OA, AA

SD of thoracic spine at viscerosomatic levels (T10-11)

SD of the psoas muscles

28
Q

5 model approach

What are the considerations you would make for AKI with…

Respiratory/Circulatory

A

O2 via mask/nasal canula

Lymphatics:

(Thoracic inlet MFR, diaphragms, Thoracic area [pectoral traction, doming the diaphragm, thoracic pump], Abdominal area [abdominal pump, sacral rocking, pelvic diaphragm], Extremities [effleurage, petrissage, pedal pump], Rib raising)

29
Q

5 model approach

What are the considerations you would make for AKI with…

Neurologic?

A

Consider the sympathetics and parasympathetics of:

–> Kidneys, ureters (upper and lower), bladder

–> Chapman points

–> Rib raising treatment

30
Q

5 model approach

What are the considerations you would make for AKI with…

Metabolic/Erergetic/Immune?

A

Loop diuretics

Fluid restriction

Remove offending agents (NSAIDS, PPI)

Adjust meds based on renal function

Monitor I/O’s, weights

31
Q

5 model approach

What are the considerations you would make for AKI with…

Behavioral?

A

Exercise

Diet — restrict fluids, decrease salt intake

Avoid offending agents

Better management of CHF

32
Q

What are the (4) mechanisms to account for AKI in conjunction with AHF?

A

Neurohormonal adaptations

Reduced renal perfusion

Increased renal venous pressure

Associations with heart failure with preserved ejection fraction (HFpEF)

33
Q

What are the (9) possible treatment options for AKI?

A
  1. Remove offending agents (NSAIDS, PPI, etc)
  2. Loop diuretics
  3. Adjust medications
  4. Supportive care = oxygen
  5. Monitor weight
  6. Fluid restriction
  7. Monitor electrolytes
  8. Case management/manager
  9. Dietary consult
34
Q

What is the MAJOR drug used in the treatment of AKI?

A

Loop diuretics

(furosemide)

35
Q

What type of diuretics should be avoided in treating AKI?

A

K+ sparing diuretics

(they will complicate K+ management)

36
Q

What is a living will?

A

Summarizes choices about future medical care

(typically addresses resuscitation and life support)

37
Q

What is a durable power of attorney for healthcare (DPAHC)?

A

Authorizes another person (or surrogate) to make decisions on the patient’s behalf

38
Q

If a patient has elected some restriction in their living will (do not resuscitate, do not intubate, etc), the physican MUST???

A

DOCUMENT the order appropriately.

The presence of the living wil alone will NOT prevent resuscitation

39
Q

What is the KDIGO criteria?

A

KDIGO = Kidney Disease Improving Global Outcomes

It is a set of criteria used to “stage” the level of kidney disease

40
Q

What is STAGE 1 of KDIGO?

A

Increase in serum creatinine of greater than or equal to 0.3mg/dL / 50 to 99% increase

OR

Urine output of <0.5 mL/kg/hour for 6 to 12 hours

41
Q

What is STAGE 2 of KDIGO?

A

Increase in serum creatinine of 100 to 199% of normal

OR

Urine output of <0.5 mL/kg/hour for 12 to 24 hours

42
Q

What is STAGE 3 of KDIGO?

A

Increase in serum creatinine of >220% of normal

OR

Urine output of <0.3 mL/kg/hour for more than 24 hours

OR

Anuria for greater than 12 hours

OR

Initiation of renal replacement therapy

PCM 3 Exam 1 (13 decks)

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