HYHO II - Acute Kidney Injury Flashcards
You have a patient that you suspect has Acute Kidney Injury (AKI) what sort of data would help you to conclude that your diagnosis is correct?
An Increase in Serum Creatinine and BUN
Little Urine output (0.5 mL/kg/hour for more than 6 hours)
You suspect AKI, and want to rule out any obstructions – what would you look for that effectively rules out obstruction?
Hydronephrosis
You have a patient that has been on Lisinopril and Losartan for the past 3 years and has an increase in serum creatinine in the past 72 hours, and has had little to no urine output for more than 8 hours. Upon further evaluation you find that they have BP of 80/50 and you are starting to see some liver failure as well. What sort of problem are you thinking?
What sort of other things are associated with this dz?
Pre-Renal Acute Kidney Injury
Hypovolemia, CHF, NSAIDS, ACEi, ARBs, Cyclosporine
You have a patient that is presenting with an elevated serum creatininne within the past 48 hours, and has little urine output for the past 7 hours. Your patient is noted to have frequent kidney stones, – this makes you worried about what?
Post-Renal AKI
(Bladder outlet obstruction, Obstructions!)
Your attending wants to know some of the major forms of Intrinsic forms of AKI. What are some of the major forms?
Acute Glomerulonephritis
Damage/Ischemia to the Tubules and Intersitium
Vasculitis (ANCA dz’s)
TTP-HUS
Malignant HTN
Associate the following with their potential associated disease process?
Blue Toes
Appearance of a Drug Rash
Volume Contraction
Volume Overload
Jaundice/Ascites
Blue Toes –> Cholesterol Emboli
Drug Rash –> Acute Interstitial Nephritis
Vol Cont –> Dehydration
Vol Overload –> Cardiorenal Synd
Jaundice/Ascites –> Liver Failure/Portal HTN
What are some of the other associated symptoms/signs you need to be worried about in your patient after you have diagnosed them with AKI?
Decreased Urine Output
Worsening Dyspnea/Orthopnea/PND
Ascites/Liver Distention
S3 –> HF
Hypotension
JVD
You are a physician who is trying to detect large amount of free intraabdominal fluid. How would you position the patient to perform the Fluid Wave Exam?
1) Patient puts ulnar surface of their hand over belly button area
2) You than put one hand on flank and tap on the opposite flank
A + sign would be if you feel a moderate to strong fluid wave emanating into the opposite side
For some reason your attending wants you to perform the puddle sign on this patient. . . you denote that you get it. . . he vapes. . . but then proceed to perform it:
1) Patient gets on hands and knees for 5 mins
2) you listen with diaphragm while flicking the flank area (starting low and working up)
A + sign is if you hear a sudden intensity and clarity of a sound. (this is when it has passed the edge of the peritoneal fluid)
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
What specific areas would you need to do an OSE on?
What specific chapman point locations do you need to check?
Kidney – evaluate T10-T11 / Vagus N
Ureters – evaluate T10-L2 / Vagus N & Pelvic Splan
Bladder – evaluate T12-L2 / Pelvic Splan
Kidney – (Ant) 1 inch up and lateral to belly button
(Post) Between TP of T12/L1 on ipsi side
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
What specific things would you want to evaluate if you wanted to take care of the biomechanical approach to the patient?
SD of the OA, AA, T10-11 (kidneys), Psoas Muscles
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
What specific things would you want to evaluate on the respiratory/circulatory method?
Give them O2 via Mask/Nasal Canula
Check LYMPHATICS –> Thoracic Inlet MFR, Diaphragm techniques, Rib Raising, Efflaurage/Petra, Pectoral traction, Thoracic Pump, Abdominal Pump, sacral rocking etc.
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
Next you decide that they deserve your best approach to the neurological component – what are the best techniques?
You are going to work on the Vagus N/Pevlic Splanchnics for Parasymp
and their viscero-somatic levels for Kidney/Ureter/Bladder
Also look at Chapman Points!
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
You want to help him out with the Metabolic/Energetic/Immune component of his healing process - -what is the best way?
Give them Loop Diuretics, Fluid Restriction,
Stop any offending meds (NSAIDS/PPI’s),
adjust their meds now that they have CKD
Monitor Food Intake/Weight
You have a patient that was diagnosed with CKD, and they ask you to help them with some of their symptoms with your magic osteopathic ways. You gladly agree.
What are some behavioral things you can help this patient with?
Excersize, Diet, Avoid Offending agents, help them with inciting cause of this dz
Diane is noted to have an increase in serum creatinine of 125%, with a urine output that has been less than 0.5 mL/kg/hour for 15 hours.
What KDIGO stage is she at?
Stage 2
