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Med/Serg > Kidney Disease 1 > Flashcards

Kidney Disease 1 Flashcards

1
Q

What is AKI?

A

abrupt loss of kidney function

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2
Q

What is CKD?

A

gradual loss of kidney function

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3
Q

What is kidney disease?

A

partial or complete loss of the kidney

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4
Q

What does kidney disease result in?

A
  • impaired ability to excrete metabolic waste products and water
  • functional disturbances of all body systems
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5
Q

Characteristics of AKI?

A
  • quick onset
  • caused by acute tubular necrosis
  • Acute ↓ in urine output and/or ↑ in serum creatinine
  • possibly reversible
  • 50-60% mortality rate
  • infection is primary cause of infection
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6
Q

Causes of AKI with renal failure?

A
  • pre-renal causes: hemorrhage
  • intra-renal cause: acute tubular necrosis
  • post-renal cause: cancer BPH (functions which occur outside of the kidney)
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7
Q

Prerenal causes of AKI?

A
  • characterized by a marked decrease in renal blood flow (vasodilation, CHF, obstruction/narrowing )
  • reversible if the cause of the decreased renal blood flow can be identified and corrected before renal damage occurs
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8
Q

Intrarenal causes of AKI?

A
  • account for 25-40% of all cases of AKI with renal failure
  • characterized by damage to the structures within the kidney and impaired nephron function
  • usually the result of prolonged ischemia or the presence of substances that are toxic to kidney tissue
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9
Q

Postrenal causes of AKI?

A
  • result from obstruction of urine outflow from the kidneys
  • obstruction can occur at ant level of the urinary system
  • obstruction must be bilateral to produce renal failure
  • prostatic hyperplasia is the most common underlying problem
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10
Q

Characteristics of Renal Failure?

A
  • Systemic disease
  • Final common pathway of many different kidney and urinary tract diseases
  • Fluid and Electrolyte imbalances
  • Metabolic derangements
  • Acid-base disturbances
  • Azotemia (buildup of nitrogenous waste products)
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11
Q

Phases of Acute Tubular Necrosis?

A
  • initiation
  • maintenance
  • recovery phase
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12
Q

Initiation phase characterized by?

A
  • ↑’ed serum creatinine
  • ↑’ed serum blood urea nitrogen
  • ↓’ed urine output

min 400cc of urine/day required to eliminate waste
under 400cc/day is called oliguria

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13
Q

Maintenance phase manifestations?

A
  1. Changes in urinary output
  2. Fluid and electrolyte abnormalities
  3. Uremia (high blood-urea nitrogen)
  4. Other derangements
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14
Q

Urinary changes?

A

Oliguria: less than 400 ml of urine in 24hrs

  • urine has a normal specific gravity
  • urine has a low osmolarity
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15
Q

Fluid Abnormalities ?

A

-fluid volume excess

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16
Q

Electrolyte imbalances?

A
  • sodium depletion (hyponatremia)
    • potassium excess (hyperkalemia)
    • calcium deficit (absorption of calcium is poor due to non-functioning kidney)
    • phosphate excess
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17
Q

Fluid volume excess symptoms?

A
  • JVD
  • peripheral edema
  • crackles
  • LOC changes in result of uremia
  • increased BP
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18
Q

Electrolyte imbalance symptoms?

A
  • changes in cardiac rhythm
  • muscle cramps which could lead to weakness and paralysis
  • decreased BP
  • dysrmythmias
19
Q

What is uraemia and its S&S?

A
  • “Urine in the blood”
  • Develops as the kidneys fail and are unable to remove nitrogenous wastes from the body.
  • Elevated BUN and serum creatinine
  • Elevated serum creatinine a better indicator of kidney failure

*uremia affects platelet adhesiveness which leads to increased bleeding

20
Q

Other derangements of kidney disease?

A
  • hematological disorders

- acid/base balance disruptions (metabolic acidosis)

21
Q

S&S of acute renal failure?

A
  • Decreased urine output
  • Manifestations of
  • Fluid and electrolyte abnormalities
  • Uremia
  • Metabolic derangements
22
Q

Central nervous system manifestations (attributed to the uremia)?

A
  • headache
  • drowsiness
  • irritability
  • confusion
  • preipheral neuropathy
  • seizures
  • coma
23
Q

Gastrointestinal manifestations?

A
  • anorexia
  • nausea & vomiting
  • diarrhea or constipation
  • dry mucous membranes
  • uremic breath
  • hematemesis
  • GI bleeding (hematologic)
24
Q

Cardiovascular manifestations?

A

-hypotension (early on)
-hypertension (later on)
-arrhythmia’s
-fluid overload
-heart failure s&s (R side failure: edema, ascites, hepatomegaly) (L side failure: pulmonary edema, crackles, SOB)
-increased RR
-decreases LOC
-systemic edema
-anemia (hematologic)
altered clotting

25
Q

respiratory manifestations?

A
  • pulmonary edema

- kussmaul’s respirations

26
Q

integumentary manifestations?

A
  • dry skinn
  • pruritis
  • pallor
  • purpura

might last weeks or days

27
Q

Recovery phase characterized by the return to normal of?

A
  • Blood urea nitrogen
  • Serum creatinine
  • GFR
28
Q

Manifestations of recovery phase?

A
  • Diuresis (3-5 liters/day or more)
  • Hypotension
  • Hypovolemia
  • Hyponatremia
  • hypokalcemia
29
Q

Diagnostic tests?

A
  • History and physical (determine the cause of kidney failure)
  • Urine analysis
  • Blood (Creatinine and BUN, serum electrolytes)
  • Renal ultrasound
  • Renal scan (can see blood flow, integrity of filtration system)
30
Q

Complications include?

A
  • Death 50 - 60% (with renal failure)
  • Sepsis infection (leading cause of mortality)
  • Hypertension exacerbated by fluid overload: Use antihypertensive that do not decrease renal blood flow).
  • Anemia is common, caused by increased red blood cell (RBC) loss and decreased RBC production.
  • Platelet dysfunction may occur secondary to the uremia and present as gastrointestinal (GI) bleeding.
31
Q

Collaborative therapy?

A

-Restore Chemical balance and prevent complications

  • treatment of the cause
  • management of fluids (fluid restriction)
  • nutritional therapy
  • management of elevated potassium
  • calcium supplements
  • renal replacement therapy
32
Q

Management of fluids?

A

Fluid loss in previous 24 hrs + 600mls

-number would equal pt fluid restriction for that day

33
Q

Nutritional Therapy; Adequate calories?

A

Prevent catabolism

less protein and more fat + carbs

34
Q

Nutritional Therapy; restrictions?

A
  • prevent azotemia
  • Prevent electrolyte disturbances
  • Prevent fluid overload
35
Q

Vitamins, Minerals, Electrolytes?

A

-Limit sodium and Potassium

Monitor for:

  • High phosphorus
  • High magnesium
  • Low calcium (Consider Vitamin D intake)
36
Q

Indications for Renal Replacement Therapy?

A
  • Volume overload resulting in compromised cardiac or respiratory status or both
  • Hyperkalemia
  • Metabolic acidosis
  • Uremia
  • Alterations in mental status
37
Q

Renal Replacement Therapy- dialysis?

Three Treatment Options in AKI

A
  • hemodialysis
  • peritoneal dialysis
  • continuous renal replacement therapy
38
Q

Dialysis?

A

Movement of fluid and molecules across a membrane from one compartment to another.

39
Q

Hemodialysis?

A
  • A method of removing waste products and excess fluid from the blood using a machine to pump the blood through an artificial semipermeable membrane.
  • filters blood and eliminates water

3-4 times a week
Takes 2-4 hours
Machine filters blood and returns it to body

40
Q

Types of Access for Hemodialysis?

A
  • Temporary site (often for aki)

- AV fistula or AV Fistula if condition is chronic and will require long term dialysis

41
Q

Peritoneal Dialysis?

A

A catheter is used to fill the abdominal cavity with a dialysis solution that absorbs waste and excess fluids.

42
Q

Continuous Renal Replacement Therapy?

A
  • Renal replacement therapy applied for 24 hours/day.

- Uses various blood purification techniques

43
Q

Nursing Management?

A
  • Monitoring fluid and electrolyte imbalances
  • Reducing metabolic rate
  • Promoting pulmonary function
  • Preventing infection
  • Providing skin care
  • Providing support

Med/Serg (10 decks)

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