Kidney Disease 1 Flashcards
What is AKI?
abrupt loss of kidney function
What is CKD?
gradual loss of kidney function
What is kidney disease?
partial or complete loss of the kidney
What does kidney disease result in?
- impaired ability to excrete metabolic waste products and water
- functional disturbances of all body systems
Characteristics of AKI?
- 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
Causes of AKI with renal failure?
- pre-renal causes: hemorrhage
- intra-renal cause: acute tubular necrosis
- post-renal cause: cancer BPH (functions which occur outside of the kidney)
Prerenal causes of AKI?
- 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
Intrarenal causes of AKI?
- 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
Postrenal causes of AKI?
- 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
Characteristics of Renal Failure?
- 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)
Phases of Acute Tubular Necrosis?
- initiation
- maintenance
- recovery phase
Initiation phase characterized by?
- ↑’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
Maintenance phase manifestations?
- Changes in urinary output
- Fluid and electrolyte abnormalities
- Uremia (high blood-urea nitrogen)
- Other derangements
Urinary changes?
Oliguria: less than 400 ml of urine in 24hrs
- urine has a normal specific gravity
- urine has a low osmolarity
Fluid Abnormalities ?
-fluid volume excess
Electrolyte imbalances?
- sodium depletion (hyponatremia)
- potassium excess (hyperkalemia)
- calcium deficit (absorption of calcium is poor due to non-functioning kidney)
- phosphate excess
Fluid volume excess symptoms?
- JVD
- peripheral edema
- crackles
- LOC changes in result of uremia
- increased BP
Electrolyte imbalance symptoms?
- changes in cardiac rhythm
- muscle cramps which could lead to weakness and paralysis
- decreased BP
- dysrmythmias
What is uraemia and its S&S?
- “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
Other derangements of kidney disease?
- hematological disorders
- acid/base balance disruptions (metabolic acidosis)
S&S of acute renal failure?
- Decreased urine output
- Manifestations of
- Fluid and electrolyte abnormalities
- Uremia
- Metabolic derangements
Central nervous system manifestations (attributed to the uremia)?
- headache
- drowsiness
- irritability
- confusion
- preipheral neuropathy
- seizures
- coma
Gastrointestinal manifestations?
- anorexia
- nausea & vomiting
- diarrhea or constipation
- dry mucous membranes
- uremic breath
- hematemesis
- GI bleeding (hematologic)
Cardiovascular manifestations?
-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
respiratory manifestations?
- pulmonary edema
- kussmaul’s respirations
integumentary manifestations?
- dry skinn
- pruritis
- pallor
- purpura
might last weeks or days
Recovery phase characterized by the return to normal of?
- Blood urea nitrogen
- Serum creatinine
- GFR
Manifestations of recovery phase?
- Diuresis (3-5 liters/day or more)
- Hypotension
- Hypovolemia
- Hyponatremia
- hypokalcemia
Diagnostic tests?
- 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)
Complications include?
- 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.
Collaborative therapy?
-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
Management of fluids?
Fluid loss in previous 24 hrs + 600mls
-number would equal pt fluid restriction for that day
Nutritional Therapy; Adequate calories?
Prevent catabolism
less protein and more fat + carbs
Nutritional Therapy; restrictions?
- prevent azotemia
- Prevent electrolyte disturbances
- Prevent fluid overload
Vitamins, Minerals, Electrolytes?
-Limit sodium and Potassium
Monitor for:
- High phosphorus
- High magnesium
- Low calcium (Consider Vitamin D intake)
Indications for Renal Replacement Therapy?
- Volume overload resulting in compromised cardiac or respiratory status or both
- Hyperkalemia
- Metabolic acidosis
- Uremia
- Alterations in mental status
Renal Replacement Therapy- dialysis?
Three Treatment Options in AKI
- hemodialysis
- peritoneal dialysis
- continuous renal replacement therapy
Dialysis?
Movement of fluid and molecules across a membrane from one compartment to another.
Hemodialysis?
- 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
Types of Access for Hemodialysis?
- Temporary site (often for aki)
- AV fistula or AV Fistula if condition is chronic and will require long term dialysis
Peritoneal Dialysis?
A catheter is used to fill the abdominal cavity with a dialysis solution that absorbs waste and excess fluids.
Continuous Renal Replacement Therapy?
- Renal replacement therapy applied for 24 hours/day.
- Uses various blood purification techniques
Nursing Management?
- Monitoring fluid and electrolyte imbalances
- Reducing metabolic rate
- Promoting pulmonary function
- Preventing infection
- Providing skin care
- Providing support
