Kidney diseases Flashcards
what are the functions of the kidneys
- regulates water balance
- electrolyte regulation
- regulated acid-base
- removes waste
- produced hormones
BUN
bi-product of preotein metabolism
creatinine
by product of muscle metabolism
GFR
rate at which blood passes through the glomeruli
anuria
no urine output or less than 100ml in 24 hours
oliguria
less than 400 ml of urine in 24 hours
poluria
more than 2.5L of urine in 24 hours
pathophys for acute kindey injury
abrupt decline in kindey fcxn.
can be reversed if treated fast enough
what does the RIFLE classification look at
- urine output
- GFR
- creatinine
what are the main complications when kidneys begin to fail
- fluid volume excess
- hyperkalemia
- hematological disorders
- neuro disorders
- metabolic acidosis
- hyponatremia
- decrease calcium and increase phosphate
- waste products accumulate
oliguric phase of kidney injury
- BUN and creatinine rise while GFR fals
- main concerns are fluid overload, electrolyte imbalances and acidosis (H+ accumulation)
diuretic phase
- damaged tubules are recovering their functions
- excessive urination, hypovolemia and hypotension
- GFR increases and BUN and creatinine begin to normalize
recovery phase of AKI
- normalisation of fluid and electrolyte imbalances
- GFR becomes normal to near normal
prerenal causes of AKI
- decreased renal blood flow such as renal hypoperfusion whihc causes them to become ischemic
- no structural damage occurs unless untreated
intra-renal causes of AKI
- structural damage to the glumeruli or tubules
- recvoery is less likely and prolonged
post-renal causes of AKI
- mechanical obstruction of urine flow
what are the multiple causes of ATN
- decreased blood flow
- injury or trauma to muscles
- low blood pressure lasting longer than 30 minutes
- recent major surgery
- septic shock
- liver and kidney disease casued by diabetes
- medications that are toxic to th kidneys (aminoglycosides, antibitoics and antifungals)
Most important clinical monitoring for AKI
- MAP at least 70 mmhg or larger
- urine output with a fluctuation of normal 5% or less
what is the focused assessment for patient coming in with kindey injury
- nausea and vomiting
- FATIGUE OR LETHARGY
- neuro changes
- urine output or changes
- ## medications or recent infections
^physical assessment for kidney injury
- vitals, ins and outs, bruises
- edema, JVD
- crackles wheezing or breath sounds
- heart murmursor rubs
what are labs and test that should be run for kidney injury
- urineanalysis
- bloods
- renal ultrasounds
- kidney scan
- CT - caution for contrast since kidney might have trouble excreting it
how would you treat FVD with AKI
- 1-3L of crystalloids
how do you treat FVE with AKI
- IV lasix
what is the management for acute hyperkalemia with AKI
- calcium gluconate
- IV glucose
- insulin
- B2 adrenergic agonist
Nursing intervention for AKI
- monitor vitals
- perform ECG
- resp and cardio assessment
- neuro assessment
- assess edema and weight gain
- insert catheter for better urine monitring if no risk for infection
- monitor ins and outs, and characteristics of urine
Nutritional management for AKI
- increase fats and carbs to prevent glucogenesis
- limits fluids, protein, sodium, potassium, phosphate
- increase fresh frits and veggies
- dietician
what urine characteristics do you want to monitor
- urine volume, colour and odour
- protein in the urine
- urine specific gravity
what types of meds will be given for AKI and why
- IV fluids - FVD
- Duiretics - to flush kidneys of debris and FVE
- CCBs - to help influx of calcium in kidneys cells to maintain cell integrity
- antihypertensives - increase renal blood flow
kayexalte - reduce levels fo potassium
when in RRT indicated
- svere hyperkalemia
- volume overload that comprimises cardiac or resp. function
- acute poisoning
- life-thretaneing uremic symptoms
- svere metabolic acidosis
- changes in mental status
risk factors for chronic kidney disease
- diabetes
- HTN
- family hisotry
- heart problems
- chronic use of NSAIDs
- obesity
- urinary system issues
uremia
syndrome that incorporates all signs and symptoms seen in various systems throughout the body
GFR of 10mlémin orless
what are the metabolic distubrance with CKD
- impaired glucose use
- hyperinsulinemia cuasing elevated triglycerides
- altered lipid metabolism
mineral bone disorder
- systemic disorder of mineral and bone metabolism
- skeletal complications and extra-skeletal calcifications
non-pharmacological treatment for MBD
- phosphate restriction (limit dairy intake)
pharmacological treatment for MBD
- phophate binders
- calcium caronate
- supplementation with activated vitamin D
what nutritiona therapy should be implemented for CKD
- protein restriction
- water intake urine output + 600ml
- potassium restriction of 2-4g
- sodium restriction 2-4g
what are the main priority problems for CKD
- excess fluid volume
- risk for electrolyte imbalance
- imbalanced nutrition
- imapired skin intergrity
- activity intolerance
what is the nursing management of stage 4-5 CKD
- daily weights and BP
- signs and symptoms of fluid overload , hyperkalemia and electrolyte imbalances
- strict diet adherence
- medication education
main goals of CKD
- maintenance of ideal body weight
- acceptance of chronic disease
- no infection
- no edema
- CBc is good ranges
- electrolyte in good ranges
what are the main goals of pre-dialysis
- delayed the progression of CKD
- manage complications and co-morbidities
- social issues
- prepare client for dialysis
what are the characteristics of PD catheter
- small plastic tube inserted into peritoneal cavity
- could be straight or coiled
what are the criteria for PD
- poor vascualr acess
- complicated CVD
- HTN
- younger patients
- 1st line treatment for patient with ignificant co-morbidities
advantages of PD
- more gentle of the body
- flexible schedule
- diet is more liberal
- no blood wasted
- no needle
- can be done at home
what are the complications associated with PD
- peritonitis
- lowerback pain
- atelectasis
- nutritional deficits - protein loss
nursing management for PD
- monitor BP, weight and temperature
- cleaning the site daily
- measure and observe drainage
- visit clinical 4-6 weeks
- patient teaching
what will a HD prescription include
- type of dialysis
- dialysate fluids
- dialyzer
- fluid removal
- anticoagulation
measures to take with fistula for HD
- patient education
- no heavy lifting, BP or blood work
- feel for thrill and listen for bruti with stethescope
- remove bandage the next day
- no tape around the arm
post-dialysis care
- weight
vital signs - inspect acess site
fatigue so bed rest
no blood work for 4 hours post
what are complications psot HD
- hypotension
- muscle cramping
- blood loss
- sepsis
