Kidney/Pudenda - Unit 4 - AKI and CDK Flashcards
What is acute renal failure?
Abrupt loss of kidney function
Acute Renal Failure - not reversible. T/F?
False - it is if you have prompt medical intervention.
What is azotemia?
the accumulation of nitrogen and waste products in blood.
What is uremia?
Azotemia WITH symptoms.
What is the mortality rate for acute renal failure?
50-80%
What is the Pre-Renal cause of AKI?
Perfusion to kidney’s is decreased (map
What is the intra-renal cause of AKI?
damage to kidney itself, like acute tubular necrosis (nephrotoxic chemicals, meds, etc), infections (cytomeglovirus), diseases that precipitate vascular changes
What is the post-renal cause of AKI?
Obstruction of urinary collecting system - urethral stricture, BPH, bladder cancer, ureteral obstruction, abdominal tumor, etc.
What are the most common causes of AKI?
Medication, hypovolemia, hypotension
What are some nursing things to watch for with AKI?
Watch for low U/O
What are the 4 phases of AKI?
Onset, oliguric, diuretic, recovery
What happens during “onset” ?
Insult - may occur hours or days before oliguria
What happens during the “oliguric” phase?
May lass 7-14 days,
What happens during the diuretic phase?
Urinary output greater than 500CC/24 hours. Tubule system unable to concentrate urine, hypovolemia and hypotension, BUN stops increasing, watch for hypovolemia and hyponatremia
What happens during the recovery phase?
Continues until renal function is fully restored, although some permanent loss of possible.
What are some symptoms of AKI?
sudden or decrease in urine output, low BP, tachycardia, pulmonary edema, kussmaul respirations, anemia, leukocytosis, altered platelet function, decrease in LOC, fluid retention, hyperkalemia, hyponatremia, metabolic acidosis
Should we worry about decreasing the potassium level for AKI?
YES
Is sodium bicarb the antidote for K+?
Bicarb brings it back out to the cell.
What are some dietary things for AKI?
Fluid restriction, intake of protein, potassium and sodium is regulated according to blood work, increase intake of carbs.
When is dialysis indicated?
Volume overload, BUN >120, metabolic acidosis, increased potassium w/EKG changes, pericardial effusion, cardiac tamponade
What are some nursing considerations for patients with AKI?
Daily weight, VS, daily lab, fluid balance, fluid restriction, restrict protein, K+, sodium, fluid, encourage carbs and fats, prevent infection, prevent skin breakdown, emotional support
What is Chronic Kidney Disease?
Progressive irreversible destruction of kidney tissue.
How much damage can the kidney’s handle?
75-80%
ESRD (End-stage-renal-disease) more common in what nationalities?
African Americans, Native Americans and Asian Americans
What is the relationship between chronic kidney disease and diabetes?
The vascular damage of DM causes the problems in CKD
What are some risk factors for CKD?
Acute renal failure, poorly controlled diabeetus, chronic glomerularnephritis, chronic HTN, lupus, polycystic kidney disease, etc.
What happens in stage 1 of CKD?
Minimal kidney damage with normal GFR (greater than 90 mL/Min)
What happens in stage 2 of CKD?
Mild kidney damage with mildly decreased GFR (60-90 mL/min)
What happens in stage 3 of CKD?
Moderate kidney damage with moderate decrease in GFR (30-60 mL/min) - decreases renal reserve and 50% of nephrons lost - SYMPTOMS can start here.
Stage 1-3 of CKD - do diuretics work?
Yes
Stage 4 CDK - what happens?
severe kidney damage with severe decrease in GFR (15-30 ml/min) - renal insufficiency and 75-80% of nephrons lost.
What happens in stage 5 CKD?
Kidney failure with little or no GFR taking place (less than 15 ml/min) - ESRD - 90-100% nephrons lost.
what are some clinical manifestations of CKD?
GFR
Is hyperkalemia a problem with CKD?
YES - give Ca carbonate to protect the heart!
What are some meds given for patients with renal failure?
Antihypertensives, iron supplements and folic acid, kayexalate (gets rid of K+), erythropoietin alfa (for Hct’s less than 30), alkalizers, vitamin d supplements, stool softeners, diuretics
What are the 4 goals of dialysis?
remove end products and waste, control potassium, remove excess fluid, correct acid/base balance
What is hemodialysis?
It’s when you’re hooked up and your blood is filtered. 200-500 ml/hr. 3 x a week for 2-3hours.
What’s a fistula for dialysis? what must you feel/hear?
It’s when they take a vein/artery and combine them. Takes about 6 weeks to mature. NEED TO HEAR A BRUIT AND FEEL A THRILL!
What’s a graft?
Dacron shunt placed in arm, leg, or chest.
What’s a temporary quinton catheter?
Catheter for dialysis used for the short term. Stick in an artery..
What is a perm cath?
More permanent - 2-4 weeks but can go longer.
What should we do before dialysis?
Bun, Creat, BP, hold h20 soluble meds, vitals, weight
What do we do during dialysis?
LOC, vitals, monitor fistula, headache (from pulling fluid too fast)
What are some nursing considerations after dialysis?
LOC, BP, warm patient, they may be tired, could be cold from vasoconstriction, weight (how much came off)
What are some complications of hemodialysis?
Clotting/infection of access site, anemia, hypotension, disequilibrium syndrome, sepsis
What is disequilibrium syndrome?
Caused by rapid exchange of F/E, our blood becomes hypoosmotic - too much fluid in blood so it leaks into CSF causing cerebral edema. N/V, confusion, headache, restlessness, seizures, etc - STOP DIALYSIS, infuse hypertonic solution!
What is peritoneal dialysis?
Began in the 20’s - uses peritoneum.
What is the procedure for peritoneal dialysis?
- Infuse peritoneum for 30min-2hours.
- Dwell (leave it for 30-min-2hours)
- Place bag on floor and let it all drain out.
What are indications for peritoneal dialysis?
Treatment for older clients, those who can’t handle the anticoagulation need for hemodialysis, clients with poor blood vessels, those with infections, etc.
What are some contraindications for peritoneal dialysis?
H/O multiple abdominal surgeries, etc, recurrent hernia’s, obesity, chronic back pain, severe COPD, cognitive problems, etc.
If no fluid comes out for peritoneal dialysis, what do we do?
Move the patient, take a laxative, etc.
What should we do pre-peritoneal dialysis?
Weight, edema, ten-cough catheter, vitals, heart sounds, LOC, Bun/Creat, heating pad, etc.
What do we do during peritoneal dialysis?
Watch LOC, vitals, drainage (white/yellow/clear = normal, cloudy = infection)
Protein is lost during peritoneal dialysis, so patients should have more protein. T/F?
TRUE
what are the two peritoneal dialysis systems?
CAPD (continuous ambulatory peritoneal dialysis - throughout the day, the patient does it)
CCPD (continuous cyclic, the patient hooks up to a machine at night)
What are some complications of peritoneal dialysis?
Peritonitis, protein loss, flow problems, respiratory distress, access site infections, hyperglycemia, hyperlipidemia, pain
What are some complications for renal failure?
Hyperkalemia, HTN, seizures, cardiac dysrhythmias, pulmonary edema, infection, acidosis (metabolic), uremia
Where do osmotic diuretics (mannitol) work?
Proximal tubule
Where do loop diuretics (lasix, bumex) work?
Loop of henle
Where do HCTZ/Zaroxolyn (Thiazide diuretics) work?
Distal tubule
Where do K sparing diuretics (Aldactone) work?
someplace awesome. ha!
If a client feels sick, with like the flu, should dialysis be held?
NO
Where is a transplanted kidney place?
Near the hip - it’s more protected and easier to transplant here.
Kidney donor - it’s okay if they’ve been dead for a while and have a major infection. T/F?
FALSE - soon after death and they can’t have an active infection.
After kidney transplant, it’s okay that the urine is pink - T/F?
TRUE
Why is a patient on a stool softener following a kidney transplant?
They have to go through the bowel to get to the kidney.
