Kidneys

Question 1

Kidneys are able to make?

Answer 1

Adjustments to fluid volume
Electrolyte Composition
Acid Base Balance

Question 2

Causes of AKI

Answer 2

Reduced perfusion to kidneys
Damage to kidney tissue
Obstruction of urine flow

Question 3

Phases

Answer 3

1. Onset: Begins w event
2. Oliguria: Kidney insult 100-400 ml
3. Diuresis: When kidneys start to recover
4. Recovery phase: Function is fully resorted

Question 4

Classes

Answer 4

Stage 1: Risk ( creatine is 1.5-1.9 )
Stage 2: Injury ( creatine is 2.0-2.9 )
Stage 3: Failure ( creatine is 3 times baseline )

Question 5

Renal Failure

Answer 5

Kidneys unable to remove metabolites from blood
Prerenal ARF: most common ( perfusion ) , hemmorage, dehydration
Intrinsic: Damage to kidney tissue, toxins, drugs, infection, reduced blood supply
Postrenal: Obstuction to renal flow

Question 6

Renal Failure assessment

Answer 6

CV: Hypertension, fluid overload, dysrhyhmia
Resp: Crackles, decreased oxygen
Neuro: Lethargy, twitching

Question 7

Labs for renal disease

Answer 7

Increased creatine
Increased BUN
Electrolyte imbalances
HCT: decreased

Question 8

Interventions

Answer 8

Avoid nephrotoxic meds
Restrict fluids
EKG
Daily weights
Diet
Meds: Diuretics, electrolyte balancing

Question 9

CKD patients are at risk for…

Answer 9

Fluid overload and hyperkalemia.
- Clients should avoid salt substitutes.

Question 10

Stages of CKD

Answer 10

1: Screening, monitoring > 90 ml/min
2: Reduce risk factors ( 60-89 ml/min )
3: Utilize strategies ( 30-59 ml/min )
4: Manage complications, discuss options ( 15-29 ml/min )
5: Possible transplant <15 ml/min
ESRD: 90% of nephrons destroyed

Question 11

System changes

Answer 11

Cardiac: Fluid overload, hypertension, heart failure
Resp: Frothy pink sputum, crackles, SOB, tachy
Hemat: Anemia
GI: Ulcers, vomitting
Skin: Uremia, jaundice

Question 12

Diagnostics

Answer 12

Urine: hematuria
Blood creatine: increased gradually
BUN: gradually increased
Electrolytes: Decreased sodium, calcium and increased potassium
CBC: decreased hg and hct for anemia

Question 13

Treatment and Interventions

Answer 13

Daily weight, VS, Urinary elimination
Restrict protien
Restrict sodium, pot, phos, mag
Increased fiber ( carb )
Restrict intake of fluids

Meds: Avoid aminoglycosides, and amphotericin b, diltiazem ( CCB ) nsaids, and IV contrast dye
Epoetin alfa- stimulates RBC
Calcium carbonate = binds phosphate in food