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168.362 > Kidneys - DKA, HHNS, AKI > Flashcards

Kidneys - DKA, HHNS, AKI Flashcards

1
Q

What is DKA?

A
  • Absence of insulin

- Leads to disorders of metabolism of carbohydrates, proteins and fat

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2
Q

What are the three clinical features of DKA?

A
  • Hyperglycaemia
  • Dehydration and electrolyte loss
  • Acidosis
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3
Q

What does DKA stand for?

A
  • Diabetic ketoacidosis
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4
Q

What does HHNS stand for?

A

Hyperosmolar Hyperglycemic Nonketotic Syndrome

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5
Q

What is HHNS?

A
  • Lack of effective insulin leading to hypersmolarity and hyperglycemia
  • Causes osmotic diuresis resulting in water and electrolyte losses
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6
Q

What are the characteristics of DKA?

A
  • Type I diabetes
  • Omission of insulin, physiological stress
  • Rapid onset less than 24 hours
  • BGL >13.9 mmol/L
  • Arterial pH <7.3
  • Present serum and urine ketones
  • Serum osmolatity of 300-350 mmol/L
  • Plasma bicarbonate <15 mmol/L
  • Elevated urea and creatinine levels
  • Mortality rate <5%
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7
Q

What are the characteristics of HHNS?

A
  • Type II diabetes
  • Physiological stress
  • Slow onset (days)
  • BGL >33.3 mmol/L
  • Normal arterial pH
  • Absent serum and urine ketones
  • Serum osmolatity >350 mmol/L
  • Normal plasma bicarbonate
  • Elevated urea and creatinine levels
  • Mortality rate 10-40%
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8
Q

What are the precipitating factors?

A
  • ↑ amounts of stress hormone:
  • Infection, myocardial infarction, surgery
  • New diabetics
  • Management errors in insulin doses
  • Deliberate omission of insulin by patient
  • Erratic compliance with insulin and eating
  • Recreational drug use/ alcohol binges
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9
Q

What are the signs and symptoms of DKA?

A
  • Fatigue, headache
  • Polyurina
  • Polydipsia
  • Polyphagia
  • Nausea and vomiting
  • Abdominal pain
  • Dehydration
  • Kussmaul respirations
  • Acetone on breath
  • Decreased LOC
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10
Q

What are the nursing assessments taken for DKA and HHNS?

A
  • LOC
  • ABC
  • ABGs
  • Dehydration assessment
  • Signs of hypokalemia
  • Potential for hypovolemic shock
  • Signs of infection
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11
Q

What are the signs of hypokalaemia?

A
  • Fatigue
  • Muscle weakness, leg cramps, soft, flabby muscles
  • Nausea and vomiting, paralytic ileus
  • Paraesthesia, decreased reflexes
  • Weak, irregular pulse
  • Polyuria
  • Hyperglycaemia
  • ECG changes: ST segment depression, flattened T wave, presence of U wave, Ventricular arrhythmias, bradycardia
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12
Q

What are some nursing interventions for DKA and HHNS?

A
  • Monitoring of vital signs, LOC, ECG, O2 saturations, urine output – 1/24
  • Monitor FBC 1/24
  • Monitor serum glucose and potassium
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13
Q

What is rehydration therapy?

A
  • 1L 0.9% saline over 1 hour
  • 1L over 1-2 hours
  • 2 L over 4 hours
  • 1L every 4-6 hours
  • Switch to 5-10% glucose over next 8 hours once BGL <15mmol/L
  • Continue with saline in addition to glucose if patient remains volume depleted
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14
Q

How is insulin administrated?

A
  • 50 units actrapid in 50ml NaCl in syringe driver for IV infusion
  • Start 6 unit/hour
  • Laboratory venous BGL should be checked 2/24
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15
Q

How much potassium choride is added to each litre of fluid depending on the serum potassium levels?

A
  • > 5.5 = Nil recheck in 2 hours
  • 3.5-5.5 = 20 mmol/L
  • 3.0-3.4 = 40 mmol/L
  • <3.0 = Higher rates of potassium should be administered in ICU
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16
Q

What are some important factors to potassium replacement?

A
  • Don’t add potassium chloride to the first litre of fluid administered
  • Establish potassium levels
  • Monitor potassium levels every 2 hours
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17
Q

When should sliding scale insulin be stopped?

A

When insulin and ketone levels are normal

18
Q

How to prevent DKA?

A
  • Seek prompt medical treatment – antibotics/ paracetamol
  • Cough mixtures should be sugar-free
  • In unable to eat normally – carbohydrates should be replaced with cereals, soups or liquid carbs
  • Drink plenty of sugar-free liquids
  • If vomiting – seek medical attention
  • Insulin should be continues even if not eating
  • It is likely that insulin doses will need to increased during illness
  • BGL should be checked more regularly (4x/day)
19
Q

What is AKI?

A
  • Characterised by rapid onset and rapid loss of kidney function
  • Accompanied by a rise in serum creatinine and/ or reduction in urine output
  • Potentially reversible – but has high mortality rate
  • Usually affects people with life threatening conditions
  • Commonly follows severe, prolonged hypotension or hypovolaemia or exposure to nephrotoxic agent
20
Q

What are the common prerenal causes of AKI?

A
  • Hypovolaemia
  • Decreased cardiac output
  • Decreased peripheral vascular resistance
  • Decreased renovascular blood flow
21
Q

What are the common intrarenal causes of AKI?

A
  • Nephrotoxic injury
  • Interstitial nephritis
  • Other – acute tubular necrosis
22
Q

What are the common postrenal causes of AKI?

A
  • Benign prostatic hyperplasia
  • Bladder cancer
  • Calculi formation
  • Neuromuscular disorders
  • Prostrate cancer
  • Spinal cord disease
  • Strictures
  • Trauma
23
Q

What is acute tubular necrosis?

A
  • Nephrotoxic or ischemic injury that damages renal tubular epithelium
  • ATN most common cause of intrarenal failure especially in hospitalized patients.
  • Damage to cellular structure:
  • Prevents normal concentration of urine
  • Filtration of wastes
  • Regulation of acid-base, electrolyte and water balance
24
Q

What is RIFLE used for?

A

The classification of acute renal failure

25
Q

What does RIFLE stand for?

A 
R - risk
I - injury
F - failure
L - loss
E - end-stage kidney disease
26
Q

What is the MDT care for acute renal failure?

A
  • Treat precipitating cause
  • Fluid restriction (600 mls + previous 24 hours loss)
  • Nutritional therapy (enteral nutrition)
  • Measures to lower potassium
  • Calcium supplements
  • Dialysis
27
Q

What nursing management is undertaken for acute renal failure?

A
  • Monitor vital signs
  • Fluid and electrolyte balance
  • Urine assessment
  • Respiratory assessment
  • Skin assessment
  • Prevent infection
  • Monitor fatigue and potential anxiety
  • Monitor of complications – arrhythmias, infection
28
Q

What are the general principles of dialysis?

A
  • Diffusion
  • Osmosis
  • Ultrafiltration
29
Q

What is the RIFLE criteria for risk of acute renal failure?

A
  • Increased creatinine x 1.5 or GFR decreases >25%

- UO <0.5 ml kg-1 h-1x6hr

30
Q

What is the RIFLE criteria for risk of injury of acute renal failure?

A
  • Increased creatinine x 2 or GFR decrease >50%

- UO <0.5 ml kg-1 h-1x12hr

31
Q

What is the RIFLE criteria for acute renal failure?

A
  • Increased creatinine x 3 or GFR decrease >75% or creatinine >4 mg per 100 ml (acute rise of >0.5 mg per 100 ml)
  • UO <0.3 ml kg-1 h-1x24hr or anuria x 12hr
32
Q

What is the RIFLE criteria for loss?

A
  • Persistent ARF - complete loss of renal function >4 weeks
33
Q

What is the RIFLE criteria for end-stage kidney disease?

A
  • End-stage renal disease
34
Q

What is collaborative management aiming to do?

A
  • Treating hyperglycemia
  • Correcting dehydration and hypovolemia
  • Correcting electrolyte loss
  • Correcting acidosis
  • Identify and correct the precipitating cause
35
Q

What to check for in DKA and HHNS?

A
  • Hourly vital signs
  • Consider CVP monitoring if clinical evidence of poor LV or renal function
  • Consider NG tube if drowsy or vomiting and in severe cases of DA as gastroparesis may be present
  • Hypothermia may be present in admission - hourly temperature recording required
  • Give oxygen if paO2 below 8ommHg (11kPa)
  • Check urine ketones twice daily
36
Q

What laboratory monitoring is needed in the first 24 hours of DKA?

A
  • Glucose
  • Sodium, potassium chloride and urea
  • Creatinine
  • Bicarbonate
  • Arterial gas
37
Q

What is the normal potassium levels?

A

3.5 - 5.2 mmol/L

38
Q

What are some nephrotoxic drugs?

A
  • Gentamicin
  • Vancomycin
  • MI contrast
39
Q

What are the phases of AKI?

A
  • Initial or onset phase (hours too days)
  • Oliguric or maintenance phase ( 1-7 days or longer)
  • Diuretic phase (7-14 days, can last up to 3 weeks)
  • Recovery phase (months to years)
40
Q

What is TPN?

A
  • Total parenteral/peripheral nutrition - nutrients are given that bypasses the digestive system (through a vein)
41
Q

What is PPN?

A
  • Partial parenteral nutrition - intravenous administration of nutrients
42
Q

What to check for in a drain bag?

A
  • Color
  • Clarity
  • Mucous shreds
  • Weight

168.362 (8 decks)

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