Problems Of Urinary Function: Acute Kidney Injury & Chronic Kidney Disease Flashcards
What is renal failure?
Happens when the kidneys cannot remove wastes or perform regulatory functions
What is acute renal failure?
reversible syndrome that results in decreased glomerular filtration rate(GFR) and oliguria lasts less than 3 months
What is chronic renal failure?
progressive; irreversible deterioration of renal function results in azotemia prognosis fatal- renal replacement therapies
dialysis, transplantation
What are the three causes of renal failure?
- pre-renal
- intrarenal
- postrenal
What is the cause pre renal in renal failure?
sudden and severe drop in blood pressure(shock) or interruption of blood flow to the kidneys from severe injury or illness
- impaired blood leak to hypoperfusion of the kidney and a drop in the GFR: hemorrhage, renal losses(diuretics, osmotic diuresis)
- impaired cardiac efficiency resulting from MI, heart failure, dysrhythmias, cardiogenic shock
- vasodilation resulting from sepsis, anaphylaxis, antihypertensive meds (or vasodilation drugs)
What is the cause intrarenal in renal failure?
direct damage to the kidneys by inflammation, toxins, drugs, infections, or reduced blood supply
prolonged renal ischemia, nephrotoxic agents, infectious processes
What is the cause postrenal in renal failure?
sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tutor or injury
urinary tract obstruction: calculi, tumours, benign prostatic hyperplasia, strictures, blood clots
What is the cause of acute renal failure?
-obstruction of the kindness or lower urinary tract
- obstruction of renal arteries or veins
- Hypovolemia and hypotension
- reduced cardiac output and heart failure
What is the cause of chronic renal failure?
- ** DM and HTN**
- infections –> pyelonephritis
- obstruction of urinary tract
- heredity lesions
- vascular disorders
- meds or toxic agents
- chronic glomerulonephritis
What is acute kidney injury?
- varying and subtle degrees of renal impairment
- changes in first 48 hours
- 50% of cases have normal or increased urinary output
What is the etiology and pathophysiology of acute renal failure?
etiology: complex disorder, elevation in serum creatinine and anuric renal failure
pathological: hypovolemia and decreased renal blood flow, ischemia, tubules damages, edema and necrosis, globular filtrate leaks decreasing nitratubular fluid flow
What is the four phases of acute renal failure?
- onset
- oliguric-anuric
- diuretic
- recovery
What is the onset phase in acute renal failure?
- can last several hours or days
- gradual accumulation of nitrogen waste
- oliguria
What is the oliguric-anuric phase in acute renal failure?
-rise in urea, creatinine, uric acid, organic acid, and intracellular anions (potassium and magnesium)
- decreased urinary output
- decreased renal function but excrete normal urine amount
- metabolic acidosis
What is the diuretic phase in acute renal failure?
- gradually increase urine output
- glomerular filtration has started to recovery
-lab values stop rising and start dropping - renal function abnormal
- observe pt for dehydration
What is the recovery phase in acute renal failure?
- ct begins to return to normal levels of activity decrease energy level
- renal function may never return to preillnesss levels
- renal function is sufficient for a long healthy life
What is the collaborative care for acute renal failure?
- fluid restriction, nutritional therapy, enteral nutrition, and dialysis if indicated
- detailed treatment of hyperkalemia
primary goal: to eliminate cause, manage symptoms, and prevent complications
What is age related considerations for acute renal failure?
- more susceptible due to # of functioning neurons decrease with age
- impairment of other organ systems can increase risk of developing an AKI
- aging kidney less able to compensate for changes in fluid volume, soul load and cardiac output
- mortality rate higher
What is chronic kidney disease?
progressive, irreversible loss of kidney function
What is normal GFR?
GFR 125 ml/min
What is kidney failure GFR?
GFR <15ml/min
What is the two leading causes of end stage renal disease(ESRD)?
DM and HTN
What is the clinical manifestations for chronic kidney disease?
psychological changes,
effects all bodily systems
What is the accumulated waste products in CKD?
increased BUN and creatinine
What is metabolic disturbances in clinical manifestations for CKD?
defective carb metabolism caused by impaired glucose
- elevated triglycerides
What is electrolyte/acid-base imbalances in clinical manifestations for CKD?
potassium–> hyperkalemia
sodium
calcium and phosphate, magnesium alterations
metabolic acidosis
How is the hematological system effected in clinical manifestations for CKD?
anemia, bleeding tendencies, infections, increased incidence of cancer
What is the treatment for electrolyte imbalance for renal failure? What is the biggest electrolyte imbalance?
monitor potassium levels, KAYEXALATe, dialysis, IV calcium gluconate, IV insulin with dextrose
Biggest imbalance: Hyperkalemia
How is the cardiovascular system effected in clinical manifestations for CKD?
HTN, heart failure, left ventricular hypertrophy, peripheral edema, dysrhythmias, remix pericarditis
How is the respiratory system effected in manifestations for CKD?
dyspnea, pulmonary edema, kussmaual respirations, ureic pleuritis, infections depressed cough, ureic lung
How is the gastrointestinal system effected in clinical manifestations for CKD?
All parts affected
- N/V, anorexia, GI bleeding, ureic fetor (urine breath), stomatitis, mucosal ulcerations
How is the neurological system effected in clinical manifestations for CKD?
altered mental ability, seizures, coma, restless leg syndrome, muscle twitching, irritability, unable to concentrate, encephalopathy, peripheral neuropathy
How is the musculoskeletal system effected in clinical manifestations for CKD?
renal osteodystrophy, osteomalacia, osteitis fibrosa, metastatic calcifications
How is the integumentary system effected in clinical manifestations for CKD?
yellow-grey skin, pruritus, ureic frost, brittle hair, thin nails, petechiae, ecchymoses
How is the reproductive system effected in clinical manifestations for CKD?
infertility, decreased libido, low sperm count, sexual dysfunction
How is the endocrine system effected in clinical manifestations for CKD?
hypothyroidism, low levels of t3&4
What is the diagnosis studies for CDK?
renal ultrasound, renal scan, ct scan, renal biopsy
What is the collaborative care for CKD?
- drug therapy to treat electrolyte imbalances, edema, dyslipidema
- restriction of sodium, potassium, protein, fluid, and phosphate
- calcium supplementation
What is the nursing implementation and ambulatory/home care for CKD?
nursing implementations: regular checkups and changes in urinary appearance, frequency, and volume, daily weights, BP, strict dietary, meds, fluid overload
Ambulatory/home care: consider HD, PD, or transplant when conservative therapies don’t work
What is dialysis?
remove fluid and ureic waste products from body when kidneys cannot
- may also treat pts with edema, hepatic coma, hyperkalemia, hypercalcemia, HTN, and uraemia
What is acute dialysis?
high and rising level of potassium, fluid overload, pulmonary edema, increasing acidosis, pericardia, or severe confusion
TO REMOVE CERTAIN MEDS OR OTHER TOXINS FROM BLOOD
What is chronic dialysis?
chronic renal failure(ERSD)
Hyperkalemia: fluid overload not responsive to diuretics and lack of well being
- uremic S&S affecting all body systems: N&V, anorexia, lethargy, mental confusion
What are two methods of dialysis?
- peritoneal dialysis(PD)
- hemodialysis(HD)
What is peritoneal dialysis?
** not as efficient over hemodialysis**
- remove toxic substances and metabolic wastes and reestablish normal fluid and electrolyte balance
- choice for pt unable or unwilling to undergo hemodialysis or transplant
- fewer problems than hemodialysis
How does peritoneal dialysis work?
- catheter inserted through anterior wall working as a semipermeable membrane
- urea and creatinine and other waste products are cleared through blood by diffusion and osmosis
- surgery
What is the complications of peritoneal dialysis?
exit site infection, peritonitis, abdominal pain, outflow problems, hernias, lower back problems, bleeding, protein loss, pulmonary complications, loss of ultrafiltration, carbs and lipid abnormalities
What is hemodialysis?
- prevents death for ESRD pt
- 3x/week for 3-4 hours
- artificial kidney that replaces the glomeruli
How does hemodialysis work?
long plastic cartridge that contains thousands of parallel hollow tubes of semi permeable fibres
What is the complications of hemodialysis?
clotting, narrowing, infection, bleeding
What are the two type of vascular access sites for hemodialysis?
- arteriovenous fistula
- arteriovenous graft
What are the types of access for vascular sites for hemodialysis?
shunts, interna; arteriovenous fistulas and grafts, temporary vascular access
What is a fistula for hemodialysis?
preferred method more durable and resistant to infection
- joining artery to a vein
- when mature, vein increases in size and may look like a cord under skin
- takes 3-6 months
- once mature, it is ready for dialysis
What is a graft for hemodialysis?
- man made tube connecting artery to a vein
- 2-6 weeks till healed
What is vascular access care?
- make sure it is functioning and properly taken care of by pt, maintop bleeding after dialysis
restrictions: NO BP or VENIPUNCTIONS to affected arm, label, do not carry items, sleep on that arm, constrictive clothing
What is the complications of hemodialysis?
hypotension, muscle cramps, loss of blood, hepatitis, sepsis, disequilibrium syndrome
What is nursing management for hospitalized pt on dialysis?
- monitor fluid balance, S&S of uraemia and electrolytes imbalances, BP, RR, HR, medications given
- address pain and discomfort
- provide skin care
- Iv therapy
- protect vascular site
What is kidney transplantation donor sources?
- blood relatives
- compatible blood type decreased donors
- emotionally related living donors
- altruistic living donors
What does the kidney transplantation surgical procedure look like?
- live donor
- nephrectomy
- begins an hour or two before recipients surgery is started
- rib may need to be removed for adequate view
- takes 3 hours
What are kidney transplantation complications?
- rejection
- infection
- cardiovascular disease ( increased incident of atherosclerotic vascular disease, immunosuppressant can worsen HTN and hyperlipdemia)
- malignancies
What is hyperacute (antibody-mediated, humoral) rejection for a kidney transplant?
occurs minutes to hours after transplant
What is acute rejection for a kidney transplant?
occurs days to months after transplant
What is chronic rejections for a kidney transplant?
Process that occurs over months or years and is irreversible
What is age related considerations for CKD?
- ESRD pt are 65+
- comorbid conditions to treat as well
- dialysis decision and withdrawal
