Renal

Question 1

Complications/downsides to hemodialysis?

Answer 1

-Permanent
-Infection risk at site (thrombosis can also occur at cite as well)
-Can blow a cite (once its gone its gone)
-Hypovolemic shock due to pulling to much fluid
-Risk of clotting due to heparin

Question 2

Symptoms patients will feel if they have a intra-renal AKI?

Answer 2

1.)Decreased urine output
2.)Swelling+fluid retention
2.)Increase SOB (from fluid retention)
4.)Increase Nausea
5.)Increase weight gain
6.)Increase flank pain

Question 3

What are we going to for our patients if their K+ is elevated?

Answer 3

For potassium that is out of wach we are going to give insulin because it is going to push potassium back into the cell – we can also administer to non-potassium sparing diuretic – dialysis (when it is critically high) – or administer kayexlate (it is potassium binding) in the form of an edema (shits out all the potassium)

Question 4

When we give someone a transplant what are we increasing the risk of them having? What does this cause?

Answer 4

-When we give someone a transplant we are increasing the risk of having an alloimmune reaction – patients are on lifetime immunosuppressants – this increased the risk for infection

Question 5

S+S of kidney disease?

Answer 5

S+S of kidney disease:
1.) Hypervolemia – edema throughout body
2.) Urine retention
3.) Decreased RBC production – this means that we are not carrying enough O2 around the body – hypoxic in body tissues

Question 6

Charactiertics of the oliguric phase?

Answer 6

1.)Urine output<400mL/day
2.)Fluid volume overload
3.)Electorylyte imba;nces
4.)Matabolic Acidosis

Question 7

What do we really watch for on patients reciving hemodialysis?

Answer 7

-Drop in BP
-Hypovolemic shock

Question 8

Who would be eligible/recive peritoneal dialysis?

Answer 8

This is a person who has had long-term kidney issues – not super sick but has impared kidney function

Question 9

Common causes of a post renal AKI

Answer 9

Kidney stones, enlarged prostate, tumours, stirctures ,(closing down of the urethra), trauma

-Anything that is stopping urine from leaving the body

Question 10

Symptoms patients will feel during the oliguric phase?

Answer 10

From Sue
Metabolic acidosis – Kusmal breathing, SOB (pulmonary congestion)
Kidney are unable to properly filter out the waste
Altered mental status (irritable, hypoxic)
-Anemia because were not able to create enough RBC

From class:
-Patient would feel bloated, sluggish, retaining to much fluid, edema, pulmonary edema, fluid volume overload
-Getting some fluid in the lungs… we will have an elevated and deep resp rate (Kussmal breathing)
-Metabolic acidosis
-Itchy

Question 11

What is renal replacement therpay used for? WHat are the 3 different types?

Answer 11

Used to replace kidney function: Fluid overload or Electrolyte Imbalance

Types
Continuous Renal Replacement Therapy (CRRT)
Intermittent Hemodialysis (IHD or “hemo”)
Peritoneal Dialysis (PD)

Question 12

What will labs show for the oliguric phase of AKI?

Answer 12

-Labs would show increase creatinine, Urea, and a decrease GFR
-concentration of urine will be higher than water – increased specific gravity

*BUN + Creatine will increase, Electrolyte imbalance, Na down, K+ up

Question 13

What will componsate and show up on blood work following a Kindey transplant? How does the kidney grow?

Answer 13

GFR will compensate

-Hypertrophy occurs (cells increase in size)

Question 14

Treatment during recovery phase of AKI?

Answer 14

Treatment: Send them home, not much we can do because things are returning to normal, don’t require really diligent care

Question 15

What does Vitman D do?

Answer 15

Promotes calcium+phospahte absorption(strong bones)

(kidneys help activate)

Question 16

What are patients at risk for during diuretic phase of AKI?

Answer 16

-Risk for dehydration and hypotension

Question 17

Education we provide to patient following a kindey transplant?

Answer 17

Education:
-Going to be on immunosuppressants for life
-Greater infection risk due to being on immunosuppressants

Question 18

What is continous renal replacement therpay?

Answer 18

Dialysis for patients who are to hemodynamictly unstable to recive hemodialysis

-Only in CC areas

-Ran for 24hrs (pulling mL/hr/small amounts (12mL)

Question 19

Examples of what can cause a pre-renal AKI?

Answer 19

Heart failure, hypovolemic shock, hemorrhage, nausea + vomiting, shock (this is caused because blood flow is being adverted from everywhere else to the heart, lungs, and brain) – not enough blood flow is getting to the kidneys, so they cant do their job

Question 20

Symptoms/charatceritics of the diuretic phase of AKI?

Answer 20

1.)Increase in urine output (polyuria)

2.)Hypovolemia

3.)Hypotnetion

Question 21

What is happening to the kidneys in the diuretic phase of AKI?

Answer 21

They are starting to heal

Question 22

What is a post renal AKI?

Answer 22

occurs when there is an obstruction to urine flow from the kidneys, leading to impaired kidney function. This obstruction can occur anywhere along the urinary tract beyond the kidneys, including the ureters, bladder, or urethra. As a result of the blockage, urine backs up into the kidneys, causing pressure buildup and potential damage.

Question 23

What will labs be/show in the diuretic phase?

Answer 23

Decrease K+ due to not being able to properly concentrate urine

Increase Urea + creatine (kidneys aren’t functing yet)

Question 24

What drops (lab work) in a pre renal AKI?

Answer 24

GFR

Question 25

With transplants and kidney disease, what is importent for us to make sure we look at? Why?

Answer 25

Transplant aren’t a cure for kidney disease and its important to make sure we treat/look at the underlying issue

Question 26

Indications of use for hemodialysis?

Answer 26

End-Stage Renal Disease (ESRD): This is the most common indication for regular, long-term hemodialysis. Patients with ESRD have lost most or all of their kidney function and require dialysis or a kidney transplant to survive.

Acute Kidney Injury (AKI):
Hemodialysis may be used in cases of severe acute kidney injury where there is a sudden and temporary loss of kidney function. This may be due to causes like severe infections, drug toxicity, or complications following surgery.

Fluid Overload: Hemodialysis is effective for managing fluid overload, which can be critical, especially in patients who do not respond to diuretics.

Toxin Removal: In cases of poisoning or drug overdose, hemodialysis can be used to remove toxins from the bloodstream, particularly if the substances are known to be dialyzable.

Severe Electrolyte and Acid-Base Imbalances: Hemodialysis can quickly correct severe electrolyte disturbances (such as hyperkalemia, or high potassium levels) and acid-base imbalances that are potentially life-threatening.

Question 27

Characterisitcs of a post-renal AKI?

Answer 27

Post-renal AKI is characterized by decreased urine output (oliguria or anuria), elevated levels of waste products in the blood (such as serum creatinine and blood urea nitrogen), and signs and symptoms of kidney dysfunction, such as fluid retention and electrolyte imbalances.

Question 28

Treatment of oliguric phase?

Answer 28

Treatment: Diuretics, monitor fluid/electrode balance + correct it, low protein diet, limited fluid intake, monitor in/out, monitor ECG (peaked T wave + prolonged PR interval), daily weights (done every morning) (same scale, time, clothing, before meal), monitor BP, O2 saturation
-Monitoring how much fluid is being retained
-On the radar for dialysis because we can elevated labs that require it (especially if we are in the 2nd week)

Question 29

How long does the diuretic phase last for?

Answer 29

1-3 weeks

Question 30

What is the initiation stage of AKI?(what will be see and do?)

Answer 30

Initiation: It has started

-We are anticipating that an issue is going to happen
-Working at preventing the issue
-We will see NO lab changes – everything will be normal EXCEPT what is causing the issues – no changes in kidney functions

Question 31

Causes of an intra-renal AKI?

Answer 31

Damage to nephrons, tubules, glomeruts

1.) Acute Tubular Necrosis (ATN):
-Ischemic ATN: Caused by a significant reduction in blood flow to the kidneys, often due to shock, severe dehydration, or major surgery, leading to oxygen
deprivation in the kidney tissues.

-Toxic ATN: Resulting from exposure to substances that are toxic to kidney cells, such as heavy metals (e.g., mercury, lead), organic solvents, or certain medications (e.g., aminoglycosides, chemotherapy drugs, contrast agents used in imaging).

2.) Glomerulonephritis:
This is inflammation of the glomeruli, the small filtering units of the kidneys. It can be acute or chronic and is often caused by autoimmune diseases (such as lupus or Goodpasture’s syndrome), infections (post-streptococcal glomerulonephritis), or other systemic disorders.

3.) Acute Interstitial Nephritis:
Often triggered by allergic reactions to medications (antibiotics like penicillin or sulfonamides, NSAIDs, diuretics), infections, or autoimmune disorders. It involves inflammation of the interstitial tissue of the kidneys, which contains the tubules.

4.) Vascular Disorders:
Conditions affecting the blood vessels of the kidneys, such as thrombosis (clotting) of small renal arteries or veins, vasculitis (inflammation of the blood vessels), and conditions like malignant hypertension or hemolytic uremic syndrome.

5.) Rhabdomyolysis:
The rapid breakdown of muscle tissue that releases muscle fiber contents (myoglobin) into the bloodstream, which can be harmful to the kidneys and lead to AKI.

6.) Hemolysis:
The rapid destruction of red blood cells that releases hemoglobin into the bloodstream, which can become toxic to the kidneys.

Question 32

Time frame/how long does the oliguric phase last for?

Answer 32

1-2 weeks

Question 33

Clinical manifestations of Recovery phase of AKI?

Answer 33

1.) Decresed edema
2.)Normalization of fluid and electorylyte imbalances

Question 34

What is a intra-reanal AKI?

Answer 34

-Issue is coming from within the kidneys! (inflammation)

Damage to nephrons, tubules, glomeruts

occurs when there is direct damage to the structures within the kidneys. (This type of AKI can be caused by various factors that affect the kidneys’ cells and structures)

Question 35

What is a pre-renal AKI?

Answer 35

The prerenal form of AKI is due to any cause of reduced blood flow to the kidney. This may be part of systemic hypoperfusion resulting from hypovolemia or due to selective hypoperfusion of the kidneys, such as resulting from renal artery stenosis or aortic dissection.

Not happening within the kidneys – issue with blood getting to the kidneys

Question 36

How do we know when a patient is in the reocvery stage of an AKI?

Answer 36

When their bloodwork is back to normal

Until their bloodwork returns to normal (depends on person for how long that it takes)

-Know that they have recovered because the blood work has returned to normal

Question 37

Nursing interventions for diuretic phase?

Answer 37

Nursing intervention: daily weights, low protein diet,

Question 38

Symptoms of electroylyte imbalnces? (what phase will these be in?)

Answer 38

Electrolyte Imbalances: The increased urine output can lead to imbalances in electrolytes such as sodium, potassium, and magnesium. Symptoms of electrolyte imbalances may include muscle weakness, muscle cramps, irregular heart rhythms, and nausea.

Oliguric+diuretic

Question 39

In hemodialysis, once blood gets pulled out what do we need to do? Why?

Answer 39

-Once blood gets filtered out we need to heparinize the blood as it goes through so we are running the risk of bleeding

Question 40

What are the over all goals with AKIs?

Answer 40

Goal:
-Prevent it
-Stop it
-Restore as best as we can

Question 41

What is the major problem/complication with peritoneal dialysis?

Answer 41

1.) Infection!!! –putting and pulling fluid into our abdominal wall

Question 42

Patient symptoms if they are in the diuretic phase of an AKI?

Answer 42

-Increasing our urine output (much much higher)
-Hypotension + Hypovolemic
-Voiding more the 3L a day
Hypovolemia, dehydration – unable to properly concentare urine

Question 43

Why would we do a CT on a kidney as a diagnositic tool? What kind of advantage does it have over an ultrasound?

Answer 43

CT - Kidney size can be evaluated; tumours, abscesses, suprarenal masses (e.g., adrenal tumours, pheochromocytomas), and obstructions can be detected. The advantage of CT over ultrasonography is its ability to distinguish subtle differences in density

Question 44

Why would we use an MRI for a kidney?

Answer 44

MRI - radiofrequency waves and alteration in magnetic field. MRI is useful for visualization of kidneys. – soft tissue

Question 45

Why would we do a kindey biopsy? What does it determine/tell us?

Answer 45

Kidney Biopsy - obtain renal tissue for examination to determine type of renal disease or to monitor progress of renal disease. This technique is usually performed percutaneously (skin biopsy) through needle insertion into the lower lobe of the kidney.

Question 46

What does a BUN test look at?

Answer 46

A bloodureanitrogen (BUN) testmeasuresthe amount of nitrogen in your blood that comes from the waste producturea..Ureais made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneysareworking.

Question 47

What is creatine?What causes it’s levels to increase?

Answer 47

Creatinine is an end product of muscle and protein metabolism and is liberated at a constant rate. Creatinine levels in the blood can vary depending on age, race and body size. The level of creatinine in the blood rises, if kidney disease progresses

Question 48

WHat is GFR?What is it looking at?(what does a low GFR inidctae?)

Answer 48

GFR - average rate of blood filtration through the glomerulus. If your GFR number is low, your kidneys are not working as well as they should.

Question 49

What are the two 24 hour tests we run/do to check how well the kindeys are function?

Answer 49

24 hr – examine or measure specific components such as electrolytes, glucose, protein, catecholamines, creatinine, minerals (we can do 2 things – creatine clearnce there are going to take creatine in the urine for 24 hours to see how much there is and then divide it by the amount that is in the blood)

Question 50

What is the use of an ultrasound in investigating for signs of acute kidney injury?What might we find?

Answer 50

Going to be looking at the overall size, density, for inflammation, tumors, cysts

-Look at size, shape, and density of the tissue
-Signs of infection (not as detailed as a biopsy)