Renal Disorders Flashcards
Acute Kidney Injury/Acute Renal Failure
- occurs suddenly/generally reversible
- abrupt loss of kidney function and glomerular filtration rate
Glomerular Filtration Rate (GFR)
test used to check how well the kidney’s are working; estimates how much blood passes through the glomeruli each minute
Glomeruli
cluster of capillaries around end of kidney’s where waste products are filtered from blood
Causes of Acute Kidney Injury Prerenal
- diabetes
- fluid volume deficit; GI, hemorrhage, diuretics
- decreased cardiac output; MI, CHF
- prolonged hypovolemic status; sepsis, anaphylaxis, antihypertensive
AKI Prerenal
blood flow INTO kidney is affected
AKI Intrarenal
damage to the actual kidney
AKI Intrarenal Causes
- rhabdomyolysis
- nephrotoxicity; mycin antibiotics, IV dye, ACE inhib, NSAIDS
- infections; pyelonephritis
AKI Postrenal Causes
- bilateral kidney stones
- tumors
- BPH
- ureteral strictures
AKI Postrenal
flow of urine OUT of kidney is affected
How many phases of AKI are there?
4
Phase 1 AKI (onset)
triggering event begins—start of kidney injury
Phase 2 AKI (oliguric)
- urine output decreases and fluid volume overload develops
- serum waste begins to increase (BUN, Cr, K+, Mg+, Phosphorus)
Phase 3 AKI (diuretic)
- triggering event is corrected
- urine output increases, sometimes in in large dilute amounts
Phase 4 AKI (recovery)
- kidney function improves
- health status improves/energy increases
S/S of AKI
- Oliguria
- Anuria
- low specific gravity
- hyperkalemia
- metabolic acidosis
- increased BUN/Creatinine
- hypocalcemia/hyperphosphatemia
Oliguria
< 400 mL in 24 hrs
Anuria
< 50 mL in 24 hrs
Hyperkalemia w/ AKI
- cardiac arrhythmias w/ EKG changes
- tall peaked T-waves
- muscle weakness/paralysis
- nausea/diarrhea
- decreased or absent DTR’s
Hypocalcemia w/ AKI
- tetany
- seizures
- prolonged QT interval on EKG
- trousseau sign
- Chvostek sign
Trousseau Sign
carpal spasm that is the result of inflation of a BP cuff
Chvostek Sign
twitching of facial muscles in response to tapping over the area of facial nerve
Prevention of AKI
- prevent dehydration
- replace blood and fluids as appropriate
- strict I&O’s
- Assess BUN & Creatinine routinely on patients at risk
- Do NOT give IV contrast w/ elevated creatinine
- treat infections quickly
- eliminate use of catheters
- prompt perineal care
- assess use of nephrotoxic drugs
Treatment for Prerenal AKI
IV fluids / blood transfusions
Treatment for Intrarenal AKI
temporary dialysis
-prevent FVE, hyperkalemia, metabolic acidosis
Treatment for Postrenal AKI
remove obstruction
- prostatectomy
- stents
- indwelling catheter
Complications of Fluid Volume Excess
- hypertension
- congestive heart failure
- pericarditis
- pulmonary edema
CHF Symptoms
- dyspnea
- crackles
- tachycardia
- JVD
- dependent edema
What is pericarditis?
CP that worsens w/ lying down, fever, pericardial friction rub
Pulmonary Edema Symptoms
- bloody, frothy sputum
- orthopnea
- “air hunger”
- patient feels like they are drowning
Kayexalate
- oral, NG, edema
- for hyperkalemia
IV Insulin w/ Dextrose and Diuretic
shifts K+ back into cells / dextrose to prevent hypoglycemia / diuretic to remove excess K+
IV Ca+ Gluconate
protect cardiac function from high K+ levels
Sodium Bicarbonate
neutralize acidosis
Phoslo
to absorb and lower phosphorus levels
-give w/ food
What medications should you adjust the doses of to help excrete through the kidneys?
antibiotics
digoxin
ACE inhibitor
Nutrition Facts
- restrict foods high in K+
- restrict foods high in phosphorus
- moderately restricted protein intake
- avoid salt substitutes
Considerations of Elderly
- kidney weight and volume decreases
- blood flow to kidneys decrease
- number of nephrons decline
- reduced bladder tone
- enlarged prostate
- decreased muscle mass
Reduced bladder tone increases the risk of what?
UTI secondary to incomplete emptying
Chronic Kidney Disease
kidney damage or decreased kidney function for 3 or more months
-progresses more quickly in those w/ HTN
Uremia
build up of urea in the blood
Who is at an increased risk for Chronic Kidney Disease?
- HTN
- 65 and older
- African American
- men
Stage 1 CKD
- 90%+
- kidney damage w/ normal function
Stage 2 CKD
- 60-89%
- kidney damage w/ mild loss of function
Stage 3 CKD
- 30-59%
- moderate to severe loss of function
Stage 4 CKD
- 15-29%
- severe loss of function
Stage 5 CKD
- 15%
- kidney failure and need treatment to live
Risks for CKD in Kidney Failure
- diabetes
- HTN
- proteinuria
- family history
- increasing age
Neuro S/S of CKD
- fatigue
- confusion/disorientation
- tremors/seizures
- restless leg
Cardiac S/S of CKD
- HTN
- pitting edema
- JVD
- tachycardia
- pericarditis
- anemia
- thrombocytopenia
Integumentary S/S of CKD
- dry/flaky/itchy skin
- ecchymosis
- thin brittle nails
- coarse thin hair
- dark bronze skin
Pulmonary S/S of CKD
- crackles
- thick, bloody frothy sputum
- pleuritic lung pain
- dyspnea/tachypnea
GI S/S of CKD
- ammonia breath
- metallic taste in mouth
- anorexia, N/V
- change in bowel habits
Reproductive S/S of CKD
- ED
- amenorrhea
- infertility
- decreased libido
Musculoskeletal S/S of CKD
- muscle cramps/spasms
- loss of muscle tone/strength
- bone pain/fractures
- foot drop
What to do for daily weights?
Same scale, same time, everyday
Fluid Restriction
- amount based on patient condition
- provider will determine
- educate to pace amount of fluid through day
Methods to help with thirst/
- hard candy
- chew gum
- rinse mouth w/ water
- lip moisturizer
- sip don’t gulp
- limit salt
- limit during day if have evening plans
What is dialysis?
mechanical method of removing bodily wastes when the kidney is unable to do so
Hemodialysis
- machine functions as artificial kidney
- 3 x weekly / 3-5 hrs each
Peritoneal Dialysis
-uses the peritoneum and a cleaning solution called dialysate to clean the blood
Dialysate
absorbs waste and fluid from the blood using the peritoneum as a filter
Temporary Vascular Access
- double lumen large bore catheter
- temporary for quick emergency access
- flushed w/ heparin after use
- NEVER flush before using
- aspirate 5-10 mL before using
Arteriovenous Fistula
- usually placed in forearm
- artery and vein are connected
- 2 large bore catheters are inserted during dialysis
- exercises such as squeezing a ball
How long does an arteriovenous fistula take to heal?
4-6 weeks
Education for Fistula
- “feel the thrill and hear the bruit”
- no labs or BP
- no IV sticks
- no tight clothes, jewelry, purses, etc.
- do not tie or sleep on that arm
Nursing Care for Dialysis Patient
- make sure patient eats breakfast
- most meds will be held
- daily weights
- psychosocial support
- involve case management
Kidney Transplant
- treatment of choice w/ end-stage failure
- helps to avoid dialysis
- less expensive
- living/deceased donor
- blood relatives not required
