Renal Disorders & Diuretic Flashcards
What is an AKI? Which lab tests does it affect?
Acute kidney injury
Abrupt decline in kidney function that is reversible
Elevated creatinine and BUN
What are the three causes of acute renal failure?
- Prerenal : sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness (affects blood vessels BEFORE the kidneys) — kidneys are not getting blood
- Intrarenal: direct damage to the kidneys by inflammation, toxins, drugs, or infection or reduced blood supply
- Postrenal: sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury (obstruction after the kidneys)
What are the possible S&S of an acute kidney disease ?
- fluid volume excess
- metabolic acidosis (volume excess bc can’t be excreted= all waste is acidic so increased fluid that is acidic in body causes metabolic acidosis)
- sodium balance (hyponatremia)
- potassium (hyperkalemia)
- hematological disorder
- calcium deficit and phosphate excess
- waste product accumulation
- neurological disorders
Diseased kidney = hard time excreting the waste
Why is calcium in deficit during an AKD?
Bc the kidneys are needed to activate vitamin D (which is needed to create calcium)
So if kidneys are injured = no activation of vitamin D = less calcium
George biscotti, 58 yrs old, comes to the ER with 10/10 pain to his left flank.
The pain started progressively a few hours prior and got steadily worse.
He took Tylenol and Advil at home 2hrs ago and found no relief.
He has a PMHx of HTN. He also tells you that he had dysuria for the past week and has only been voiding a small amount twice today.
Meds: amlodipine (norvasc) 10mg PO QD
The doctor prescribed:
- Morpine IV 3mg q5min (max dose : 12mg)
- CBC, electrolytes, U/A& C&S
- CT abdo
What do you suspect is going on with mr. biscotti?
A) pyelonephritis
B) rénal calculi
C) UTI
D) AKI
B)
Flank pain indicates the calculi and usually 10/10 pain not relieved by meds is the renal calculi
Not enough data to guess it to be any of the other options
But flank pain = big indicator for renal calculi
What assessments are needed before administering polystyrene sulfonate (kayexelate)?
- make sure pt has no diarrhea (bc won’t attract and absorb k+)
- make sure bowel is working normally or won’t work properly
- assess s&s of hyperkalemia
- blood test to verify k+ levels
- full bowel assessment
- CBC (look at lab values before administering)
Mr. Biscotti scan revealed a 2.5 mm renal calculi which is now resting in the bladder and a UTI.
Iv antibiotic therapy is initiated.
What dietary teaching will you give to this pt?
A) avoid drinking black teas and coffee
B) hydrate with 2-3L daily
C) limit protein intake
D) reduce calcium intake
B) hydration is for the infectious stone struvite as it will help dilute it and help excrete it
Since pt has a UTI it shows it is an infectious stone
A) would be good for the oxalate renal calculi
C) would be good for the yeux acid stone
D) would be a good answer for the calcium stone
What are some risk factors for a urinary calculi?
- concentrated urine
- diet (large amount of calcium, large amount of oxalate and/or proteins)
- low mobility levels
What are some drinks/foods high in oxalate?
Which renal calculi can be caused by this and what the usual therapeutic interventions needed?
Foods/drinks with oxalate:
- coffee
- black tea
- beer
- chocolate
- asparagus
- rhubarb
- spinach
Risk factor for the calcium oxalate renal calculi
Therapeutic interventions:
- increase hydration
- reduce oxalate in diet
What is a struvite urinary calculi? What are its usual therapeutic interventions?
Struvite urinary calculi:
- associated with UTI by bacteria split urea into ammonium in urine
Therapeutic interventions:
- meds
- surgical management
- control infection (antibiotics)
- increased fluids 2-3L / day (to dilute it and help excrete it)
What is the uric acid renal calculi? What usually helps cause it? What is it’s usually therapeutic intervention?
- metabolic produce purines from protein (seafood, meat)
Foods high in purines:
- sardines
- chicken
- pork
- protein powder
Therapeutic intervention:
- reduce urine concentration of uric acid usually with allopurinol
What is a cystine renal calculi? What are its usual therapeutic interventions?
Cystine:
Genetic defect causing absorption of cystine in GI tract and kidneys causing stone formation
Therapeutic intervention:
- hydration and meds
What are some foods that are high in calcium that are a risk factor for the calcium stones?
Dairy
Lentils
Fish
What are the usual elements In nutrition therapy for an AKI?
- fluid and electrolyte restriction (depending on the cause of AKI sometimes increased fluid is ordered)
- increased carbs and fats
- adequate protein intake
- caloric I rate
- potassium restriction
- phosphate restriction
- sodium restriction
- enteral feeds
Will vary depending on type of renal stone and cause
What are meds that should be avoided when having an AKI?
- avoid nephrotoxic drugs (met for min, NSAIDs, cyclosporine, etc..)
What is a chronic kidney disease? What are the phases?
Irreversible loss of kidney function
5 phases
Early (1-4)
- delay progression of disease, conserve kidney function and tx symptoms
- meds
- nutrition therapy
End stage (4-5): renal replacement therapy:
- transplant
- hemodialysis
- peritoneal dialysis
What are some S&S of CKD?
- anxiety
- depression
- hypertension
- HF
- anorexia
- n&v
- GI bleeds
- erectile dysfunction
- hyperlipidemia
- anemia
- infection
- fatigue
- sleep disturbances
- restless leg syndrome
- pulmonary edema
- pneumonia
- pruritus
- ecchymoses
- dry scaly skin
Etc
What are usual pharmacological intervention with CKD?
- kayexalate to lower k+
- calcium supplements (calcium, vitamin D)
- sevelamer to lower phosphate
- diuretic therapy with furosemide (lasix)
- renal replacement therapy until kidney function improves
What is the diuretic most often used with CKD?
The loop diuretic furosemide (Lasix)
PO or IV
Why is the diuretic furosemide (lasix) used for kidney disease?
- bc it is one of the only diuretics that works effectively even on kidneys that are not working properly or almost not at all
- it is used to tx the edema associated with kidney diseases
- has a rapid onset
- will work by dilating the blood vessels of the kidneys, lungs and rest of the body
- works even when creatinine clearance <25ml/min
(Normal values are usually above 88ml/min)
Why is electrolyte imbalance a major side effect of furosemide (lasix)?
Bc furosemide will work by taking away sodium, fluid, potassium, it gets rid of it all
So because of that reason, a possible AE Is electrolyte imbalances since loop diuretics will go and decrease edema caused by fluid overload by getting rid of everything
If a pt has hypokalemia, and fluid overload, is the dose of furosemide (lasix) still going to be given?
Yes because fluid overload is more difficult to reverse and the complications are much more serious
So the dose will be given with potassium supplements as it is reversed more easily
What are some possible AE of furosemide (lasix)?
Vasodilator so:
- hypotension
- orthostatic hypotension
Gets rid of everything so:
- electrolyte imbalances
- hypokalemia
Prolonged administration oh high doses can cause hearing loss
Erythema, dermatitis, photosensitivity
What are some important assessment and interventions to be done when a pt is on furosemide (lasix)?
- monitor electrolytes levels
- monitor BP (check BP and pulse before giving if systolic lower than 100 meds may be held)
- monitor potassium levels before giving
- daily weights
- monitor for signs of hypokalemia (anorexia, nausea, lethargy, muscle weakness, mental confusion, hypotension)
- assess for risk of falls due to risk of orthostatic hypotension or hypotension episodes
- meds taken by pt, if pt is on anti hypertensives meds may be held since furosemide will also decrease BP
What are contraindications to the use of furosemide (lasix)?
- cross sensitivity to sulfonamides
- hypovolemia
- electrolyte depletion
What are some drug interactions with furosemide (lasix)?
Increased effect with: vancomycin, digoxin, corticosteroids, lithium, NSAIDs
When administering a loop diuretic (lasix) to a pt, it is important for you to determine if the pt is also taking which drug?
A) lithium
B) acetaminophen
C) penicillin
D) théophylline
A
Med is a salt so hydration status needs to be very closely monitored bc it can affect lithium very easily, so if taken with lasix, fluid shift is very important and could impact lithium very strongly
Two days after admission, you are reviewing the pt’s lab results. Which is the most common electrolyte finding resulting from the administration of furosemide (lasix)?
A) hypocalcemia
B) hypophosphatemia
C) hypokalemia
D) hypomagnesemia
C
An older adult pt has been discharged following tx for a mild case of HF. He will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate? (Select all that apply)
A) take the diuretic at the same time each morning
B) take the diuretic only if you notice selling in your feet
C) be sure to stand up slowly because the medication may make you feel dizzy if you stand up quickly
D) drink at least eight glasses of water each day
E) here is a list of foods that are high in potassium- you need to avoid these
F) please call the doctor immediately if you notice muscle weakness or increased dizziness
A, C, F
What are some possible electrolyte imbalances in CKI?
- hyperkalemia (can cause arrhythmias)
- hyponatremia (fluid balance, cerebral edeman)
- hypomagnesia (atrioventricular block)
- hypocalcemia (muscle contractions) will become high bc body will go find it in bones which can lead to osteoporosis
- hyperphosphatemia
