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S4E2 Flashcards

1
Q

Name that condition….

Sudden decrease in renal function
Build up of waste, fluid & electrolytes

A

Acute kidney injury / Acute renal failure

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2
Q

What’s happening during prerenal AKI

A

Issue with perfusion to kidney
⬇️ blood supply to filter
⬇️vascular nutrition
Oxygenation
Vascular

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3
Q

Prerenal AKI can lead to

A

Intrarenal injury

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4
Q

Causes of prerenal AKI

A

Cardiac issues (MI, ⬇️CO)
Massive internal/external bleeding
Dehydration/hypovolemia
Burns

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5
Q

Intrarenal AKI damage is…

A

Damage to The nephrons
⬇️ability to filter blood, remove waste
Excessive water build up
Can’t maintain electrolyte levels

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6
Q

Intrarenal AKI causes

A

Nephrotixic drugs
Infection : glomerulonephritis
Injury

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7
Q

Nephrotoxic drugs

A

NSAIDs
Antibiotics :aminoglycoside family
Chemo drugs
Contrast dye

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8
Q

Post renal AKI is

A

Blockage in urinary tract after the kidney to the urethra that prevents urine drainage
⬆️pressure in kidneys
⬆️waste in kidneys
⬇️kidney function

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9
Q

Causes for post renal AKI

A

Renal calculi
Enlarged prostate
Neuro injury(bladder doesn’t empty completely)

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10
Q

Creatinine levels

A

0.6-1.2

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11
Q

Labs associated with AKI

A

Creatinine levels
Creatinine clearance
Glomerular filtration rate: GFR
BUN

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12
Q

⬆️ creatinine means…

A

⬇️ kidney function

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13
Q

Female creatinine clearance level

A

85-125

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14
Q

Male creatinine clearance level

A

95-140

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15
Q

Normal GFR

A

> 90

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16
Q

⬇️GFR will lead to

A

⬇️UOP
⬆️water build up
⬆️waste and electrolytes imbalance

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17
Q

Normal BUN level

A

6-20

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18
Q

INITIATION stage of AKI

A

First stage
Starts with cause
Ends with s/s appear ( hrs-days)

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19
Q

OLIGURIC stage of AKI

A

2nd stage

UOP <400 ml/day (⬇️GFR)
⬆️BUN & Creatinine
⬆️hyperkalemia >5.1
⬆️fluid in body
Metabolic acidosis
⬇️pH <7.35
⬇️mild hyponatremia
⬆️phos
⬇️cal
⬆️⬆️urine specific gravity >1.020

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20
Q

What AKI stage can pts possibly skip

A

OLIGURIC stage

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21
Q

OLIGURIC stage s/s

A

Neuro changes: Sluggish, Tired
Itching (from waste)
Tall peak T waves
Wide QRS
Prolonged PR intervals
Edema
Risk of pulm & cardiac issues
Htn
Confusion
Kussmaul breathing (deep&rapid)

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22
Q

Nursing management for OLIGURIC stage

A

Low protein diet
Fall safety
Restrict potassium foods
EKG
Labs
Kayexalate po / rectal (⬇️ potassium)
Fluid restriction
Strict I/Os
Daily wts
Monitor BP
Lung sounds
O2 sat
Monitor swelling
Resp status
Monitor electrolyte foods

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23
Q

Initiation stage nursing management

A

Find cause and correct to prevent damage to nephrons

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24
Q

OLIGURIC stage time frame

A

1-2weeks
Shorter is better to decrease risk of nephrons damage

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25
Q

Diuresis stage of AKI

A

Stage “3”
Nephrons on the way to recovery
Filters blood but can’t concentrate urine
Improving GFR, BUN, Creat. (still abnormal)

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26
Q

Diuresis stage s/s

A

Increase mental status
Voiding 3-6L/day
Hypovolemia
Dehydration
Hypotension
Hypokalemia

27
Q

How long can Diuresis stage last

28
Q

Diuresis stage nurse management

A

Strict IOs
Daily wts
S/s of dehydration
Supplements
IV fluids

29
Q

Recovery stage of AKI

A

Last stage
Starts when:
GFR, BUN, creat & electrolytes = normal
Everything maintained

30
Q

How long is Recovery stage

A

Depends how much damage was done and pt age.

Up to a year or more

31
Q

What if a pt doesn’t make it to recovery stage of AKI

A

Chronic kidney disease or end stage renal failure

32
Q

What stage of CKD

Normal function
Proteinuria
GFR >90
3m or more

33
Q

What stage of CKD

Mild loss of function
Proteinuria
GFR 60-89
3m or more

34
Q

What stage of CKD

Mild to severe loss of function
GFR 20-59

35
Q

What stage of CKD

Severe loss of function
GFR 15-29

36
Q

What stage of CKD

End stage
GFR <15

37
Q

When GFR decreases it leads to:

A

⬆️ urea
⬆️ creatinine
Hypervolemic
⬇️ UOP

38
Q

UOP <400 ml/day

39
Q

UOP <100 ml/day

40
Q

Types of burns

A

Thermal
Chemical
Electrical
Recitation
Smoke
Inhalation

41
Q

Under 2/over 60 yo Burn risk factors

A

<2
-minimal protein stores
-immature immune system
-intolerant of fluid shifts
>60
-immunocompromised
-diabetes healing

42
Q

Past medical hx risk factors

A

Immunocompromised
Diabetes
Tetanus shot after 5 years

43
Q

Other burn risk factors

A

Adaptability
Coping
Concomitant injury(other injuries)
Body size

44
Q

How to classify a burn

A

Extent of burn
Depth of burn
Location

45
Q

Rule of 9’s is used for…

A

Extent of burn

46
Q

1sr degree burn

A

Epidermis
Superficial
Redness
Painful
Blisters later

47
Q

2nd degree burn

A

Dermis
vascular
instant blister
nerves
severe body pain
swelling
Edema
shiny
epithelial regeneration possible

48
Q

Third-degree burns

A

That tissue
expose muscle/bone
decrease blood flow

49
Q

4thdegree burns

A

Dry waxy
White
Leathery/hard skin
Visible thrombosed vessels
Insensitive to pain
Soft tissue or bones involved
Surgery needed (graft/escharotomy)

50
Q

Emergent phase of burn

A

Burn onset-5 days
Resolve immediate problems
Fluids are shifting
Evaporation
Loss of RBC
⬆️H&H

52
Q

Emergent burn complications

A

Fluid shift is worst in the first 24
Hypovolemia
Edema
Dehydration
Shock
Hypothermia
Hyponatremia
Hyperkalemia
Hemoconcentration
Upper airway burns
Inhalation injuries
Dysthymias
Acute tubular necrosis

53
Q

Emergent burn nurse management

A

Airway:
Oxygen
Intubation/mechanical vent
IV/Central Line
Access
IVF
Meds
TPN
Fluid therapy
Parkland formula
Fluid resuscitation
Titrate to pt response
Hourly UOP
VS
S/s of hypervolemia
Wound care
Drug therapy
Nutritional therapy
Eval outcomes

54
Q

Parkland formula

A

4g/kg/%TBSA=24 hrs

1/2 in first 8 hrs
1/4 next 8 hrs
1/4 in the next 8 hrs

55
Q

Burns acute phase

A

> 5 days
Mobilization of extracellular fluids
Diuresis
Burn is completely covered/healed
Eschar
Hyponatremia
Hypokalemia

56
Q

Acute burn phase complications

A

Infection
CV
Resp
Neuro
GI
Paralytic ileus (stress)
Diarrhea (tube feeding)
Altered nutrition (body needs)

57
Q

Acute burn phase nurse management

A

ABCs
Wound care
Pain management
Nutrition therapy
2-4gm/kg
3500-5000cals/day
Supplements
PT/OT
Psychosocial
Comfort (drug therapy)

58
Q

Wound care for acute burn phase

A

Goal: prevent/minimize further destruction, promote comfort
Daily observation/assess
Dressing changes
Skin graft
Escharotomy
Silver sulfadiazine

59
Q

Burn rehab phase

A

Months after burn
Pt must be self-motivated
Burn is covered or healed
Capable of self-care activity
F/E/UOP are normal
Goals based on pt/fam/support system

60
Q

Rehab burn phase complications

A

Altered body image
Ineffective coping
Contractures
Scarring

61
Q

Burn rehab phase nurse management

A

Assist with resume functional role in society (with PT/OT)
Accomplish functional cosmetic reconstruction
Support pt/fam psychosocial needs
Comfort
Positions
ROM
Splints
Scarring
Emollients
Antihistamines(itching)
Pressure suit
Splints
Neutral position

62
Q

Normal sodium

63
Q

Normal potassium

64
Q

What is added to fluids to keep fluids intravascular?

MedSurg (8 decks)

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