T6: Acute Kidney Injury Flashcards
Acute Kidney Injury (AKI)
rapid (sudden) loss of renal function due to damage to the kidneys; formerly called acute renal failure
AKI is accompanied by a rise in
serum creatinine level and/or a reduction in urine output
mean arterial pressure for the kidney
60
GFR tells you
how effective the kidney is
azotemia
an accumulation of nitrogenous waste products [urea nitrogen, creatinine] in the blood
pre-renal acute kidney injury
factors that reduce systemic circulation causing reduction in renal blood flow
pre-renal causes
*Severe dehydration,
*heart failure,
*↓ CO
HINT HINT: Prerenal azotemia results in
üreduction in the excretion of sodium (less than 20 mEq/L), increased salt and water retention, and decreased urine output.
intrarenal acute kidney injury
causes include conditions that cause direct damage to kidney tissue
intrarenal acute kidney injury causes
kindey stones, kidney cancer/tumors, DRUGS (nephrotoxic), bullet, crushed in accident, ect trauma
Postrenal acute kidney injury
occurs with urinary tract obstructions that affect the kidneys bilaterally
Postrenal acute kidney injury causes
*Benign prostatic hyperplasia (BPH)
*Prostate cancer
*Calculi
*Trauma
*Extrarenal tumors
*Bilateral ureteral obstruction
HINT HINT: what is the rifle classification
used to describe the stages of AKI
RIFLE classification
Risk (R)
Injury (I)
Failure (F)
Loss (L)
End-stage renal disease (E).
what labs do we use to check for kidney failure
BUN and CRE
oliguria UO amount
less than 400mL/day
oliguric phase occurs within
1-7 days after injury
oliguric phase lasts
10-14 days
oliguric phase: fluid volume
Decreased urine output fluid retention:
*Neck veins distended
*Bounding pulse
*Edema
*Hypertension
*Fluid overload can lead to heart failure, pulmonary edema, and pericardial and pleural effusions
oliguric phase: metabolic acidosis
*Impaired kidney cannot excrete hydrogen ions
*Serum bicarbonate production is decreased
*Severe acidosis develops
*Kussmaul respirations
oliguric phase: potassium excess
*Impaired ability of kidneys to excrete potassium
*Increased risk with massive tissue trauma
*Usually asymptomatic
*ECG changes
oliguric phase: hematologic disorders
leukocytosis
oliguric phase: waste product accumulation
*Elevated BUN and serum creatinine levels
oliguric phase: neuro disorders
*Fatigue and difficulty concentrating
*Seizures, stupor, coma
Daily urine output
1-3L
HINT HINT Diuretic phase
During the diuretic phase of AKI, daily urine output usually is around 1 to 3 L but may reach 5 L or more
diuretic phase urine output
5L or more
what needs to be monitored in the diuretic phase
*hyponatremia, hypokalemia, and dehydration
recovery phase
*The recovery phase begins when the GFR increases, allowing the BUN and serum creatinine levels to decrease. Major improvements occur in the first 1 to 2 weeks of this phase, but kidney function may take up to 12 months to stabilize.
diagnostics for AKI
*Thorough history
*Serum creatinine
*Urinalysis
*Kidney ultrasonography
*Renal scan
*CT scan
*Renal biopsy
contraindicated diagnostics for AKI
*MRI with gadolinium contrast medium
*Magnetic resonance angiography (MRA) with gadolinium contrast medium
*Nephrogenic systemic fibrosis
*Contrast-induced nephropathy (CIN)
In patients with diabetes receiving metformin, the drug should be held for
48 hours prior to and after the use of contrast media to decrease the risk of lactic acidosis.
position after kidney biopsy
lay patient on side of body that kidney was biopsied and check the skeets, kidneys are very vascular so you want to put pressure on it
how to Ensure adequate intravascular volume and cardiac output in AKI
*Force fluids
*Loop diuretics (e.g., furosemide [Lasix])
*Osmotic diuretics (e.g., mannitol)
interventions for hyoerkalemia
*Insulin and sodium bicarbonate
*Calcium carbonate
*Sodium polystyrene sulfonate (Kayexalate)
Renal replacement therapy (RRT)
a treatment that replaces kidney function; the treatment may be some type of dialysis or it may be kidney transplantation
Peritoneal dialysis (PD)
The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane
Continuous renal replacement therapy (CRRT)
-Typically done in an ICU setting and is continuous, so the patient doesn’t have drastic fluid shifts
-DONE 24 hr 7 days a week to slowly pee all day long
*Indications for renal replacement therapy (RRT)
*Volume overload
*Elevated serum potassium level
*Metabolic acidosis
*BUN level > 120 mg/dL (43 mmol/L)
*Significant change in mental status
*Pericarditis, pericardial effusion, or cardiac tamponade
*Nutritional therapy
*Maintain adequate caloric intake
*Primarily carbohydrates and fat
*LIMIT protein
*RESTRICT sodium
*Increase dietary fat
*Enteral nutrition
nursing implementation: acute care
*Accurate intake and output
*Daily weights
*Assess for signs of hypervolemia or hypovolemia
*Assess for potassium and sodium disturbances
*Meticulous aseptic technique
*Careful use of nephrotoxic drugs
*Skin care measures/mouth care
nursing interventions: ambulatory care
*Regulate protein and potassium intake
*Follow-up care
*Teaching
*Appropriate referrals
Gerontologic Considerations: why are they more susceptible to AKI
*Dehydration
*Polypharmacy- diuretics, laxatives
*Illness and immobility
*Hypotension
*Diuretic therapy
*Aminoglycoside therapy
*Obstructive disorders
*Surgery
Infection
