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NSG 430 - Critical Care > T6: Acute Kidney Injury > Flashcards

T6: Acute Kidney Injury Flashcards

1
Q

Acute Kidney Injury (AKI)

A

rapid (sudden) loss of renal function due to damage to the kidneys; formerly called acute renal failure

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2
Q

AKI is accompanied by a rise in

A

serum creatinine level and/or a reduction in urine output

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3
Q

mean arterial pressure for the kidney

A

60

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4
Q

GFR tells you

A

how effective the kidney is

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5
Q

azotemia

A

an accumulation of nitrogenous waste products [urea nitrogen, creatinine] in the blood

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6
Q

pre-renal acute kidney injury

A

factors that reduce systemic circulation causing reduction in renal blood flow

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7
Q

pre-renal causes

A

*Severe dehydration,
*heart failure,
*↓ CO

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8
Q

HINT HINT: Prerenal azotemia results in

A

üreduction in the excretion of sodium (less than 20 mEq/L), increased salt and water retention, and decreased urine output.

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9
Q

intrarenal acute kidney injury

A

causes include conditions that cause direct damage to kidney tissue

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10
Q

intrarenal acute kidney injury causes

A

kindey stones, kidney cancer/tumors, DRUGS (nephrotoxic), bullet, crushed in accident, ect trauma

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11
Q

Postrenal acute kidney injury

A

occurs with urinary tract obstructions that affect the kidneys bilaterally

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12
Q

Postrenal acute kidney injury causes

A

*Benign prostatic hyperplasia (BPH)
*Prostate cancer
*Calculi
*Trauma
*Extrarenal tumors
*Bilateral ureteral obstruction

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13
Q

HINT HINT: what is the rifle classification

A

used to describe the stages of AKI

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14
Q

RIFLE classification

A

Risk (R)
Injury (I)
Failure (F)
Loss (L)
End-stage renal disease (E).

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15
Q

what labs do we use to check for kidney failure

A

BUN and CRE

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16
Q

oliguria UO amount

A

less than 400mL/day

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17
Q

oliguric phase occurs within

A

1-7 days after injury

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18
Q

oliguric phase lasts

A

10-14 days

19
Q

oliguric phase: fluid volume

A

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

20
Q

oliguric phase: metabolic acidosis

A

*Impaired kidney cannot excrete hydrogen ions
*Serum bicarbonate production is decreased
*Severe acidosis develops
*Kussmaul respirations

21
Q

oliguric phase: potassium excess

A

*Impaired ability of kidneys to excrete potassium
*Increased risk with massive tissue trauma
*Usually asymptomatic
*ECG changes

22
Q

oliguric phase: hematologic disorders

A

leukocytosis

23
Q

oliguric phase: waste product accumulation

A

*Elevated BUN and serum creatinine levels

24
Q

oliguric phase: neuro disorders

A

*Fatigue and difficulty concentrating
*Seizures, stupor, coma

25
Q

Daily urine output

A

1-3L

26
Q

HINT HINT Diuretic phase

A

During the diuretic phase of AKI, daily urine output usually is around 1 to 3 L but may reach 5 L or more

27
Q

diuretic phase urine output

A

5L or more

28
Q

what needs to be monitored in the diuretic phase

A

*hyponatremia, hypokalemia, and dehydration

29
Q

recovery phase

A

*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.

30
Q

diagnostics for AKI

A

*Thorough history
*Serum creatinine
*Urinalysis
*Kidney ultrasonography
*Renal scan
*CT scan
*Renal biopsy

31
Q

contraindicated diagnostics for AKI

A

*MRI with gadolinium contrast medium
*Magnetic resonance angiography (MRA) with gadolinium contrast medium
*Nephrogenic systemic fibrosis
*Contrast-induced nephropathy (CIN)

32
Q

In patients with diabetes receiving metformin, the drug should be held for

A

48 hours prior to and after the use of contrast media to decrease the risk of lactic acidosis.

33
Q

position after kidney biopsy

A

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

34
Q

how to Ensure adequate intravascular volume and cardiac output in AKI

A

*Force fluids
*Loop diuretics (e.g., furosemide [Lasix])
*Osmotic diuretics (e.g., mannitol)

35
Q

interventions for hyoerkalemia

A

*Insulin and sodium bicarbonate
*Calcium carbonate
*Sodium polystyrene sulfonate (Kayexalate)

36
Q

Renal replacement therapy (RRT)

A

a treatment that replaces kidney function; the treatment may be some type of dialysis or it may be kidney transplantation

37
Q

Peritoneal dialysis (PD)

A

The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane

38
Q

Continuous renal replacement therapy (CRRT)

A

-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

39
Q

*Indications for renal replacement therapy (RRT)

A

*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

40
Q

*Nutritional therapy

A

*Maintain adequate caloric intake
*Primarily carbohydrates and fat
*LIMIT protein
*RESTRICT sodium
*Increase dietary fat
*Enteral nutrition

41
Q

nursing implementation: acute care

A

*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

42
Q

nursing interventions: ambulatory care

A

*Regulate protein and potassium intake
*Follow-up care
*Teaching
*Appropriate referrals

43
Q

Gerontologic Considerations: why are they more susceptible to AKI

A

*Dehydration
*Polypharmacy- diuretics, laxatives
*Illness and immobility
*Hypotension
*Diuretic therapy
*Aminoglycoside therapy
*Obstructive disorders
*Surgery
Infection

44
Q
A

NSG 430 - Critical Care (42 decks)

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