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203D Custom > Test 4/Week 12: AKI > Flashcards

Test 4/Week 12: AKI Flashcards

1
Q

AKI Definition/Identification

A

Rapid loss of kidney function (hours to days)/increase in serum creatinine or UO/decreased perfusion to the kidneys

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2
Q

Azotemia

A

Early AKI: excess nitrogenous waste in blood (urea, creatinine)

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3
Q

Oliguria

A

Reduced UO <400mL/day

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4
Q

Uremia

A

Late CKF: “urine in the blood,” excess nitrogenous waste in blood

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5
Q

Decreased Kidney Perfusion Examples

A

hypotension, hemorrhage, dehydration, acute MI, liver failure, burns, traumatic injury, major surgery

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6
Q

AKI Direct Causes

A

toxins (vanco, contrast, chronic NSAID use), sepsis, urinary obstruction (stones, blood clots, BPH)

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7
Q

Pre-Renal

A
  • “outside the kidney”
  • hypoperfusion
  • causes: hemorrhage, dehydration, shock/sepsis, HF, anaphylaxis
  • findings: oliguria, increased BUN, slightly increased creatinine
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8
Q

Intra-Renal

A
  • “damage to renal tissue”
  • acute tubular necrosis
  • causes: prolonged kidney ischemia (trauma, nephrotoxic agents, TxFx rxn, acute renal disease)
  • findings: oliguria, increased BUN/Cr
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9
Q

Post-Renal

A
  • “obstruction”
  • outlet obstruction: acute bilateral ureteral/bladder
  • causes: calculi, BPH, neurogenic bladder
  • leads to hydronephrosis (correct within 2 days, no recovery after 12 weeks)
  • findings: UO may be normal or decreased, increased BUN, Cr varies
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10
Q

3 most common reasons for increased mortality rate

A

hypotension, hypovolemia, nephrotixic agents

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11
Q

Phases of AKI

A

onset, oliguric/anuric, diuretic, recovery

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12
Q

Onset Phase

A

What are the precipitating events?

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13
Q

Oliguric/Anuric Phase

A
  • minimal to no urine
  • S/Sx: edema, HTN, wt. gain, fluid excess, metabolic acidosis, Kussmaul respirations
  • Nursing diagnosis: fluid volume excess, risk for injury d/t hyperkalemia, metabolic acidosis
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14
Q

Diuretic Phase

A
  • increased quantity of urine, but quality isn’t better (nephrons not fully recovered)
  • S/Sx: increases UO, hypovolemia, dehydration, low lytes (K, Na, Mg)
  • Nursing Diagnosis: fluid volume deficit, risk for injury r/t fluid/electrolyte imbalance
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15
Q

Recovery Phase

A
  • improved renal function, but still vulnerable
  • better quantity and quality of urine
  • watch for infection (can be fatal)
  • permanent partial reduction of GFR
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16
Q

AKI Nursing Priorities

A
  • ABCs
  • heart (tele)
  • H/H
17
Q

Hyperkalemia Assessment

A

Peaked T-waves, muscle cramps, twitching, arrythmias

18
Q

Hyperkalemia Plan

A
  • I/O and electrolytes
  • maintain fluids, K/protein restriction
  • insulin IV or dextrose (pull K)
  • kayexalate
  • dialysis
19
Q

Low calcium/rising phosphorous Assessment/Plan

A

Paresthesia, tetany, Chvostek sign, calcification, seizures

Plan: monitor lytes, seizure precautions, phosphate binders with food, Vitamin D supplements, dialysis

20
Q

Metabolic acidosis assessment/plan

A

Assessment: Kuszmaul respirations, altered LOC, hyperkalemia, pH<7.35 and HCO3<23

Plan: treat with nutritional support, oral/IV bicarb, dialysis

21
Q

Fluid volume deficit assessment

A

Poor skin turgor, output>intake, orthostatic hypotension, dry mucous membranes

22
Q

Fluid volume deficit plan

A

Monitor I/O trends, Daily weight, monitor for postural blood pressure changes, monitor lytes/BUN/creatinine imbalance, monitor for overload (dialysis less likely)

23
Q

Fluid volume excess assessment

A

Rales/crackles, peripheral edema, intake > output, HTN and tachycardia, increased respiratory rate

24
Q

Fluid volume excess plan

A

Lasix drip, daily weight, monitor for jugular vein distention, monitor I/O, restrict fluids (meds with fluids at meals, oral hygiene), regulate lytes/BUN/creatinine, dialysis

25
Q

Chvostek Sign

A

Positive: tap under earlobe on jaw, mouth twitches toward tap

Indicates hypocalcemia

26
Q

Orthostatic hypotension

A

Drop in BP when sitting/standing up: >20 systolic, >10 diastolic, or both

Symptoms: Faintness, light-headedness, dizziness, confusion, blurred vision

27
Q

AKI neurological function Assessment/plan

A

Assessment: change in level of consciousness due to electrolyte imbalance

Plan: dialysis to keep BUN under 100, monitor for changes in an LOC, frequent neurochecks, family teaching that condition will improve with recovery

28
Q

AKI Infection plan

A

Pan C&S, begin renal dose of antibiotics after specimen obtained, Foley unnecessary if no UO

Minimize the use of invasive lines, adequate nutrition, effective airway clearance, dietary consult

29
Q

AKI Anemia

A

Low H/H, packed red blood cells to treat symptomatic anemia (lethargic, hypotension), epogen

203D Custom (6 decks)

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