UNIT 3 - Acute Kidney Disease Flashcards
sudden cessation of renal function that occurs when blood flow to the kidneys is significantly compromised. Manifestations occur abruptly.
acute kidney injury
begins with the kidney insult; urine output is 100 to 400 mL every 24 hours with or without diuretics, and lasts for 1 to 3 weeks.
- increased BUN and creatinine
- hypervolemia
- increased potassium and phosphate levels
oliguria
begins when the kidneys start to recover; diuresis of a large amount of fluid occurs; and can last 1 to 3 weeks.
- increased GFR
- electrolyte depletion
diuresis
continues until kidney function is fully restored and can take up to 12 months.
-normalization of fluids and electrolytes. 70-80% of normal GFR, unless irreversible renal damage has occured.
recovery
serum creatinine is 1.5 times the baseline and urine output is less than 0.5mL/kg/hr for 6 or more hours.
stage 1 (risk stage)
serum creatinine is 2 times the baseline and the urine output is less than 0.5 mL/kg/hr for 12 hours or more .
stage 2 (injury stage)
serum creatinine is 3 times the baseline and the urine output is less than 0.3 mL/kg/hr for 12 or more hours.
stage 3 (failure stage)
occurs as a result of volume depletion and prolonged reduction of blood flow to kidneys, which leads to ischemia of the nephrons. Occurs before damage to the kidney. Early intervention restoring fluid volume deficit can reverse AKI and prevent chronic kidney disease.
pre-renal
occurs as a result of direct damage to the kidney from lack of oxygen. (acute tubular necrosis)
intra-renal
occurs as a result of bilateral obstruction of structures leaving the kidneys.
post renal
- drink at least 2 L daily. Consult with the provider regarding prescribed fluid restrictions if needed.
- stop smoking
- maintain a healthy weight
- use NSAIDs and other prescribed medications cautiously.
- control diabetes and hypertension to prevent complications
- instruct clients to take all antibiotics prescribed for infections.
health promotion and disease prevention
- renal vascular obstruction
- shock
- decreased cardiac output causing decreased renal perfusion
- sepsis
- hypovolemia
- peripheral vascular resistance
- use of aspirin, ibuprofen, or NSAIDs
- liver failure
risk factors for pre-renal acute kidney injury
- physical injury: trauma
- hypoxic injury: renal artery or vein stenosis or thrombosis
- chemical injury: acute nephrotoxins (contrast dye, heavy metals, blood transfusion reaction, cocaine, alcohol, and antibiotics)
- immunologic injury: infection, vasculitis, acute glomerulonephritis
risk factors for intra-renal AKI
- stone, tumor, bladder atony
- prostate hyperplasia, urethral structure
- spinal cord injury or disease
risk factors for post renal AKI
- cardiovascular: fluid overload (dependent and generalized edema), dysrhythmias (hyperkalemia)
- respiratory: crackles, decreased oxygenation, shortness of breath (CHF or pulmonary edmea)
- renal: scant to normal or excessive urine output
- neurological: lethargy, fatigue, muscle twitching, seizures, confusion
- integumentary: dry skin and mucous membranes
expected findings
what are the top two risk factors for AKI?1
diabetes and hypertension
what is the normal value of serum creatinine level
0.5 - 1.2
what is the average GFR ?
125 mL/min
> 90 mL/min is best but some may have a normal GFR of 60-89 mL/min
at least 50 % of kidney function has to be lost in order for the ____ to increase.
creatinine
what is the normal range of BUN
5 - 20 mg/dL
what is the normal range of the BUN/creatinine ratio?
6 - 25
** this is BUN divided by creatinine values
what is the normal range for blood osmolality?
280 - 300 mOsm/kg
decreased cardiac output and dehydration means that BUN will be ?
increased
what is the best indicator of decreased kidney function
GFR
what is the normal range of microalbuminuria
< 2 mg/dL
- indicator of kidney damage in a patient with diabetes
what is the normal range of specific gravity?
- 005 - 1.030
* 1.005 is more diluted
* 1.030 is more concentrated
- urine color
- specific gravity
- pH: 4.6 to 8
- protein: 0 - 0.8 mg/dL
- sediment (crystals, cells, casts, and bacteria)
urinalysis
calcium and phosphate should never be trending in the same _____
direction
lab values for calcium?
8.5 to 10.5
lab values for magnesium?
1.5 - 2.5
lab values for phosphate
2.5 - 4.5
lab values for chloride
97 - 107
a BUN above ___ is indicative of a kidney issue
20
lab value for PLT count
100,000 - 400,000
lab values for HGB?
12 to 18
lab values for HCT
36 to 48
congenital defect involving a narrowing or obstruction in the child’s kidney that slows or stops the flow of urine from the kidney to the bladder. Most often only one kidney is affected
ureteropelvic junction (UP) obstruction
ocurs in boys 2 -5 years old due to infection not treated. (ex strep throat)
acute post infectious glomerulonephritis
administer IV fluid therapy as a fluid _______ to promote kidney perfusion, or as a fluid replacement if the client is in the diuretic phase.
challenge
administer ______ (furosemide, mannitol, ethacynic acid) to promote increased filtration of blood by kideny.
diuretics
for acute kidney injury caused by medication nephrotoxicity, administer _____ _______ _______ to prevent the movement of calcium into the kidney cells and to maintain cell integrity and increase the GFR.
calcium channel blockers
what replaces sodium with potassium in the intestinal tract to promote potassium excretion.
sodium polystyrene sulfonate
____ induces a bowel movement to promote excretion of excess potassium
sorbitol
in an emergency, IV medications (dextrose, insulin and ____) can be required to reduce potassium.
calcium
if the client has sever metabolic acidosis what will you administer?
sodium bicarbonate
