Urinary Alternations Flashcards
why is calcium acetate (PhosLo) admistered in CKD patient ?
To lower the phosphorous level
Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low.
Which assessment finding is a consequence of the oliguric phase of AKI?
Hyperkalemia
What occurs in the diuretic phase of AKI
Hypokalemia, dehydration, hyponatremia
How is ultrafiltration achieved in peritoneal dialysis ?
by increasing the osmolality of the dialysate with additional glucose.
How is ultrafiltration achieved in hemodialysis ?
the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration
During hemodialysis If the pt. complains of lightheadedness and nausea what should the nurse do?
The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased
what does management of acute renal failure(ARF) include?
adequate protein, measures to lower potassium, potassium phosphate and sodium restriction, fluid restriction
Measures taken to lower potassium
Regular insulin- potassium moves into cells when insulin is given
sodium bicarbonate- correct metabolic acidosis, potassium shifts into cells
Calcuium gluconate- given when hyperkalemia with ECG changes present to lower the excitation threshold
Hemodialysis- effective and works in short time
Sodium Polysyrene sulfontate(kaylexalate)- potassium is exchanged for sodium in GI and eliminated in feces.
potassium restriction- primarily used to prevent recurrent elevation
What occurs in the diuretic phase of AKI
Hypokalemia, dehydration, hyponatremia, increased clotting tendency
How is fluid excess managed?
weigh daily, Lasix( not given if pt. is hypokalemia or hypotensive), dialysis
What discharge instructions are important for a patient diagnosed AKI?
weigh everyday, report if edema occurs, discuss with HCP before taking OTC meds
Chronic renal failure (CRF)
progressive and irreversible
what is the leading cause in AKI?
Infection
What is the leading cause of death in CRF?
cardiovascular disease
why metabolic acidosis occur in kidney injury?
Because kidney can not synthesize ammonia which is needed for hydrogen ion excretion.
serum bicarbonate is decreased in buffering hydrogen ions
Why kussmal respiration occurs?
rapid and deep respiration in an effort to compensate metabolic acidosis by increasing exhalation of CO2
Hyponatremia in oliguria happens because
tubules can not conserve Na, which results in increased urinary excretion of sodium
Potassium in AkI
kidneys normal ability to excrete potassium is impaired
Conditions that may worsen hyperkalemia
Bleeding, metabolic acidosis( hydrogen ion into the cells and k out of the cells)
what changes are seen on EKG for hyperkalemia?
Peaked T waves, widening QRS complex, ST segment depression
What additional factors could lead to a high BUN other than kidney injury
Infection, dehydration, corticosteroids, GI bleeding
Asterixis
is commonly seen in advanced stage of kidney disease
what teaching is important about Kayexalate?
They should expect diarrhea that is potassium rich stool.
What are nursing interventions for uremic frosts?
bathing in cool water will remove the crystals and decrease the itching
Why is cardiovascular major cause of death in CKD?
Due to elevated triglycerides R/T to decreased levels of enzyme that is important in the breakdown of lipoproteins.
why anemia occurs in CKD?
due to decreased production of erythropoietin hormone by kidneys . iron and folic supplements may be required
why bleeding and infection are seen in CKD?
impaired platelet aggregation, hyperglycemia( insensitivity to the normal action of insulin occurs and this promotes bacterial growth)
GI problems related to CKD
stomatitis, constipation( from iron supplement or calcium containing phosphate binders, inactivity)
Neurologic effects in CKD
decreased concentration, depression, restless leg syndrome, paresthesia, nocturnal leg cramps
Musculosketal problems in CKD
low calcium( decreased serum level of active vitamin d needed for absorption of calcium from GI tract ), in response increased PTH to release calcium from bones causing accelerated rate of bone remodeling. This leads to increased risk of fractures.
Reproduction problem in CKD?
decreased libido and fertilization in b oth men and women may both return after dialysis
What cautions are important before administering sodium polystyrene sulfate ?
check bowel sounds. paralytic ileus is contraindicated, watch for Na and water retention
Reproduction problem in CKD?
decreased libido and fertilization in both men and women may both return after dialysis
what is given for anemia ?
Epogen SQ, Darbepoetin( longer acting) uncontrolled hypertension is contraindicated
The diuretic phase of acute kidney injury is characterized by
an increase in urine output of more than 1000 mL in a 24 hour period. This increase in urine output indicates the return of some renal function; however, BUN and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.
