Week 11 Flashcards
Renal failure
1
Q
What is AKI?
A
Acute kidney injury
2
Q
Is acute kidney injury (AKI) reversible with early treatment?
A
Yes
3
Q
What condition results in decreased glomerular filtration rate (GFR) and oliguria?
A
Acute kidney injury (AKI)
4
Q
What is CKD?
A
Chronic kidney disease
5
Q
What is ESRD?
A
End stage renal disease
6
Q
What disease is progressive, permanent, irreversible damage to kidneys leading to failure of both kidneys?
A
Chronic kidney disease (CKD)
7
Q
What is a condition in which you have too much nitrogen, creatinine and other waste products in your blood?
A
Azotemia
8
Q
What secondary condition occurs after CKD that causes excessive nitrogenous waste products in your blood?
A
Azotemia
9
Q
What disease requires dialysis or kidney transplant for survival?
A
Chronic kidney disease (CKD)
10
Q
What is ARF?
A
Acute renal failure
11
Q
Is ARF the same as AKI?
A
Yes, AKI is a newer term
12
Q
What are (3) types of AKI?
A
- Intrinsic (damage to structures within the kidney)
- Prerenal (marked decrease in renal blood flow)
- Postrenal (blockage of urine outflow from the kidney)
13
Q
What is the causes of prerenal AKI? (6)
A
- Cardiac issues,
- Decreased cardiac output
- Massive bleeding
- Hypovolemia
- Burns
- Dehydration with excessive vomiting and/or diarrhea
14
Q
Where does prerenal AKI occur?
A
From renal artery to the heart
15
Q
What type of AKI causes damage to nephron?
A
Intrarenal/Intrinsic AKI
16
Q
What type of AKI causes damage to inside structures of the kidney?
A
Intrarenal
17
Q
What type of AKI causes a decreased ability to filter blood, remove waste & excessive H20, maintain electrolyte levels?
A
Intrarenal
18
Q
What is intrarenal AKI caused by? (2)
A
- Nephrotoxic drugs: NSAIDS,
antibiotics, chemo drugs, contrast dyes, infections (e.g., glomerulonephritis) - Kidney injury
19
Q
What type of AKI has a blockage in urinary tract after the kidney?
A
Postrenal AKI
20
Q
What type of AKI can extend to the urethra that prevents urine from draining out of the system?
A
Postrenal AKI
21
Q
In a postrenal AKI, does the blockage in the urinary tract happen before or after the kidneys?
A
After
22
Q
Postrenal AKI leads to an increase of what?
A
Increase pressure in kidney & waster & this decreases kidney function.
23
Q
Kidney stones are AKA?
A
Renal calculi
24
Q
What are the (3) causes of postrenal AKI?
A
- Renal calculi (kidney stones) can be in ureter/bladder/urethra
- Enlarged prostate (can squeeze urethra causing backflow)
- neuro injury e.g. Stroke
25
What are (8 general) diagnostics for AKI?
* Urine output; ACCO of urine
* US, CT or MRI of abdomen/kidneys
* KUB-old term, X-Ray
* Retrograde pyelogram
* Renal biopsy
* Urinalysis, specific gravity, osmolality
* Urine GFR
* CBC, Electrolytes, BUN
26
KUB stands for?
Kidney, ureter, and bladder
27
What is the type of medical imaging procedure that is used to examine the kidneys, ureters, and bladder that involves inserting a catheter?
Retrograde pyelogram
28
A high BUN level may indicate what about the kidneys?
The kidneys are not functioning properly
29
What is BUN?
Blood urea nitrogen
30
What is GFR?
Glomerular filtration rate
31
Does a higher or lower GFR indicate impaired kidney function?
Low GFR
32
In the initiation phase of clinical manifestations of AKI, what (3) things happen?
- BUN and CR increase
- Decreased urinary output
33
How many mL or urine is seen in the maintenance phase of AKI per day?
Less than 400 mL per day
34
In clinical manifestations in the recovery phase, what phase can be seen in pt with AKI?
Diuretic phase - can take weeks to 12 months
35
What are (7) ways to prevent AKI?
* Monitor I/O - provide adequate hydration
* Monitor lab values
* Prevent and treat shock with blood and fluid replacement
* Treat hypotension promptly
* Prevent and treat infections promptly
* Proper indwelling catheter care - remove ASAP
* Monitor toxic drugs - pre/post levels (antibiotics)
36
What are (2) goals in treatment of AKI?
- To restore chemical balance
- Prevent complications until healing occurs
37
What are (5) nursing assessments that need to be done for AKI?
* Monitor VS
* I/O (ACCO of urine), daily weights, may need IV fluids, dopamine, & diuretics
* Integumentary and any bruises
* Peripheral edema
* Check neck vein distension
38
What are some nursing diagnoses for AKI? Name a few
- Excess fluid volume
- Risk of infection
- Imbalance nutrition: less than body
requirements
- Disturbed thought process
- Fatigue
- Anxiety
- Potential complication: dysrhythmias
39
What are (8) nursing interventions for AKI?
- Strict intake and output, daily weights (edema)
- Monitor electrolytes, hyperkalemia symptoms
- Nutritional therapy
- Bedrest
- Promote pulmonary function (DB&C; turn q2h)
- Prevent infection
- Provide skin care
- Provide psychosocial support
40
What are signs of hyperkalemia? (5)
- malaise
- anorexia
- paresthesia
- muscle weakness
- ECG changes
41
What is included in nutritional therapy for AKI?
- replace protein
- high carbohydrate
- restricted potassium, phosphorous,
and sodium
42
What occasionally results from rapid progression of AKI?
Chronic kidney disease (CKD)
43
To be considered CKD, what percentage of kidney function is lost?
90-95%
44
In CKD, does GFR increase or decrease?
Decreases
45
How many stages of CKD/ESRD are there?
5 stages
46
At what stage does ESRD occur?
Stage 5
47
For stage 1 CKD, how low is the GFR mL/min?
More than 90 mL/min
48
For stage 2 CKD, how low is the GFR mL/min?
60-89 ml/min
49
For stage 3 CKD, how low is the GFR mL/min?
30-59 ml/min
50
For stage 4 CKD, how low is the GFR mL/min?
15-29 ml/min
51
For stage 5 CKD, how low is the GFR mL/min?
Under 15ml/min
52
What (2) things are needed at stage 5 CKD?
Needs regular dialysis and kidney transplant.
53
What stage of CKD has kidney damage with normal renal function?
Stage 1
54
What are the risk factors of CKD? (9) Name a few
* Diabetes (# 1 cause)
* Hypertension, vascular disease
* Toxic substances-such as?
* Chronic glomerulonephritis
* Pyelonephritis/infections
* Smoking
* Obesity
* Family history
* Socio-economic status
55
What is the #1 cause of CKD?
Diabetes
56
What are (5) diagnostic test for CKD?
* Glomerular Filtration Rate
* Blood tests
* Radiologic studies
* Renal biopsy
* Urinalysis
57
What are (3) electrolyte complications of CKD?
Imbalances with hyperkalemia, calcium and phosphorous
58
For CKD is the treatment curative or supportive?
Supportive
59
What hematologic complication be caused by CKD?
Anemia
60
How is anemia managed for CKD? (3)
- Erythropoietin
- Iron supplements
- Vitamin B12
61
What is given for pts with hyperkalemia from CKD? (4)
Kayexalate, retention enema, IV glucose and insulin
62
What does the medication Kayexalate used for?
Used to treat high levels of potassium in the blood by helping the body get rid of it through the stool
63
What is a condition that means too much phosphate in the blood?
Hyperphosphatemia
hai-per-fos-fa-TEE-mee-uh
64
How is hyperphosphatemia treated?
Aluminum hydroxide (TUMS)
65
What are some key nursing concerns for CKD? (6) name a few
*Monitor for complications
*Monitor and treat fluid and
electrolyte imbalances
*Monitor response to treatment
*Physical support
*Emotional support
*Education
66
What are (3) things the nurse is assessing for in CKD?
*Complete history of any existing renal disease, family history
*Long-term health problems
*Dietary habits
67
What are nursing diagnoses for CKD? Name a few (6)
- Excess fluid volume
- Potential for electrolyte imbalance
- Inadequate nutrition
- Decreased functional ability
- Deficient knowledge
- Grieving
68
For excess fluid volume from CKD, what is the nurse monitoring? (5)
- Monitor BP
- Edema
- Dyspnea (SOB)
- Monitor daily wt
- I&O
69
In excess fluid volume from CKD, should fluid be restricted with pt?
Yes
70
What are some principles and restrictions of the renal diet? (5)
- High calories, carbohydrates
- Limit protein to 1g/kg/day.
- Phosphate restriction less than 1000mg/day
- Limit sodium to 2 to 4 g/day
- Potassium restriction to 2 to 4 g/day
71
For CKD, why should we select high quality proteins?
- It minimizes phosphorus and potassium
- It is better protein utilization
72
Which vegetables have high potassium? (3)
- Avocado
- Spinach
- Sweet potatoes
73
What (3) fruits have high potassium?
- Bananas
- Tomatoes
- Citrus fruit
74
What medical treatment removes excess fluid, excess electrolytes and waste products when the body is unable to?
Dialysis
75
Dialysis is life-long unless?
You get a kidney transplant
76
What are (3) type of dialysis?
- Hemodialysis
- Peritoneal dialysis
- CRRT
77
What type of dialysis uses a machine and a special filter to clean the blood outside the body?
Hemodialysis
78
What type of dialysis uses the lining of the abdomen (peritoneum) to filter the blood inside the body?
Peritoneal dialysis
79
What does CCRT stand for?
Continuous Renal Replacement Therapy
80
What type of dialysis is a continuous process that runs slowly over 24 hours?
Continuous Renal Replacement Therapy (CCRT)
81
What is dialysis used for?
To correct fluid and electrolyte imbalances and remove waste products in renal failure
82
Is dialysis used for drug overdoses?
Yes
83
What are (3) principles of dialysis?
* Diffusion
* Osmosis
* Ultrafiltration
84
What is the the special fluid used in dialysis?
Dialysate
85
What are (3) treatment options for renal failure?
- Hemodialysis
- Peritoneal dialysis
- (CRRT), done in critical care
86
How long is hemodialysis?
3-4 hours
87
What type of dialysis requires AV line?
Hemodialysis
88
Which type of dialysis can be done overnight with a machine?
Peritoneal dialysis
89
How many times per day for peritoneal dialysis?
4-6 times/day
90
Is CRRT slow or fast infusing?
Slow dialysis
91
What type of dialysis may have a
fistula or catheter?
Hemodialysis
92
How many days per week for hemodialysis?
3-4 times per week
93
What are (5) complications of hemodialysis?
*Hypotension
*DDS (Dialysis disequilibrium syndrome )
*Muscle Cramps
*Loss of Blood
*Sepsis
94
What is DDS?
Dialysis disequilibrium syndrome
95
In peritoneal dialysis, the catheter is clamped, and the solution “dwells” for how many hours before being unclamped and drained?
1-4hrs
96
Peritoneal dialysis is used for what (2) kinds of clients?
- Stable clients
- Those who cannot tolerate HD
97
What type of dialysis can be performed independently at home?
Peritoneal dialysis
98
Is automated or continuous-ambulatory peritoneal dialysis done in the day time?
Continuous ambulatory peritoneal dialysis
99
What are complications of peritoneal dialysis? (9) Name a few
* Peritonitis
* Outflow Problems
* Bleeding
* Abdominal pain
* Hernias
* Lower back problems
* Pulmonary complications
* Protein loss
* Carbohydrate and lipid abnormalities
100
What is an infection of the peritoneum (the lining of the abdominal cavity) called?
Peritonitis
101
What is CAPD?
Continuous Ambulatory Peritoneal Dialysis
102
When using peritoneal dialysis, what medications should the nurse avoid?
Medications containing potassium and
magnesium
103
What condition occurs when waste products and toxins build up in the blood because the kidneys are no longer functioning properly?
Uremia
104
What type meds must be taken for life if a pt receives a kidney transplant?
Anti-rejections
105
When is transplant rejection most common?
during the first year after transplant
106
hyperacute transplant rejection is within how many hours?
within 24hrs
107
acute transplant rejection is within how many days?
3-14 days
108
Chronic transplant rejection is within how long?
Years
109
If the body rejects the transplanted kidney, what will be the client's next step?
the client will need to resume dialysis
110
What are signs and symptoms of transplant rejection?
- Oliguria
- Edema
- Fever
- Increasing BP
- Weight gain
- Swelling or tenderness over transplant site
111
Transplant rejection can be detected by what (2) things?
Ultrasound and renal biopsy
112
Nephrolithiasis is AKA?
Kidney stones, renal calculi
113
What are the (5) major categories of renal stones?
(a) calcium phosphate (most common of all renal stones are calcium)
(b) calcium oxalate
(c) uric acid
(d) cystine
(e) struvite
114
What is most common renal stone?
Calcium phosphate
115
What are the (2) manifestations of renal stones?
Pain and hematuria
116
How are renal stones diagnosed? (4)
- Urine culture
- Ultrasound
- Cystoscopy
- Stone analysis:
strain all urine and save stones
117
What is a medical procedure in which a doctor uses a thin, flexible tube with a camera to examine the inside of the bladder and urethra?
Cystoscopy
118
What is a non-invasive treatment used to break up kidney stones into smaller pieces using shock waves?
Extracorporeal Shock Wave Lithotripsy (ESWL)
119
What is ESWL?
Extracorporeal Shock Wave Lithotripsy
120
What is a surgical procedure used to remove large kidney stones. The doctor makes a small cut in your back and inserts a tube into the kidney.
Percutaneous Nephrolithotomy (PCNL)
121
What is PCNL?
Percutaneous Nephrolithotomy
122
Nursing diagnoses for renal stones? (3)
- Acute pain r/t irritation of stone
- Inadequate urinary elimination
- Inadequate knowledge
123
What dietary teaching would you give to someone with renal stones?
Restrict protein, sodium and calcium
124
How many L per day for someone with kidney stones?
3L
125
What is Post-op DB&C?
Postoperative Douche, Bladder and Catheter Care
126
What is a post op condition where the intestines stop moving properly, causing a blockage in the digestive system?
Paralytic ileus
127
Can the nurse preform leg exercises post-op?
Yes
128
What kind of tube is inserted directly into the kidney?
Nephrostomy tube
129
Is a nephrostomy tube used for internal or for external drainage of urine?
External drainage
130
What are (3) things you should never do to a nephrostomy tube?
Never clamped, irrigated, or kinked
131
Should the nurse push fluids for client with a nephrostomy tube?
Yes, if no renal or heart concerns
132
What are (2) serious kidney-related conditions linked to contrast dyes?
- Contrast-induced nephropathy (CIN)
- Nephrogenic systemic fibrosis (NSF).
