Week 3 (exam 2) Flashcards
Kidney disorders
Functions of the kidney
Acid-Base balance
Water removal
Erythropoiesis
Toxin removal
Blood pressure (ADH)(Vasopressin)
Electrolyte balance
Vi D activation
Chronic Kidney Disease
Umbrella term that describes decrease in kidney function lasting 3 or more months. Untreated leads to ESKD (end stage kidney disease)
Stages 1-5 of chronic kidney disease
Stage 1: GFR > 90
Stage 2: GFR 60 – 89
Stage 3: GFR 30 – 59
Stage 4: GFR 15 – 29
Stage 5: GFR < 15
Clinical manifestations of CKD
Increased creatinine levels
Anemia
Metabolic Acidosis
Fluid retention
Edema
Heart failure
Abnormal calcium and phosphorus levels.
Management of CKD
- Treat underlying cause
- Monitor labs (GFR), Creatinine clearance, BP and Weight
- Dialysis or early referral to RRT
Acute Kidney Injury
a rapid loss of renal function due to damage to the kidneys
if treated it can be reversed
Clinical manifestations of AKI
- critically ill and lethargic
- drowsiness
- headache
- muscle twitching
- seizures
- elevated BUN and creatine
- decline in GFR
- may have hematuria
- elevated Phos and potassium and Low Ca
- progressive metabolic acidosis
Underlying causes of AKI
-hypovolemia
-hypotension
-Reduced cardiac output and HF
-obstruction
Assessments and diagnostics of AKI
- BUN levels
- Creatine
- GFR
- US
- Non contrast CT
Prevention of AKI
- Monitor kidney function when giving nephrotoxic medications
- Contrast induced nephropathy (use mucomyst)
- Fluids
- Catheter care
Tx of AKI
- blood flow is restored to the kidneys with the use of IV fluids albumin and blood products
- maintaining fluid balance
- dialysis or RRT
- sodium bicarbonate to elevate PH levels
- Phosphate binding agents
- Kayexelate to reduce K+ levels
- IV dextrose 50%, insulin and Ca replacement to those who are hemodynamically unstable
- high carbohydrate feedings
Medical management of AKI
- monitor for hyperkalemia
- if the pt is experiencing EKG changes give 50% dextrose and insulin
- Medication dosages should be reduced
- monitor ABGs
- Weigh pt daily (if the pt gains or does not loose weight then fluid retention should be suspected)
Nutritional therapy CKD
low sodium, low potassium low phosphorus, moderate protein intake
End Stage Kidney Disease
5th stage of CKD, pt will require permanent renal replacement therapy
Complications of ESKD
Anemia
Bone disease
Hyperkalemia
HTN
Pericarditis
Pericardial effusion/tamponade
Vascular access device
Temporary dialysis catheter in the Subclavian vein, IntraJugular, or Femoral
the main type of vascular access devices for dialysis are
- arteriovenous fistulas
- arteriovenous grafts
- central venous catheters (there is cuffed vs non cuffed and cuffed has reduced chance of infection)
Renal function tests
- 24 Hour Urine/creatinine clearance (keep in dark container on ice)
- Creatinine level
- BUN
- GFR (should be >125)
Risk factors of chronic kidney disease
- cardiovascular disease
- diabetes
- hypertension
- obesity
Epogen
erythropoiesis-stimulating agent that is used to treat anemia in CKD
Periactin
Hemodialysis pre procedure
pt will need a patent vascular access point such as, an intra jugular CVC or an AV fistula
auscultate for bruit and palpate for a thrill
obtain vital signs, weight and labs prior to dialysis
Hemodialysis during and after the procedure
monitor for adverse effects such as hypotension, N/V, bleeding
after take pts weight and vitals (a decrease in weight and BP is expected) compare weight to estimate the amt of fluid removed
Peritoneal dialysis
instill hypertonic dialysate solution into the pts peritoneal cavity and allow it to dwell, then drain with the excess fluid and waste products
Peritoneal dialysis pre procedure
- warm dialysate solution
- assess pts weight
- sterile technique when accessing the catheter insertion site
Peritoneal dialysis post procedure
- when draining we want to make sure we are keeping the outflow lower that the patients abdomen
- monitor the color of the out flow (should be clear or yellow)
disequilibrium syndrome
a hemodialysis complication with neurologic deterioration that is associated with an increased in ICP
S&S
- N/V
- confusion
- decreased LOC
- can cause seizures coma and death
slow the rate or stop if symptoms become more severe
Peritonitis signs and symptoms
a complication associated with peritoneal dialysis
infection of the peritoneal
S&S
- fever
- cloudy outflow
- abdominal pain
- abdominal tenderness
- N/V
During hemodialysis pts may experience
- SOB- due to the extra fluid between dialysis treatments
- Hypotension
- Painful muscle cramping (electrolytes rapidly leaving ECF)
- Arrhythmias
Continuous cyclic PD (CCPD)
programmed to deliver an established amount of PD solution that will dwell in the peritoneal cavity for a programmed period of time
This process is done every night while they sleep to achieve the effects of dialysis required.
CCPD has a lower infection rate than other forms of PD
Continuous Renal Replacement Therapy (CRRT)
may be indicated for patients with acute or chronic kidney disease who are too clinically unstable for traditional HD
Some forms of CRRT may not require dialysis machines or dialysis personnel
Continuous Venovenous Hemofiltration
a type of CRRT
- often used to manage AKI
- requires a dual lumen venous catheter
- CVVH provides ultrafiltration (continuous slow fluid removal so hemodynamics effects are more tolerable)
Continuous Venovenous Hemodialysis
a form of CRRT
- requires a dual lumen venous catheter
- Provides ultrafiltration
- uses a concentration gradient to facilitate the removal of uremic toxins and fluid by adding a dialysate solution into the jacket of the dialyzer
Prerenal AKI
occurs in 60% to 70% of cases, is the result of impaired blood flow that leads to hypoperfusion of the kidney commonly caused by volume depletion
- burns
- hemorrhage
- GI losses
- hypotension
- sepsis
- shock
- obstruction of renal vessels
Intrarenal or intrinsic AKI
the result of actual parenchymal damage to the glomeruli or kidney tubules
- Rhabdomyolysis (muscle tissue breaks down, releasing harmful substances into the bloodstream)
- Contrast
- NSAIDs
- Myosin antibiotics
Postrenal AKI
results from obstruction distal to the kidney by conditions such as
- renal calculi
- strictures
- blood clots
- benign prostatic hyperplasia
- malignancies
- pregnancy
Phases of AKI
- Initiation period- whatever harms the kidney to the start of oliguria
- Oliguria period- elctrolytes become abnormal, metabolic acidosis, elevated BUN and creatine
- Diuresis period- marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover
- Recovery period- signals the improvement of renal function and may take 3 to 12 months
What is an indication that potassium is high
a Peaked T-wave and PVCs
