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34 Cards in this Set
- Front
- Back
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What is AKI?
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Acute kidney injury
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What is ARF?
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A severe AKI
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How is ARF managed?
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RRT (renal replacement therapy)
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What are 3 lab values, along with +/- oliguria, that are indicative of an AKI?
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Increased Urea
Increased Creatinine Increased K+ |
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There are three categories/causes of AKI, what are they?
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Pre renal causes
Renal/intra-renal/intrinsic Post renal causes |
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What are the pre renal causes of AKI, which make up for 55-60% of all ARF
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Hypovolemia
Vasodilation (decreased SVR) Decreased CO Renal vascular obstruction *They are all low perfusion |
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What happens to the Na values in pre renal AKI? What can happen to the renal tubules?
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Because Na is failed to be excreted, Na increases, water retention also increases. The renal tubules can undergo acute tubular necrosis because of lack of blood flow.
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What are the intrarenal causes of AKI?
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Renal ischemia
Nephrotoxins Blocked tubules Renal diseases Acute Tubular necrosis *Anything that causes direct damage to the kidneys |
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What is the most common reason behind ARF?
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ATN
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What is ATN caused by (there are 2 main)
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Ischemia
Nephrotoxins |
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What are the post renal causes of AKI
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BPH
Prostate cancer Calculi*anything that obstructs urinary flow |
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What are the three phases of ATN
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Initiation phase
Maintenance phase Recovery phase |
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How long is the initiation phase of ATN?
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From hours to days
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How long is the oliguric (maintenance) phase?
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from days to weeks
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What's the difference between anuric, oliguric, or non oliguric?
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Anuric (no urine, less than 100 ml a day)
Oliguric (low urine output, less than 400 ml a day) Non oliguric (more than 500 ml a day, little waste, blood not filtered) |
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What does the body become acidotic during the maintenance phase, and what's the body do to compensate?
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Cannot excrete bicarb as a buffer
For compensation it does Kussmaul's respirations Become hyperkalemic |
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Why does hypercalcemia ensue?
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Kidney's cannot activate Vitamin D
So it impairs GI absorption Leads to hypocalcemia But PTH secretion causes more Calcium and PO4 from the bone to be released |
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What are other concerns during the maintenance phase?
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Waste product accumulation of urea and creatinine
Anemia Neurological disorders |
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What to monitor in the recovery phase?
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Gradual increase in urine output
Monitor for hypotension, hypovolemia, Decreased K, Na, and dehydration If dehydration occurs, it'll result in hypotension, which will make us start all over again |
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What marks the recovery phase?
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GFR increases
BUN/Creatinine decreases |
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What are diagnostic tests we can do for ARF?
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Labs - Creatinine, BUN, CBC, electrolytes
Creatinine clearance test CTRenal scan |
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The best thing to do with ARF, is to prevent it. But how?
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Hydrate post angiogram
Fluids for hypovolemia Manage heart failureMonitor renal function and nephrotoxic drugs Monitoring of fluid and electrolyte status |
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The management of ARF includes
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Fluid management
Treat hyperkalemia Nutritional therapy Renal replacement therapy |
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How do you treat hyperkalemia?
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Stabilize myocardiom with calcium gluconate
Enhance K removal with -Kayexalate -Diuretics (potassium removing ones like Lasix) - Dialysis Shift potassium back into cells with -glucose and insulin combination -salbutamol -NaHCO3 Dietary restrictions Stop K enhancing meds |
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Why is nutritional therapy required?
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To stop catabolism which creates urea
To stop PTH from leeching more Ca and Phosphate from the bones |
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The most common form of RRT for AKI is?
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Hemodialysis
- done when you need a rapid effect over short time - done intermittently 4 hr/day, 3 or 4 times a week- over 24 hours or longer - slower rate of change- preferred for hemodynamically unstable patients |
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What are some nephrotoxic chemicals (outside of drugs)?
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insecticides, organic solvents, cleaning agents
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What are high risk populations?
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Trauma
Elderly Burns UTI Chemotherapy |
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What is recovery based on? 3 factors
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Age, general condition
Duration of Oliguria Severity of Nephron damage |
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1. A patient developed shock aftera severe MI and now has RF. The pt fam asks the nurse why the ptdeveloped acute
A.A decrease in the blood flow through the kidneys B.An obstruction of urine flow from the kidneys== |
A. A decrease in the blood flow through the kidneys
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2.The serum K level of a pt in ARF is 6.2. Which of thefollowing interventions may be ordered (select all that apply, circle on scantron,don’t get them all u don’t get the question right)
A.Polystyrenesulfonate (Kayexalate) B.Regularinsulin C.50%dextrose D.Dpotassiumreplacement therapy E.Clalciumgluconate |
ABCE
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3.In the Oliguric(Maintenance) phase of ARF the nurse should assess the ptfor
A.Pulmonaryedema B.Metabolicalkalosis C.Hypotension D.Hypokalemia |
A.Pulmonary edema
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4.In the oligruicphase of ARF the nurse can expect to find which of the following breathingpatterns?
A.Normal B.Apneic C.Cheyne-Stokes D.Kussmaul’s |
D.Kussmaul’s
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5.Duringthe oliguric(maintenance phase) the nurse would expect to find which of thefollowinglab values? (Select all that apply)A.Hyponatremia
B.Hyperkalemia C.Hypercalcemia D.Hypophosphatemia E.Hypocalcemia |
ABE
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