Karteikarten
AKI and CKD
Karten in diesem Stapel (59)
- 1Functions of the Kidneys-water regulation
-electrolyte regulation
-acid-base balance
-excretion of metabolic wastes
-excretion of foreign substances
-Production of Renin (RAAS cycle)
-Erythropoietin
-Activates active form Vit. D. - 2Kidney FactsThe kidneys receive 21% of the cardiac output (about 1200 ml/min). The glomerulus filters only about 125 ml/minute, so the rest is unfiltered. Substances such as WBC's, RBC's, and proteins are usually not filtered and remain in the bloodstream. About 99% of the filtrate is reabsorbed.
- 3Renal AssessmentWant to look at PMH (kidney, heart disease, DM, trauma) and drug use (nephrotoxic agents, diuretics). Include family history (PKD), and GU assessment, occupational exposure, recent blood transfusions (hemolytic reaction can damage), labs, ultrasound.
- 4Nephrotoxic Agents and SubstancesNSAID's, aminoglycosides (antibiotics such as Vanco or Gentamycin), contrast dyes, antiviral drugs, metformin, and ACE inhibitors, poisons, venom or other toxins, Hgb and myoglobin.
- 5Polycystic Kidney Disease(PKD) is a genetic disorder that involves cysts on the kidneys, results in kidney dysfunction. It is the 4th leading cause of kidney failure.
- 6Urinalysis (UA)Specific gravity: 1.001 - 1.030
pH: 4.5-8
Protein: absent
Glucose: absent
Ketones: absent
Color, odor, appearance
Blood: absent
Nitrates: negative (indicative of bacteria)
Leukocyte esterase: detects WBC's - 7Serum CreatinineNormal ranges: 0.6 - 1.5 mg/dL
Byproduct of muscle metabolism that is constantly produced and excreted. Creatinine clearance is indicative of GFR. - 8Estimated GFRNormally above 60 ml/min/1.73 m2
Is based on age, race, serum creatinine and gender. - 9Acute Renal FailureRapid decline in renal function with progressive azotemia (increased BUN) and increased Creatinine and potassium. May develop over hours or days. Less than 400 mL/day is BAD.
- 10BUN to Creatinine Ratio10:1
Bun should be about 10x more than creatinine. Rapid increase in BUN relative to a lower creatinine is indicative of acute renal failure. If they are both increased, that likely indicates chronic renal failure. - 11Three categories of causes of ARF1) Pre-renal
2) Intra-renal
3) Post-renal - 12Pre-renal causes of AKI (ARF)Factors outside of the kidney: hypovolemia, cardiac failure, sepsis, anaphylaxis, neurogenic shock, stenosis, emboli. Kidneys respond to decreased perfusion by activating RAAS cycle (increases Na and water reabsorption).
- 13Intra-renal causes of AKIDirect damage to renal tissue: glomerulonephritis, infection, acute tubular necrosis (ischemia, nephrotoxins, Hgb release, myoglobin-rhabdomyolysis).
- 14Pathology of Intra-renal AKI-Unable to eliminate or concentrate urine, reabsorb Na, eliminated K and Phosphate, metabolic acids and nitrogenous wastes
- 15Post-renal causes of AKIObstruction due to mechanical issues resulting in decreased outflow: BPH, renal calculi, trauma, prostate cancer, tumors, neurogenic bladder, diabetic neuropathy
- 16Management of AKI (ARF)Goal is to prevent prolonged episodes of hypotension and hypovolemia. Control I/O and fluid/electrolytes. Balance weight, may require short term hemodialysis. Main goal is to prevent progression to CKD.
- 17Those at greatest risk for AKI and related mortalityThose who've undergone major traumatic injuries: burns, sepsis, surgical procedures, cardiac failure, obstetric complications.
- 18Chronic Renal FailureProgressive irreversible destruction of the nephrons on BOTH kidneys with scar tissue replacement.
- 19Stage 1 CKDKidney damage with normal or increased GFR.
GFR>90
Usually has comorbid conditions.
Mngmt: Manage comorbid conditions, treatment of CVD and risk factors.
SX: HTN, hematuria, proteinuria, increased creatinine or urea, kidney damage DX. - 20Stage 2 CKDKidney damage with mild GFR reduction.
GFR > 60-89
Mngmt: slow rate of kidney damage/dysfunction.
SX: HTN, hematuria, proteinuria, increased creatinine or urea, kidney damage DX. - 21Stage 3 CKDModerate reduction in GFR.
GFR 30-59
Mngmt: Prevention and treatment of complications.
SX: evidence of anemia and bone disease - 22Stage 4 CKDSevere reduction of GFR.
GFR 15-29 mL/min
Mngmt: prepare for kidney replacement therapy and refer to nephrologist. - 23Stage 5 CKDKidney Failure.
GFR <15
Kidney replacement therapy is necessary for life. - 24Chronic Kidney (Renal) FailureCategorized by a 90% loss of GFR. Patients often have problems with hyperkalemia, hyperphosphatemia, hypocalcemia, sodium may vary, hypermagnesemia, metabolic acidosis, and HTN and pericarditis are common.
- 25Management of CRFProtein restricted diet (20-70 mg/day). Diabetics may become insulin resistant (controlled carb). May also have elevated triglycerides so low fat diet also necessary.
- 26Complications of CRFAnemia related to decreased erythropoietin production.
Bleeding tendencies d/t impaired platelets and fragile capillaries. Osteodystrophy d/t hypocalcemia and decreased Vit. D. Bronzing of the skin d/t retained pigments and "uremic frost" d/t crystallized urea in skin. - 27Neuro alterations with CRFFatigue, H/A, sleeping disturbances, lethargy, muscular irritability, seizures, confusion, and coma.
- 28Cardiovascular complications of CRFHTN, CHF, pericarditis, atherosclerosis, myocardiopathy, pericardial effusion
- 29GI complicationsAnorexia, N/V, bleeding, ulcers, stomatitis, gastritis
- 30Endocrine/Reproductive Complicationshyperparathyroidism, thyroid changes, ammenorrhea, infertility, sexual dysfunction, azospermia
- 31Metabolichyperglycemia, hyperlipidemia, malnutrition, and gout (build up of uric acid)
- 32Hematologicanemia, bleeding, infection
- 33ocularretinopathy from HTN and hyperglycemia
- 34RespiratoryEdema, pleuritis, dyspnea, pneumonia
- 35Integumentpallor, pigmentation changes, pruritis, ecchymosis, excoriation, uremic frost, dry scaly skin
- 36DialysisUsed to remove substances from the blood through a semipermeable membrane into a dialysis solution. Replaces function of kidneys essentially. Three processes are used: diffusion, osmosis, and ultrafiltration.
- 37UltrafiltrationUsing a medium fine enough to remove colloid particles, viruses, and large molecules.
- 38Substances that remain in the blood after dialysisNormal amount of electrolytes, water, bicarbonate
- 39Substances excreted during dialysisExcesses of sodium, magnesium, potassium, phosphate, creatinine, viruses, bacteria, urea.
- 40Peritoneal Dialysis AdvantagesQuickly instituted, less likely to cause fluid/electrolyte imbalances, little equipment necessary, no heparinization necessary, can be used with infants and children, dose not require vascular access.
- 41Disadvantages of Peritoneal DialysisSlow effect (takes about 36 hours at first), less efficient, high amount of protein loss, time intensive, bags of fluid are very large!
- 42Contraindications to Peritoneal DialysisActive peritonitis, recent abdominal surgery, known peritoneal adhesions
- 43Related complicationsInfection (cloudy return), perforation of the bowel (brown return), perforation of blood vessel (pink/red), perforation of bladder (amber return), catheter blockage, leakage around site, and abdominal discomfort.
- 44Continuous Ambulatory Peritoneal Dialysis (CAPD)Done 3-4 times daily, at your convenience.
- 45Continuous Cycling Peritoneal Dialysis (CCPD)Performed by machine for 9-10 hours at night. Can sleep through use.
- 46HemodialysisExcessive fluid removed across an artificial membrane that is in contact with the blood. Requires placement of a Temporary Access Catheter (Vas-Cath) usually inserted into internal jugular or femoral vein. Later would insert an AV (arteriovenuous) fistula. Done 3 to 4 times a week for 3-4 hours.
- 47AV Fistula AssessmentTakes 3 to 6 months to mature. Sometimes has a "buttonhole" or scab that forms over fistula that is removed with each access. Should feel a thrill and hear a bruit!
- 48AV GraftMan made tube is inserted by a surgeon to connect an after and a vein. Takes 2 to 6 weeks to mature.
- 49Protecting AV fistulas and graftsNO BP on that arm.
protect arm from injury.
Control obvious hemorrhage.
Maintain direct pressure.
NO IV on that arm. - 50Complications of hemodialysisHypotension d/t fluid loss, disequilibrium (rapid shift of urea) might cause confusion, tremors, seizures, nausea. Muscle cramps, N/V, seizures, bleeding, arrhythmias from rapid shift of K+, and air embolism.
- 51Steel Syndromearterial insufficiency d/t AV fistula. Insufficient blood flow to lower parts of the arm. Nurses.. do your circulation checks distal to AV fistulas and grafts!
- 52Nursing Consideration for dialysis patientsHold dialyzable medications til after dialysis. Monitor labs before and after, weigh patient daily, do not give antihypertensives before dialysis!
- 53Kidney TransplantBest option if they qualify! No need for dialysis and survival rate is 85% for 5 years. Usually one non-functioning kidney is left in place because it might still produce erythropoietin and activate Vit. D. Less expensive than hemodialysis after 1 year.
- 54Causes of Death Post TransplantCAD (30%), sepsis (27%), neoplasm (13%), stroke (8%). However infection is most common cause during first year after transplant.
- 55Hyper acute rejectionOccurs within 5 to 10 minutes up to 48 hours after transplant. Is very rare.
- 56Acute RejectionOccurs 7 to 14 days after transplant. Is more common. Kidney may fail after 6 months depending on circumstance.
- 57Signs of Kidney rejectionOliguria, edema, fever, hypertension, weigh t gain, swelling or tenderness over graft site, increased BUN an Creatinine. Kidneys should start working right away normally.
- 58Care Post-opIsolation precautions first 2 weeks after d/t immunosuppression therapy. Steroid induced GI bleed is a potential complication.
- 59Post Transplant Diabetes Mellitus (PTDM)Over 40 years, BMI >30, and elevated triglycerides poses extra risk.
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- Beschreibung
- Nursing (Renal/Genitourinary NRS 322) Karteikarten am AKI and CKD, erstellt von Allie Winningham am 05/12/2016.
- Erstellt von
- Allie Winningham
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