Terms/Definitions
End product of protein breakdown
Urea
If blood flow or pressure to the kidney decreases, ______ is released, with the end net result being vaso-constriction and increase in blood pressure.
Renin
pg 363 pearson
Name the cause of AKI:
Prolonged prerenal ischemia
Prolonged prerenal ischemia leads to Intra-renal damage -----> specifically Acute Tubular Necrosis
Is this a dumb question
True or False
Decreased osmolality that presents in the Maintenance Phase of AKI means that there is a increase in serum sodium levels.
FALSE
Decreased osmalality means that there is water retention, which dilutes sodium and causes hyponatremia
Osmolality is the concentration of solutes in the body fluid.
Which of the following is not a component of a Fluid Volume Challenge Test?
1. Administration of 500 to 1000mL of normal saline over 1 hour
2. Encourage increased oral fluid intake
3. Administer a loop diuretic to flush excess fluid through the kidneys
4. Administer a small dose of dopamine to increase renal blood flow
2 is not part of the Fluid Volume Challenge Test
The process by which a substance made by the body is released into the body to complete a particular function
Secretion
When calcium levels in the blood fall, _______ is released by the kidney. This active form of Vitamin D increases the absorption of calcium in the intestines. Outcome is increased serum calcium levels.
Calcitriol
Anaphylaxis
Pre-renal
Vasodilation and decreased systemic vascular resistance decreases perfusion to kidneys
Which of the following is not a management of hyperkalemis in the case of an emergency?
1. PO sodium bicarb
2. IV sodium bicarb
3. IV Insulin and dextrose
4. IV Calcium chloride
1 is not for use in emergency.
End product of muscle breakdown
Creatinine
Kidneys ______ hydrogen ions when there is excess acid in the body.
Excrete
Acute glomerulonephritis
Intra-renal
Which of the following is not a component of the Maintenance Phase of AKI?
1. Oliguria (<500mL in 24 hours)
2. Fixed specific gravity of 1.010
3. Hypotension
4. Crackles auscultated in the lungs
3 would be a finding of the Diuretic/Recovery Phase
HyPERtension would be a component of maintenance phase due to fluid volume excess. Crackles are a component because of FVE. Symptoms of maintenance phase caused by FVE, Metabolic Acidosis, Hypocalcemia, Hyperkalemia, Hyperphosphatemia
The urine output for the previous 24 hours was measured at 425mL. No loss of fluid through vomitus. Calculate the amount of fluid intake restriction for the patient today.
425 + 500 to account for insensible fluid loss (perspiration, respiration, through feces) = 925. Fluid restriction is limited to 925mL, including PO and IV.
Less than 500mL of urine per day
Oliguria
Kidneys _______ bicarbonate when when there is excess acid in the body.
Reabsorb
Severe prolonged nausea and vomitting
Pre-renal
related to hypovolemia
Match the clinical manisfestation with its cause:
Seizures Hypocalcemia
Fast and deep respirations Hyperkalemia
VFib Hyponatremia
Tetany Metabolic Acidosis
Seizures are mostly likely caused by hyponatremia
Fast/Deep resps are cause by Metabolic Acidosis (kussmaul resps to compensate and blow off CO2)
VFib mostly likely caused by Hyperkalemia
Tetany is caused by hypocalcemia
Which of the following is not appropriate nutrition management for a client with an AKI?
1. Encouraging or performing mouth care before meals
2. Providing small frequent meals and frequent snacks
3. Encouraging the patient to eat dried fruits like apricots.
4. Providing animal based protein rather than plant based protein
3 - dried apricots are high in potassium. This patient would be on a potassium restricted diet
All the others are correct because:
1. May be bad taste left in mouth because of nausea or uremia. Good mouth care promotes oral intake of food. p412
2. Smalls meals and snacks okay. p412
4. Patient will have protein restriction BUT the protein they do eat should be of high biological value and rich in essential amino acids. Animal protein is better than plant based protein because they generally contain more essential amino acids. Pg. 406 and also mentioned on pg 412 under safety alert
Less than 100mL urine per day
Anuria
_________ is ________ by the kidneys to stimulate the produciton of red blood cells.
Erythropoietin, secrete
Could be stimulated by severe blood loss or hypoxemia
Kidney stones
Post-renal
True or False
Hyponatremia in the Recovery/Diuretic Phase of AKI is caused by an increase in the excretion of sodium
True
Differs from hyponatremia in the maintenance phase which is caused by dilution
Which of the following is not a nephrotoxic drug or agent that should be avoided as part of management of AKI?
1. Ketorolac
2. Polyethylene glycol
3. Gentamcin
4. Lead
2 (aka miralax) is not nephrotoxic (at least doesn't say it is in Davis)
The rest are because:
1 is an NSAID
3 is aminoglycoside antibiotic
4 is a heavy metal that can be toxic to kidneys if high levels in the blood (source: Silvestri p. 822)