Row 1
Ch. 46
Ch. 46
AKI
What is the Onset, Common causes, Dx, Reversibility, and Cause of death with AKI?
(400 points added)
Onset: Sudden
Common causes: Acute tubular necrosis (kidney disorder involving damage to the tubule cells of the kidneys, which can lead to AKI. the tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys).
Dx: Reduced urine out, High creatinine
Reversibility: Potentially
Cause of death: Infection
CKD
What is the Onset, Common causes, Dx, Reversibility, and Cause of death with CKD?
(400 points added)
Onset: Gradual, over years
Common causes: Diabetic nephropathy (common complication of type 1 and type II DM. Over time, diabetes that isn't well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure).
DX: >3 months damage, <GFR
Reversibility: Progressive and irreversible
Cause of death: Cardiovascular
(1) What is AKI?
(2) What electrolytes will be elevated?
(3) What are the 3 phases of AKI?
(300 points added)
(1) Rapid loss of kidney function (acute, hours-days)
(2) BUN, Creatinine, Potassium
(3) Prerenal, intrarenal, or postrenal causes (cause is complex)
What is prerenal of AKI (think of location and what can happen in this phase)?
(200 points added)
-- Reduction in systemic circulation
- Decreased CO
- Severe dehydration
- Hypovolemia
What is Intrarenal of AKI (think of location and what can happen in this phase)?
(200 points added)
-- Direct damage to kidney tissue
- nephrotoxins
- Kidney disease
- Acute tubular necrosis (prolonged ischemia)
What is postrenal of AKI (think of location and what can happen in this phase)?
(100 points added)
-- Obstruction of outflow leading to reflux
- Enlarged prostate
- Renal calculi
- Extrarenal tumors
What are the 3 phases of AKI?
-- Oliguric
-- Diuretic
-- Recovery
Knowledge Check!
Your pt has Na+ level of 127 and has put out 2.5 L on your shift. what phase of AKI is the pt in?
A. Oliguric
B. Diuretic
C. Recovery
D. Combination
B. Diuretic
When it comes to Anemia w/ CKD (what meds are used)?
(200 points added)
--Erythropoietin (EPO)
- Epoetin alfa (Epogen): Caution: risk for htn/clots
- Iron supplements: Caution: May cause dark stool/stained teeth
Knowledge Check!
Your pt with CKD and has been dx with anemia. The provider prescribed Epogen to be given subcutaneously. You know that Epogen can cause what?
A. Tachycardia
B. Hypotension
C. Bradycardia
D. Hypertension
D. HTN
What are some nursing considerations when it comes to AKI?
-- Ensure adequate intravascular volume and cardiac output (Loop diuretics (Lasix) and Osmotic diuretics (Mannitol)
-- Closely monitor fluid intake (Fluid restriction calculation is all fluid losses for previous 24 hours + 600mL).
(1) What occurs in the Oliguric phase of AKI (think of what is happening to pt in this phase, think of electrolytes that are imbalanced, think of the pH level, PaO2, and HCO3)?
(200 points added)
-- Urine output <400 mL/day
-- Fluid overload
-- High BUN and Creatinine
-- Hyperkalemia
-- Metabolic acidosis
What are some clinical manifestations of CKD?
(200 points added)
--Uremia (GFR decreases, BUN/creatinine increase)
-- Altered carbohydrate metabolism
-- metabolic acidosis (Hyperkalemia)
-- HTN
--Fluid overload
--Anemia
(1) What is dialysis?
(2) Do you need emergent dialysis with AKI or routinely have dialysis for AKI?
(2) Do you need emergent dialysis with CKD or routinely have dialysis for CKD?
(1) Correction of fluid and electrolyte imbalances when uremia (build up of waste products in the blood) can no longer conservatively be tx.
(2) Emergent
(3) Emergent and/or routinely
What are some main outcomes that can occur with our AKI patients?
-- Regain kidney fx (expected outcome)
-- Hemodialysis (HD) (intermittent and/or emergent)
-- Peritoneal Dialysis (PD)
-- Continuous Renal Replacement Therapy (CRRT) \
**Think prevention of HTN and hypovolemia**
(1) What occurs in the Diuretic phase of AKI (think of what is happening to pt in this phase, think of electrolytes that are imbalanced)?
(100 points added)
-- Urine output >1-3 L/day
-- risk for hypovolemia
-- high BUN and creatinine
-- Risk for hypokalemia
What are some nursing considerations when it comes to CKD?
-- Preservation of existing kidney fx
-- Prevent complications
-- Closely monitor fluid intake (what's the calculation for this)?
-- Initiate dialysis when needed
(1) What is continuous renal replacement therapy (CRRT)?
(2) What unit does the pt need to be on if receiving CRRT?
(3) How long is the pt on CRRT for and what type of catheter needs to be available (temp or permanent)?
(1) Typically used for acute kidney injury (AKI) CRRT is continuous fluid and over longer period of time compared to HD. BP <90 means that the pt may not be able to tolerate too much fluid taken off at one time (hemodialysis) so, CRRT is a better option. Pt candidate for CRRT would be based on the pts stability.
(2) ICU
(3) Slow dialysis 24 hours a day (usually temporary dialysis catheter most of the time).
(1) What is chronic kidney disease (CKD)?
(2) What are some increased prevalence's among pts that increase there risk for CKD?
(3) Low glomerular filtration rate (GFR) >60 for 5+ months indicates the dx CKD. True or False?
(1) Progressive, irreversible loss of kidney fx
(2) Diabetes (1 in 3 diabetics have CKD) and HTN
(3) False (<60 for 3+ months helps indicate the dx of CKD).
(1) What occurs in the Recovery phase of AKI (think of what is happening to pt in this phase, think of electrolytes involved)?
(200 points added)
-- Urine output normalizes
-- Euvolemia
-- Decreasing BUN and Creatinine
(1) What is Hemodialysis (HD)?
(2) Explain what arteriovenous fistulas and grafts are and how are they put in (temporary and permanent).
(1) Requires rapid blood flow and access to a large blood vessel. Tx that filters wastes and water from your blood, as the kidneys do when they were healthy.
(2) Arteriovenous fistulas & grafts (permanent) connecting a piece of artery and vein together (takes time to use) Using a bridge to connect the vain and artery (use in shorter amount of time 2-4 wks). Temporary dialysis catheters: Catheter placed in right atrium of the heart. Can have 3 ports, one pot is for blood to dialysis machine, other port is blood from the dialysis machine, and the extra port at times can be used for blood draws.
(1) What do you assess before HD (pre-procedure)?
(2) What do you need assess during HD?
(3) What do you need to assess after HD (post)?
(100 points added)
(1) --assess fluid status (how much fluid can be taken and filtered out at one time)
--assess vascular access (fistula (thrill and bruit must be present, if not it can indicate a clot and cant use). Temporary, you can pull back and see if you get blood return).
--Pt weight
(2) --Assess VS's every 30 minutes (sometimes every 15 mins) Remember there is a high risk for hypovolemia, want to make sure you are not taking off too much fluid at one time. Monitor the machine (ensure it is working correctly), Watch the pt closely (massive fluid shifts can place pt at risk for hypotension (looking for signs of hypovolemia).
(3) Assess hemodynamics (electrolytes may be out of range, check labs)! Check for bleeding at access site, ensure pressure dressing is clean and intact (some blood may be present, that is ok), Frequent VSs (hypotension, temp can occur, monitor closely)! Remember pt at risk for Hypovolemia!
(1) What is Peritoneal dialysis (PD) and what is a huge risk factor with PD?
(2) What are the 3 phases of PD (explain what occurs in each phase)?
(3) What is the color and consistency we want to see after draining the fluid out?
(4) What are some complications we need to watch out for with our pts that are on PD?
(200 points added)
(1) Accesses the peritoneal cavity through surgical placement.
--caution: high risk for infection (maintain sterile environment)
--PD may be pt preference or vascular access may not be suitable for pt to do hemodialysis.
(2) Phase 1: Fill (dialysis soliton (dextrose=osmotic agent) in the peritoneum, maintain sterile environment.
--Phase 2: Dwell (solution sits inside the peritoneal cavity)
--Phase 3: Drain (get the fluid out, make sure to get as much out as you have put in. check the insertion site and the waste fluid consistency and color after draining).
(3) Light yellow (looks like light colored urine) blood may be present if the catheter insersion is new, that is normal. Do not want a lot of blood or a thick darker yellow consistency.
(4)
-- Infection (catheter site, Peritonitis)!!!
-- Bleeding
-- Protein loss
-- Pulmonary complications (decreased expansion).