kidneys?
Most common causes of AKI
1. hypotension
2. hypovolemia
3. heart failure
4. exposure to nephrotoxin
what should you assess before and after dialysis?
1. weight
2. blood pressure
3. heart and lung sounds
4. vascular access site patency
5. presence of peripheral edema
What is the most common cause of UTIs?
urine stasis
(will also take E. coli)
normal adult urine output per day
1500 mL/day
signs of acute hemolytic blood transfusion reaction
-quick onset, w/in 15 min of start of transfusion
-fever, possibly w/ chills
-back, abdominal, or flank pain
-infusion site pain
-tachycardia
-dyspnea
-tachypnea
-hypotension
-jaundice
-dark urine
-bleeding
-AKI
-shock, cardiac arrest, DIC, death
Name 4 functions of the kidneys
1. filter blood to remove/balance waste, electrolytes, and acid-base (controls composition and volume of ECF)
2. regulate BP
3. RBC production
4. Aid in Ca++ absorption
typical electrolyte imbalances of someone with CKD
hypocalcemia
hyperphosphatemia
hyperkalemia
low bicarb (acidosis)
salt?? hypo?? idk
most common cause of death of someone with an acute kidney injury
secondary infection
name a integumentary symptom that occurs with CKD
1. uremic frost- precipitation of renal urea and nitrogenous waste through sweat on skin --> pruritus
2. ecchymosis
3. dry, scaly skin
signs of febrile blood tranfusion
-rigors
-fever
-headache
-vomiting
*give antipyretics and follow HCP order
Most common location for urinary calculi to form
renal pelvis
common complications of hemodialysis
1. hypotension
2. blood loss
3. muscle cramps
4. hep c
what type of diet is preferred for someone with an acute kidney injury
low protein
________ is both a cause and consequence of CKD
HTN
Why are patients with CKD often anemic?
decreased EPO production
microvascular manifestations of CKD
nephropathy
neuropathy
retinopathy
what does CRRT stand for and what is it?
Continuous Renal Replacement Therapy
methods used to replace normal kidney function by circulating the patient's blood through a hemofilter and returning it to the patient
this medication helps alleviate the cardiac effects of hyperkalemia on the body, but does not remove K+.
calcium gluconate
raises threshold for dysrhythmias, temporarily stabilizing the myocardium
Two important nursing interventions following a TURP are bladder irrigation and strict I&Os. Calculate the patient's urinary output.
Irrigation instilled: 2000mL
PO intake: 200 mL
IV intake: 500 mL
Total Output: 2700 mL
700 mL
signs of mild vs severe allergic reaction from blood transfusion
mild:
- flushing, itching, pruritus, urticaria
severe:
-anaphylaxis
-abdominal pain
-urticaria, dyspnea, wheezing, cyanosis, bronchospasm, hypotension, shock, cardiac arrest
-pulmonary symptoms
What should you be aware of when using contrast in patients with kidney issues?
what medication is given to *permanently* treat hyperkalemia in patients with CKD?
sodium polystryene sulfonate (Kayexalate)
**Bonus Q: what is given to temporarily treat hyperkalemia?
briefly explain the RAAS pathway, including the stimulus and end result
1. BP decreases (for any reason, hypotension, blood loss, etc)
2. Low perfusion of kidneys detected by Macula Densa
3. Juxtaglomerular cells release Renin
4. Renin converts angiotensinogen into angiotensin I (which stimulates release of aldosterone ==> increase in blood volume)
5. angiotensin I --ACE--> angiotensin II, which is a powerful vasoconstrictor that increases peripheral vascular resistance, which results in an increase in BP and perfusion of kidneys
**angiotensin II also stimulates ADH and aldosterone secretion, and stimulates the SNS**
Bonus Question:
With that being said, what is the effect of ACE inhibitors on the body?
Explain the different between prerenal, intrarenal, and postrenal causes of kidney disease
Pre: causes related to reduction in renal blood flow
-decreased CO, cardiogenic shock, HF, MI, distributive shock, emboli, dehydration/burns, hemorrhage
Intra:due to direct damage to renal tissue
- nephrotoxic drugs, renal infections, hemolytic reaction, glomerulonephritis, prolonged ischemia, SLE
Post: mechanical obstruction of outflow of urine
- BPH, bladder cancer, calculi, strictures, trauma
rules for blood transfusions/handling blood products
-do not transfuse for more than 4 hours
-use within 30 min of receipt from blood bank (preferably straight from blood bank --> patient)
-do not store on unit
-can only be given with normal saline
-remain with patient for first 15 minutes