AKI
The 3 places kidney injury can occur.
What is...
Prerenal
Intrarenal
Postrenal
How many and what are the stages of AKI
What is...
4 stages: Onset, Oliguric, Diuretic, and Recovery
The normal range of Creatinine
What is...
0.6-1.2
Name four sections of your assessment tab that could be filled out if you suspect your patient has an AKI
What is...
Mental status, Skin, Chest (heart and lungs), Abdomen, Back, Extremities, GI/GU, Neurological
What is the purpose of cortisol?
What is...
A stress hormone in the body. It helps the body respond to stress.
Name 3 or more prerenal causes of AKI
What is...
Dehydration,over diuresis, hemorrhage, heart failure, hypotension, decreased cardiac output, vasoconstriction, prerenal obstruction (emboli,tumor), sepsis, or shock.
What is a normal amount of urine ouput vs a critical level of urine output?
What is...
800-2000 ml/day is considered normal
<400 ml/day is considered abnormal
What does BUN stand for and what is the most likely culprit if it is elevated?
What is...
Blood Urea Nitrogen and Dehydration
Name one neurological change that can occur in AKI
What is...
Fatigue, confusion, drowsiness, seizures, a coma, etc
Aldosterone is important for regulating what?
What is...
Blood pressure and electrolytes
Name at least 3 causes of Intrarenal AKI
What is...
Acute tubular necrosis, toxins, infections (lupus nephritis), or medications (contrast dyes, certain antibiotics), trauma
During the diuretic phase of an AKI, GFR is increased. Respectively urine output would also be increased to what? Hint: L/day
What is...
4-5 L/day
What is the lab test that is most specific to the kidneys?
What is...
Creatinine
Your patient reports that they haven't urinated in 2 days. What is a follow up question for your patient?
What is...
Make it make sense (open ended)
Name at least 3 signs or symptoms of adrenal crisis
What is...
low sodium, low BP, low cortisol, weight loss, nausea, dizziness, orthostatic hypotension, extreme weakness or fatigue
Name 3 causes of postrenal AKI
What is...
Blockage of urine flow from the kidneys, such as a kidney stone, tumors, enlarged prostate, or foley obstruction
AKIs when caught quickly are very treatable and reversible. Patients are likely to make a full recovery. How long can the recovery phase take?
What is...
Up to 12 months, 2 years in some cases
A patient on an interfacilty transfer has an AKI. She has an elevated BUN and Creatinine. BUN is 24 and creatinine is 2. What is the patient's BUN to creatinine ratio?
What is...
12
Your patient reports that they have CKD and they missed their last dialysis appointment. What would you expect their BUN, creatinine, and potassium to be? What important diagnostic intervention should we be doing?
What is...
All 3 would possibly be elevated.
12 lead ecg
Name the rescue medication for an adrenal crisis
What is...
Hydrocorticosteroids
Name 2 nephrotoxic drugs
What is...
NSAIDS, contrast dye
How quickly can an AKI be brought on?
What is...
Hours to just days
Your patient has a K+ of 6. What clinical signs would you anticipate?
What is...
slow weak pulse, muscle weakness, and deadly arrhythmias with peaked T waves
What other diagnostic tools are used in the hospital for AKI?
What is...
Ultrasound
If you run into the patient with Addisons disease (in Adams County) on a 911 and they appear to be experiencing an adrenal crisis. What is the appropriate protocol?
What is...
Treat the patient's symptoms and treat underlying problem with their prescribed rescue medications. Required two doses on the way to Mile Bluff Medical Center.