1
Q
What is AKI?
A
abrupt loss of kidney function
2
Q
What is CKD?
A
gradual loss of kidney function
3
Q
What is kidney disease?
A
partial or complete loss of the kidney
4
Q
What does kidney disease result in?
A
- impaired ability to excrete metabolic waste products and water
- functional disturbances of all body systems
5
Q
Characteristics of AKI?
A
- quick onset
- caused by acute tubular necrosis
- Acute ↓ in urine output and/or ↑ in serum creatinine
- possibly reversible
- 50-60% mortality rate
- infection is primary cause of infection
6
Q
Causes of AKI with renal failure?
A
- pre-renal causes: hemorrhage
- intra-renal cause: acute tubular necrosis
- post-renal cause: cancer BPH (functions which occur outside of the kidney)
7
Q
Prerenal causes of AKI?
A
- characterized by a marked decrease in renal blood flow (vasodilation, CHF, obstruction/narrowing )
- reversible if the cause of the decreased renal blood flow can be identified and corrected before renal damage occurs
8
Q
Intrarenal causes of AKI?
A
- account for 25-40% of all cases of AKI with renal failure
- characterized by damage to the structures within the kidney and impaired nephron function
- usually the result of prolonged ischemia or the presence of substances that are toxic to kidney tissue
9
Q
Postrenal causes of AKI?
A
- result from obstruction of urine outflow from the kidneys
- obstruction can occur at ant level of the urinary system
- obstruction must be bilateral to produce renal failure
- prostatic hyperplasia is the most common underlying problem
10
Q
Characteristics of Renal Failure?
A
- Systemic disease
- Final common pathway of many different kidney and urinary tract diseases
- Fluid and Electrolyte imbalances
- Metabolic derangements
- Acid-base disturbances
- Azotemia (buildup of nitrogenous waste products)
11
Q
Phases of Acute Tubular Necrosis?
A
- initiation
- maintenance
- recovery phase
12
Q
Initiation phase characterized by?
A
- ↑’ed serum creatinine
- ↑’ed serum blood urea nitrogen
- ↓’ed urine output
min 400cc of urine/day required to eliminate waste
under 400cc/day is called oliguria
13
Q
Maintenance phase manifestations?
A
- Changes in urinary output
- Fluid and electrolyte abnormalities
- Uremia (high blood-urea nitrogen)
- Other derangements
14
Q
Urinary changes?
A
Oliguria: less than 400 ml of urine in 24hrs
- urine has a normal specific gravity
- urine has a low osmolarity
15
Q
Fluid Abnormalities ?
A
-fluid volume excess
16
Q
Electrolyte imbalances?
A
- sodium depletion (hyponatremia)
- potassium excess (hyperkalemia)
- calcium deficit (absorption of calcium is poor due to non-functioning kidney)
- phosphate excess
17
Q
Fluid volume excess symptoms?
A
- JVD
- peripheral edema
- crackles
- LOC changes in result of uremia
- increased BP
18
Q
Electrolyte imbalance symptoms?
A
- changes in cardiac rhythm
- muscle cramps which could lead to weakness and paralysis
- decreased BP
- dysrmythmias
19
Q
What is uraemia and its S&S?
A
- “Urine in the blood”
- Develops as the kidneys fail and are unable to remove nitrogenous wastes from the body.
- Elevated BUN and serum creatinine
- Elevated serum creatinine a better indicator of kidney failure
*uremia affects platelet adhesiveness which leads to increased bleeding
20
Q
Other derangements of kidney disease?
A
- hematological disorders
- acid/base balance disruptions (metabolic acidosis)
21
Q
S&S of acute renal failure?
A
- Decreased urine output
- Manifestations of
- Fluid and electrolyte abnormalities
- Uremia
- Metabolic derangements
22
Q
Central nervous system manifestations (attributed to the uremia)?
A
- headache
- drowsiness
- irritability
- confusion
- preipheral neuropathy
- seizures
- coma
23
Q
Gastrointestinal manifestations?
A
- anorexia
- nausea & vomiting
- diarrhea or constipation
- dry mucous membranes
- uremic breath
- hematemesis
- GI bleeding (hematologic)
24
Q
Cardiovascular manifestations?
A
-hypotension (early on)
-hypertension (later on)
-arrhythmia’s
-fluid overload
-heart failure s&s (R side failure: edema, ascites, hepatomegaly) (L side failure: pulmonary edema, crackles, SOB)
-increased RR
-decreases LOC
-systemic edema
-anemia (hematologic)
altered clotting
25
respiratory manifestations?
- pulmonary edema
| - kussmaul’s respirations
26
integumentary manifestations?
- dry skinn
- pruritis
- pallor
- purpura
might last weeks or days
27
Recovery phase characterized by the return to normal of?
- Blood urea nitrogen
- Serum creatinine
- GFR
28
Manifestations of recovery phase?
- Diuresis (3-5 liters/day or more)
- Hypotension
- Hypovolemia
- Hyponatremia
- hypokalcemia
29
Diagnostic tests?
- History and physical (determine the cause of kidney failure)
- Urine analysis
- Blood (Creatinine and BUN, serum electrolytes)
- Renal ultrasound
- Renal scan (can see blood flow, integrity of filtration system)
30
Complications include?
- Death 50 - 60% (with renal failure)
- Sepsis infection (leading cause of mortality)
- Hypertension exacerbated by fluid overload: Use antihypertensive that do not decrease renal blood flow).
- Anemia is common, caused by increased red blood cell (RBC) loss and decreased RBC production.
- Platelet dysfunction may occur secondary to the uremia and present as gastrointestinal (GI) bleeding.
31
Collaborative therapy?
-Restore Chemical balance and prevent complications
- treatment of the cause
- management of fluids (fluid restriction)
- nutritional therapy
- management of elevated potassium
- calcium supplements
- renal replacement therapy
32
Management of fluids?
Fluid loss in previous 24 hrs + 600mls
-number would equal pt fluid restriction for that day
33
Nutritional Therapy; Adequate calories?
Prevent catabolism
| less protein and more fat + carbs
34
Nutritional Therapy; restrictions?
- prevent azotemia
- Prevent electrolyte disturbances
- Prevent fluid overload
35
Vitamins, Minerals, Electrolytes?
-Limit sodium and Potassium
Monitor for:
- High phosphorus
- High magnesium
- Low calcium (Consider Vitamin D intake)
36
Indications for Renal Replacement Therapy?
- Volume overload resulting in compromised cardiac or respiratory status or both
- Hyperkalemia
- Metabolic acidosis
- Uremia
- Alterations in mental status
37
Renal Replacement Therapy- dialysis?
Three Treatment Options in AKI
- hemodialysis
- peritoneal dialysis
- continuous renal replacement therapy
38
Dialysis?
Movement of fluid and molecules across a membrane from one compartment to another.
39
Hemodialysis?
- A method of removing waste products and excess fluid from the blood using a machine to pump the blood through an artificial semipermeable membrane.
- filters blood and eliminates water
3-4 times a week
Takes 2-4 hours
Machine filters blood and returns it to body
40
Types of Access for Hemodialysis?
- Temporary site (often for aki)
| - AV fistula or AV Fistula if condition is chronic and will require long term dialysis
41
Peritoneal Dialysis?
A catheter is used to fill the abdominal cavity with a dialysis solution that absorbs waste and excess fluids.
42
Continuous Renal Replacement Therapy?
- Renal replacement therapy applied for 24 hours/day.
| - Uses various blood purification techniques
43
Nursing Management?
- Monitoring fluid and electrolyte imbalances
- Reducing metabolic rate
- Promoting pulmonary function
- Preventing infection
- Providing skin care
- Providing support
