AKI/ CKD/ ESKD/Dialysis/ Kidney Transplant/ Cirrhosis
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| Acute Kidney Injury is... | show 🗑
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| Risks of developing ATN are... | show 🗑
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| R.I.F.L.E. | show 🗑
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| show | Oliguric phase to diuretic, then recovery. If not CKD results requires dialysis & transplant.
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| Prerenal is.... | show 🗑
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| show | NO
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| show | ↓ excretion in sodium = ↑NA/H2O Retention =↓ UOP
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| show | Caused by direct dmg to kidney tissue impairing nephrons- prolonged ischemia, nephrotoxins, sepsis, allergic reactions, AGN, SLE
ATN most common cause
Nephrotoxicity causes blockage of tubules
*potentially reversable
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| Nephrotoxic agents | show 🗑
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| show | Caused: BPH, prostate or bladder cancer, trauma to pelvis region, extrarenal tumors, calculi, spinal cord disease
Bilateral ureter obstruction leads to hydronephrosis- if relieved w/48hrs poss recovery
Prolonged obstruction irreversible
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| Oliguric Phase is defined as... | show 🗑
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| Best indicator of AKI is.. | show 🗑
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| Urea and creatinine is... | show 🗑
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| Diuretic Phase is | show 🗑
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| show | Hyponatremia, hypokalemia, & dehydration
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| show | Thorough PMH
Serum creat
urinalysis- casts, rbcs, wbcs, specific gravity 1.010, urine osmo 300
Kidney US
Renal Scan
CT w/o contrast
Renal Biopsy
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| Hyperkalemia in AKI treatment | show 🗑
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| First step in treating AKI is | show 🗑
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| Fluid restriction in AKI | show 🗑
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| Never give kayexalate to | show 🗑
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| show | Nephrotoxic drugs
age
trauma
surgery
burns
heart failure
sepsis
ob complications
pelvic trauma
pre-existing ckd
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| show | ↑ bun and- urea- creat in blood
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| AKI nutrition | show 🗑
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| show | Fluid intake and output
Daily weight
UOP color, glucose, gravity,protein,blood,casts
skin color edema
JVD
bruising
inflammation
LOC
crackles
murmurs
ecg for dysrythmias
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| Treatment of CAN | show 🗑
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| show | 1000ml
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| Leading cause of death in aki is | show 🗑
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| CKD is | show 🗑
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| CKD stages | show 🗑
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| Uremia indicated by | show 🗑
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| Clinical manifestations CKD | show 🗑
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| show | ↑ trig levels
hyperinsulinemia stimulates
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| show | BUN and Creat increase
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| show | Cardiovascular Disease
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| show | 7-8
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| show | Kidneys produce a hormone EPO, prompts bone marrow to make RBCs so when dmg occurs so does anemia
Tx: Iron, erythropoietin epogen, folic acid 1mg/day, bleeding tendencies
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| show | Leukocytosis ↓ WBC
↑ Glucose- hyperglycemia- susceptible to infection
trauma
av/g site infection
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| show | Thrill
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| show | Bruit upon auscultation
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| show | High ammonia levels cause hepatic encephalapathy and flapping of the hands when extended- also seen in renal
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| Diagnostics of CKD | show 🗑
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| Drug therapy for CKD | show 🗑
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| show | K Restricted
NA Restricted 2-4g/day
Protein Restricted
↓ Phos 1000mg
Low Fat
↑carbs
No salt subs
600ml+prev 24hr loss+ intake restriction
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| show | Digoxin, Antibiotics, Demerol, NSAIDS, Fluid volume overload,
Electrolyte imbalances
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| show | GFR<15ml >3months
FATIGUE, lethargy, proteinuria, pruritus, HTN
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| show | Daily weight
Constant BP's
Fluid overload monitoring
Hyperkalemia (n/v, fatigue, paresthesias, brady)
Strict Dietary
Med Teaching
HD & PD avail for home
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| show | HD 30-35/kcal/kg
PD 25-35 kcal/kg/day (includes glucose fm dialysate)
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| show | Hemodynamically unstable clients- 24hr round the clock dialysis thru cannulation of artery or vein- much slower fluid pull than HD
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| show | Volume overload
hyperkalemia
Metabolic Acidosis
Bun >120
↓LOC
Pericarditis
Peri-effusion
Cardiac Tamponade
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| Hemodialysis is.. | show 🗑
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| Hypovolemia.. | show 🗑
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| Metabolic Acidosis | show 🗑
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| show | Manual PD 30-50min- Auto 1-2 hrs
Less invasive then HD
Preferred in diabetic
issue infection/perotonitis
temporary cath
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| Complications of PD | show 🗑
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| PD pros and cons are.. | show 🗑
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| show | Continuous Ambulatory Peritoneal Dialysis
1.5L-3L removed 4xday
Manual w/4hr dwell times
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| Foods high in phospherus | show 🗑
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| Food high in salt | show 🗑
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| Foods high in Potassium | show 🗑
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| show | GI tract unable to absorb calcium in absence of VIT D.
Phosphate binders can help.
Phoslo admin w/ea meal- may need stool softener
Vit-d <30- supplement cholecalciferol needed
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| show | Movement of fluid to LESSER to GREATER of solutes
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| show | Movement fm GREATER to LESSER concentrate.
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| Ultrafiltration | show 🗑
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| Dialysis Solution | show 🗑
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| show | 2L infused over 10min, flow rate can be ↓ for pain, close clamp after infused.
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| PD Dwell phase | show 🗑
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| show | Lasts 15-30 min may be facilitated w/gentle massaging or changing position
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| show | Automatic cycler times and controls equilibrium so pt can dialize while sleeping
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| show | Manual 1.5-3L exchanges x4day 7 12 5 10
risk for peritonitis
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| show | forearm anastomosis of radial & cephalic vein
2lg needles used
bruit you hear
thrill you feel
3 months prior to HD
not good for HTN, Vascular problems, DM
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| AV graft | show 🗑
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| Steal syndrome | show 🗑
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| Temp Vascular Access | show 🗑
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| show | Long plastic cartridge w/hollow tubes & filters - blood pumped into top fibers-dialysate pumped through bottom- clean blood then returns to pt
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| HD procedure | show 🗑
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| HD nursing | show 🗑
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| HD complication hypotension | show 🗑
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| show | d/t rapid removal of NA and H2O
tx: reduce rate and infuse hypertonic or NS bolus
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| HD complication Blood Loss | show 🗑
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| show | Blood transfusions lack of precautions or blood screening for hep c
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| Diff between CVVH and CVVHD | show 🗑
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| Kidney transplant | show 🗑
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| Procedures that may be required prior to tx | show 🗑
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| Histocompatibility | show 🗑
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| show | deceased w/compatibility
blood relatives
emotionally related donors
paired organ donation
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| Expired donor | show 🗑
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| Live donor | show 🗑
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| Post-op KT care | show 🗑
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| Sudden drop in UOP KT | show 🗑
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| Nrsg Mgt KT | show 🗑
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| Immunosuppressive Drugs | show 🗑
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| S/E Immuno drugs | show 🗑
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| show | CMV most common
candida, cryptococcus, aspergillus, epstein-barr, hsv, utis pneumocystis- occurs first month
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| KT CV complications | show 🗑
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| show | Basal cell carcinoma- sunscreen avoid sun
Lymphoma
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| Recurrence of Renal Disease in KT | show 🗑
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| show | aseptic necrosis hips, joints
peptic ulcer
DM
dylipidemia
cataracts
↑ cancer
↑infection
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| show | minutes to hours
sudden ↑ BP
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| Acute rejection is | show 🗑
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| show | Over months to years is irreversible
proteinuria, ↑creat
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| show | Chronic, slow progressive disease- abnormal re-shaping of the liver with fibrous tissue impedes blood flow, 8th leading cause of death
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| Two types of Cirrhosis are | show 🗑
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| show | Jaundice, thrombocytopenia, leukopenia, asteresis, edema/ascites, spider angiomas, palmar erythema, lesions, esophageal varices, libido, gynocomasteia, ammenorrhea, dec b12, dec folic
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| Causes of Cirrhosis | show 🗑
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| Decompensated cirrhosis is | show 🗑
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| Portal HTN | show 🗑
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| show | ↑AST ↑ALT ↓Stool bilirubin, ↓plt, ↓wbc, ↓alb/protein,
↑BUN ↑CREAT
↑Serum Bilirubin
↑ Urine Bilirubin
↑PT bleeding time
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| Hepatorenal Syndrome | show 🗑
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| show | Neurotoxic effect of ammonia
CHange in LOC impaired
asterexsis
fetor hepaticus
Tx: lactulose, rifaximin, antibiotic, prevent constipation, control gi bleeds
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| Cirrhosis diet w/o complication | show 🗑
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| show | 3rd spacing belly
tx: NA restriction, albumin, potassium sparing aldactone amilodrine, tolvaptan, paracentesis, TIPS, vasopressor samsca
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| Esophageal varices | show 🗑
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| Cirrhosis nursing | show 🗑
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| Paracentesis | show 🗑
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| show | monitor for pettichiae, electric razor, soft bristle toothbrush, oral care, refractory bleeding may need shunt or tips, balloon tamponade, aspiration, scissors bedside for emergency
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| More s/s AKI | show 🗑
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| show | Epogen/erythropoietin is being given
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| AKI Diet can have | show 🗑
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| PD diet can have | show 🗑
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| HD diet can have | show 🗑
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| CKD diet can have | show 🗑
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| KT diet can have | show 🗑
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| Cirrhosis diet can have | show 🗑
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| Hepatotoxic | show 🗑
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| show | confusion
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