Human Needs Chapter 46: acute kidney injury
B
A client in kidney failure is to have a serum blood urea nitrogen level determined. What will this diagnostic test measure? A. Concentration of the urine osmolarity and electrolytes B.Serum level of the end products of protein metabolism C.Ability of the kidneys to concentrate urine D.Levels of C-reactive protein to determine inflammation
abnormalities in kidney blood flow, tubular function, and the collecting system.
What can a renal scan assess?
Potassium restriction Limit: 2 to 3 g Phosphate restriction Limit: 1g/day
What is restricted for a patient with CKD?
acute tubular necrosis
What is the most common cause for AKI?
diabetic nephropathy
What is the most common cause for CKD?
a patient with a paralytic ileus because bowel necrosis can occur.
sodium polystyrene sulfonate (Kayexalate) should not be given to who?
carbohydrate and fat sources to prevent ketosis from endogenous fat breakdown and gluconeogenesis from muscle protein breakdown. Supplementation of essential amino acids can be given for amino acid replacement.
Adequate energy should be primarily from?
rapid loss of kidney function
How is AKI characterized?
over hours or days with progressive elevations of blood urea nitrogen (BUN), creatinine, and potassium, with or without a reduction in urine output.
How long does it take for AKI to develop?
a rise in serum creatinine level and/or a reduction in urine output.
The loss of kidney function is accompanied by ?
D
The nurse teaches a patient with chronic kidney disease about prevention of complications. What should the nurse include in the teaching plan? A. Monitor for proteinuria daily with a urine dipstick. B. Perform self-catheterization every 4 hours to measure urine. C. Take calcium-based phosphate binders on an empty stomach. D. Check weight daily and report a gain of greater than 4 pounds
a small increase in serum creatinine or reduction in urine output to the development of azotemia
The severity of dysfunction can range from?
Force fluids Loop diuretics (e.g., furosemide [Lasix]) Osmotic diuretics (e.g., mannitol)
To ensure adequate intravascular volume and cardiac output what should the nurse do?
Polypharmacy Hypotension Diuretic therapy Aminoglycoside therapy (e.g. Gentamicin) Obstructive disorders Surgery Infection
What age group are more susceptible to AKI?
Excess fluid volume Risk for infection Fatigue Anxiety Potential complication: dysrhythmia
What are nursing diagnosis for patients with AKI?
volume overload, resulting in compromised cardiac and/or pulmonary status elevated serum potassium level metabolic acidosis (serum bicarbonate level less than 15 mEq/L [15 mmol/L]) BUN level greater than 120 mg/dL (43 mmol/L) significant change in mental status pericarditis, pericardial effusion, or cardiac tamponade
What are the most indications for Renal Replacement Therapy in AKI?
Preserve existing kidney function Reduce the risks of CV disease Prevent complications Provide for the patient's comfort
What are the overall goals for a patient with CKD?
Meat Dairy products
What foods are high in phosphate?
oranges, bananas, melons, tomatoes, prunes, raisins, deep green and yellow vegetables, beans, and legumes
What foods are high is K?
Correction of extracellular fluid volume overload or deficit Nutritional therapy Erythropoietin therapy Calcium supplementation, phosphate binders Antihypertensive therapy Measures to lower potassium Adjustment of drug dosages to degree of renal function
What is Conservative therapy for patients who have CKD?
has been used effectively and involves cannulation of an artery and a vein.
What is Continuous renal replacement therapy (CRRT) has?
evaluating for possible kidney disease and obstruction of the urinary collection system.
What is a kidney ultrasound useful for?
Both insulin and sodium bicarbonate
What is a temporary measure for treatment of hyperkalema?
AKI) is the term used to encompass the entire range of the syndrome, including a very slight deterioration in kidney function to severe impairment
What is acute kidney Injury?
30 to 35 kcal/kg and 0.8 to 1.0 g of protein per kilogram of desired body weight
What is adequate caloric intake?
an accumulation of nitrogenous waste products [urea nitrogen, creatinine] in the blood
What is axotemia?
thorough history
What is essential for iagnosing the etiology of AKI?
Daily monitoring of a patient's urine output
What is essential this information provides prognostic implications and is crucial in determining therapy and daily fluid volume replacement.?
•Sodium
What is restricted as needed to prevent edema, hypertension, and heart failure?
acute reduction in urine output and or elevation in serum creatine
What is the diagnostic criteria of AKI?
GFR <60 ML/MIN/1.73 M2 for >3mon
What is the diagnostic criteria of CKD?
identify lesions, masses, obstructions, and vascular anomalies.
What is the function of a CT scan?
is considered the best method for confirming intrarenal causes of AKI.
What is the function of a renal biopsy?
<60 mL/min for 3 months or longer
What is the glomerular filtration rate(GFR) for a patient is has CKD?
provide adequate calories to prevent catabolism despite the restrictions necessary to prevent electrolyte disorders, fluid disorders, and azotemia.
What is the goal for of nutritional management for AKI?
SUDDEN
What is the onset for AKI?
gradual, often over many years
What is the onset for CKD?
infection
What is the primary cause of death for AKI ?
cardiovascular disease
What is the primary cause of death for CKD ?
Eliminate the cause Manage signs and symptoms Prevent complications
What is the primary goals of AKI?
potentially
What is the reversibility for AKI?
progressive and irreversible
What is the reversibility for CKD?
A
What nursing measure would be included in the plan of care for a client with acute kidney injury? A. Observe for signs of a secondary infection. B. Provide a high-protein, low-carbohydrate diet. C. n and out catheterization for residual urine D. Encourage fluids to 2000 mL in 24 hours
sodium polystyrene sulfonate (Kayexalate) and dialysis
What removes K from the body?
Evaluate the patient's mental status and level of consciousness. Examine the oral mucosa for dryness and inflammation. Auscultate the lungs for crackles and rhonchi or diminished breath sounds. Monitor the heart for the presence of an S3 gallop, murmurs, or a pericardial friction rub. Assess ECG readings for the presence or development of dysrhythmias. Review laboratory values and diagnostic test results.
What should the nurse monitor for?
Hyperkalemia
What the most serious complication of AKI?
Calcium gluconate
What will aises the threshold at which dysrhythmias will occur, serving to temporarily stabilize the myocardium?
a loss of more than 50% of kidney function.
When will an increase in serum creatinine be evident?
ntermittent hemodialysis (HD
Which RRT treatment is the method of choice when rapid changes are required in a short period of time.?
d
Which assessment would indicate to the nurse that a patient has oliguria related to an intrarenal acute kidney injury? A. Urinary sodium levels are low. B. The serum creatinine level is normal. C. Oliguria is relieved after fluid replacement. D. Urine testing reveals a specific gravity of 1.010
Kidney
Which ultrasonography is often the first test done, since it provides imaging without exposure to potentially nephrotoxic contrast agents?
cardiac dysrhythmias
Why is hyperkalemia life-threatening?
