Acute Kidney Injury and Chronic Disease, Exams of Public Health

Download Acute Kidney Injury and Chronic Disease and more Exams Public Health in PDF only on Docsity! Acute Kidney Injury and Chronic Disease Kidney failure - ✓✓✓is the partial or complete impairment of kidney function. It results in an inability to excrete metabolic waste products and water and causes functional disturbances of all body systems. acute kidney injury (AKI) - ✓✓✓is the term used to encompass the entire range of the syndrome, ranging from a slight deterioration in kidney function to severe impairment - characterized by a raid loss of kidney function, shown by a rise in serum creatinine and/or reduction in urine output azotemia - ✓✓✓an accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood Acute kidney injury (AKI) - ✓✓✓usually develops over hours or days with progressive elevations of blood urea nitrogen (BUN), creatinine, and potassium with or without oliguria. It is a clinical syndrome characterized by a rapid loss of kidney function with progressive azotemia. AKI - ✓✓✓The causes of this are multiple and complex. They are categorized into prerenal (most common), intrarenal, and postrenal causes. Prerenal causes - ✓✓✓are factors external to the kidneys (e.g., hypovolemia) that reduce renal blood flow and lead to decreased glomerular perfusion and filtration. Intrarenal causes - ✓✓✓include conditions that cause direct damage to the renal tissue, resulting in impaired nephron function. Acute tubular necrosis accounts for most cases of intrarenal failure. Postrenal causes - ✓✓✓involve mechanical obstruction of urinary outflow. Common causes are benign prostatic hyperplasia, prostate cancer, calculi, trauma, and extrarenal tumors. RIFLE classification - ✓✓✓The ___________ (risk, injury, failure, loss, and end-stage disease) is used to describe and standardize the stages of AKI. Risk - ✓✓✓- serum creatinine increased x 1.5 OR GFR decreased by 25% - urine output <0.5 mL/kg/hr for 6 hrs Injury - ✓✓✓- Serum creatinine increased x 2 OR GFR decreased by 50% - urine output <0.5 mL/kg/hr for 12 hr Failure - ✓✓✓- Serum creatinine increased x3 OR GFR decreased by 75% OR serum creatinine >4mg/dL with acute rise >0.5 mg/dL - urine output <0.3 mL/kg/hr for 24 hr (oliguria) OR anuria for 12 hr Loss - ✓✓✓Persistent acute kidney failure; complete loss of kidney function > 4wk End-stage kidney disease - ✓✓✓Complete loss of kidney function >3 mo acute tubular necrosis (ATN) - ✓✓✓is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins, or sepsis AKI - ✓✓✓Clinically, this may progress through three phases: oliguric, diuretic, and recovery. true - ✓✓✓In some situations, the patient does not recover from AKI and chronic kidney disease (CKD) results, eventually requiring dialysis or a kidney transplant. oliguria - ✓✓✓a reduction in urine output to less than 400 mL/day Oliguric Phase - ✓✓✓- Fluid and electrolyte abnormalities and uremia occur during this phase. - Neurologic changes can occur as the nitrogenous waste products increase. oliguria - ✓✓✓The most common initial manifestation of AKI is this. diagnostic studies; AKI - ✓✓✓- Common electrolyte abnormalities include hyperkalemia, hyponatremia, and hypocalcemia. Elevated BUN and creatinine levels are found. - Other findings include metabolic acidosis, anemia, and platelet abnormalities. - is based on the history and physical as well as changes in urine output and serum creatinine. infection - ✓✓✓The most common cause of death in patients with AKI is this. diuretic phase - ✓✓✓This begins with a gradual increase in daily urine output of 1 to 3 L/day but may reach 3 to 5 L or more. - The nephrons are still not fully functional. - The uremia may still be severe, as reflected by low creatinine clearances, elevated serum creatinine and BUN levels, and persistent signs and symptoms. recovery phase - ✓✓✓This begins when the glomerular filtration rate (GFR) increases, allowing the BUN and serum creatinine levels to plateau and then decrease. Renal function may take up to 12 months to stabilize. collaborative care; AKI - ✓✓✓- treatment of precipitating cause - fluid restriction (600 mL plus previous 24-hr fluid loss) - nutritional therapy o adequate protein intake (0.6-2 g/kg/day) depending on degree of catabolism o potassium restriction CKD - ✓✓✓usually develops slowly over months to years. Death associated with cardiovascular disease is a more common outcome for patients with chronic kidney disease than survival to need dialysis. The prognosis of CKD is variable depending on the etiology, patient's condition and age, and adequacy of follow-up. end-stage kidney disease - ✓✓✓occurs when the GFR is less than 15 mL/min. At this point, RRT is required to maintain life true - ✓✓✓An elevation in serum creatinine is demonstrated only after over 50% of functioning kidney function (nephron mass) has been lost. Uremia - ✓✓✓is a syndrome that incorporates all the signs and symptoms seen in the various systems throughout the body in CKD. clinical manifestation; CKD - ✓✓✓- Fatigue, lethargy, and pruritus are symptoms associated with progression of kidney dysfunction. - Hypertension is both a cause and a consequence of CKD. - Hyperglycemia, hyperinsulinemia, dyslipidemia, and abnormal glucose tolerance tests may be seen. Metabolic derangements - ✓✓✓including hyperkalemia, hyponatremia, and metabolic acidosis tend to occur in the later stages of CKD Normocytic anemia - ✓✓✓is due to decreased production of endogenous erythropoietin. cardiovascular disease - ✓✓✓- The most common cause of death in patients with CKD is this, including ischemic heart disease, heart failure, cardiac dysrhythmias, and pulmonary edema. - Other complications include infections, neurologic changes, peripheral neuropathy, CKD-mineral and bone disease, pruritus, infertility, personality and behavioral changes, lethargy, and depression. CKD mineral and bone disorder - ✓✓✓develops as a systemic disorder of mineral and bone metabolism caused by progressive deterioration in kidney function diagnostic studies; CKD - ✓✓✓- H&P - identification of reversible kidney disease - renal ultrasound - renal scan - CT scan - renal biopsy - SUN, serum creatinine, and creatinine clearance levels - serum electrolytes - lipid profile - protein-to-creatinine ratio in first morning voided specimen - urinalysis - hematocrit and hemoglobin levels collaborative care; CKD - ✓✓✓- correction of extracellular fluid volume overload or deficit - nutritional therapy - erythropoietin therapy - calcium supplementation, phosphate binders, or both - antihypertensive therapy - ACE inhibitors or ARBs - measures to treat hyperlipidemia - measures to lower potassium - adjustment of drug dosages to degree of renal function - renal replacement therapy dialysis collaborative care; CKD - ✓✓✓- The primary goal of care in this is directed at reducing the risk of cardiovascular disease and premature death. - Secondary goals of this is to deter the progression of kidney dysfunction, recognize and treat the associated complications, and provide for the patient's comfort. - Medical management is instituted in an effort to postpone the need for maintenance dialysis. - In certain situations, CKD progression can be delayed by using drug therapy to reduce the damaging effects of proteinuria and hypertension. - Erythropoietin and iron replacement are used for the treatment of anemia. - Statins (HMG-CoA reductase inhibitors) are the most effective drugs for lowering low- density lipoprotein (LDL) cholesterol levels. - Prior to dialysis, dietary protein may be restricted to slow the progression of kidney dysfunction. Once the patient starts dialysis, protein intake is usually increased. - Water intake depends on the daily urine output. nursing management; CKD - ✓✓✓- Most persons with this are cared for in an ambulatory care setting. Hospital care is required for the management of complications. - Nursing care for the patient revolves around the nursing diagnoses of excess fluid volume, risk for injury, imbalanced nutrition, and grieving. - teach pt about lifestyle, diet, and drugs - teach pt to take daily BPs and identify s/s of fluid overload, hyperkalemia, and other electrolyte imbalances planning; CKD - ✓✓✓The overall goals are that a patient with this will; 1. demonstrate the knowledge and ability to comply with treatment and 2. participate in good self-care practices. 4. Individuals need to be empowered to actively participate in determining their own treatment plans to the highest degree that is achievable. evaluation; CKD - ✓✓✓pt will maintain; - F&E levels within normal ranges - an acceptable weight with no more than 10% weight loss Dialysis - ✓✓✓is a therapeutic intervention in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate). Dialysis solutions have an electrolyte composition similar to that of plasma. true - ✓✓✓The two methods of dialysis are peritoneal dialysis (PD) and hemodialysis (HD). peritoneal dialysis (PD) - ✓✓✓in this, the peritoneal membrane acts as the semipermeable membrane hemodialysis (HD) - ✓✓✓in this, an artificial membrane is used as a semipermeable membrane and is in contact with the pts blood true - ✓✓✓Two types of PD are automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). • Learning the self-management skills required to do PD at home usually requires a 3- to 7-day training program. PD - ✓✓✓is indicated when there are vascular access problems or poor response to the stress of HD. - The three phases of the this cycle (called an exchange) are inflow (fill), dwell (equilibration), and drain (outflow). inflow phase - ✓✓✓a prescribed amount of solution, usually 2 L, is infused through an established catheter over about 10 mins dwell phase - ✓✓✓during which the diffusion and osmosis occur between the pts blood and peritoneal cavity drain phase - ✓✓✓this takes about 15-30 mins and may be facilitated by gently massaging the abdomen or changing the position true - ✓✓✓The patient dialyzing at home will be given a daily prescription of exchanges that is specific for the individual patient automated peritoneal dialysis (APD) - ✓✓✓is the most popular form of PD because it allows pts to do dialysis while they sleep. An automated device is used to deliver the dialysate for APD nursing care; kidney transplant - ✓✓✓- emotional/physical prep for surgery - review procedure - review list of immunosuppressive drugs and possible need for dialysis at first - assess pt preop - label vascular access extremity "dialysis access, no procedures" - postop, monitor renal function and hematocrit - don't forget about attention to the donor - first goal is F&E balance - measure I&O Deceased kidney donors - ✓✓✓are relatively healthy individuals who have suffered an irreversible brain injury. - Permission from the donor's legal next of kin is required after brain death is determined even if the donor carried a signed donor card. complications; transplant - ✓✓✓- rejection - infection - malignancies - recurrence of original kidney disease - corticosteroid-related complications corticosteroid-related complications - ✓✓✓- aseptic necrosis of hips, knees, and other joints - PUD - glucose intolerance and diabetes - cataracts - dyslipidemia - infections - malignancies nursing management; kidney transplant - ✓✓✓- Nursing care of the patient in the preoperative phase includes emotional and physical preparation for surgery. - For the kidney transplant recipient, the first priority during this period is maintenance of fluid and electrolyte balance. Very large volumes of urine may occur in the immediate postoperative period, resulting in volume depletion, hypokalemia, and metabolic acidosis - Postoperative teaching should include the prevention and treatment of rejection, infection, and complications of surgery and the purpose and side effects of immunosuppression. Rejection - ✓✓✓a major problem following kidney transplantation, can be hyperacute, acute, or chronic. Immunosuppressive therapy - ✓✓✓is used to prevent rejection while maintaining sufficient immunity to prevent overwhelming infection. Infection - ✓✓✓is a significant cause of morbidity and mortality after kidney transplantation. - Transplant recipients usually receive prophylactic antifungal drugs. Viral infections, including CMV, are common. Cardiovascular disease - ✓✓✓is the leading cause of death following kidney transplant. Hypertension, dyslipidemia, diabetes mellitus, smoking, immunosuppressive medications, rejection, and infections can all contribute to the development of this. true - ✓✓✓The overall incidence of malignancies in kidney transplant recipients is higher than in the general population. The primary cause is the immunosuppressive therapy. gerontologic considerations - ✓✓✓- Approximately 35% to 65% of patients who have CKD are 65 or older. Physiologic changes in the older CKD patient include diminished cardiopulmonary function, bone loss, immunodeficiency, altered protein synthesis, impaired cognition, and altered drug metabolism. - Most older end-stage kidney disease (ESKD) patients select hemodialysis as their choice for renal replacement therapy. However, establishing vascular access for HD may be challenging because of atherosclerotic changes. - The most common cause of death in the older ESKD patient is cardiovascular disease (MI, stroke), followed by withdrawal from dialysis.