Acute Kidney Injury and Chronic Kidney Disease, Exams of Infectious disease

Download Acute Kidney Injury and Chronic Kidney Disease and more Exams Infectious disease in PDF only on Docsity! Acute Kidney Injury and Chronic Kidney Disease Renal Failure - Correct answer Results when the kidneys cannot remove wastes or perform regulatory functions > A systemic disorder that results from many different causes -- *Acute Renal Failure (now known as Acute Renal Injury)*: *metabolic* syndrome that results in decreased GFR (glomerular filtration rate) and oliguria > Lasts *less than 3 months* -- *Chronic Renal Failure (ESRD: end-stage renal disease)*: progressive, irreversible deterioration of renal function that results in azotemia > Prognosis fatal - renal replacement therapies > *Dialysis, transplantation* Azotemia - Correct answer Excessive urea and nitrogenous substances in the blood Causes of Renal Failure - Correct answer 1. Pre-Renal 2. Intra-Renal 3. Post-Renal Pre-Renal Failure - Correct answer Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness > Impaired blood leads to hypoperfusion of the kidney and a drop in the GFR -- hemorrhage -- renal losses (diuretics, osmotic diuresis) -- GI losses (vomiting, diarrhea, NG suctioning) -- Impaired cardiac efficiency resulting from > Myocardial infraction > Heart failure > Dysrhythmias > Cardiogenic shock -- Vasodilation resulting from > Sepsis > Anaphylaxis > Antihypertensive medications; or other meds causing vasodilation Intra-Renal Failure - Correct answer Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply > Prolonged renal ischemia > Nephrotoxic agents > Infectious processes Post-Renal Failure - Correct answer Sudden obstruction of urine flow d/t enlarged prostate, kidney stones, bladder tumor, or injury -- Urinary tract obstruction > Calculi > Tumours > Benign prostatic hyperplasia > Strictures > Blood clots Acute Kidney Injury (AKI) - Correct answer > Varying and subtle degrees of renal impairment > Changes occur in first 48 hours > Renal failure associated w/ AKI is referred to as *acute renal failure* > About 50% of cases have normal or increased urinary output E&P: AKI - Correct answer A complex disorder w/ many factors and manifestations ranging from minimal elevation in serum creatinine to anuric renal failure -- Possible pathological processes > HypoVol. and decreased renal blood flow > Ischemia > Tubules damaged, edema, and necrosis > Glomerular filtrate leaks decreasing intratubular fluid flow Causes of Acute Renal Failure - Correct answer > Hypovolemia > HypoTN > Reduced CO and HF > Obstruction of the kidney or lower urinary tact > Obstruction of renal arteries or veins Causes of Chronic Renal Failure - Correct answer > Diabetes, > Hypertension > Lupus > Polycystic Kidney Disease > Glomerulonephritis > Goodpasture's syndrome > Pyelonephritis or other infections > Obstruction of urinary tract > Hereditary lesions > Vascular disorders > Medications or toxic agents E&P Acute Renal Failure - Correct answer Complex disorder w/ many factors and manifestations ranging from minimal elevation in serum creatinine to anuric renal failure > Action: estimation of progress Stage 3 ESRD - Correct answer Moderate to severe loss of kidney function > Moderate decrease GFR > Anemia, early bone disease > Action: evaluation and treatment of complications Stage 4 ESRD - Correct answer Severe loss of kidney function > Severe decreased GFR > Fatigue, swelling, N&V > Action: preparation for RRT (renal replacement therapy) Stage 5 ESRD - Correct answer Kidney failure: dialysis > Action: RRT (if uremia present and pt. desires treatment) > less than 15 ml/min GFR Uremia - Correct answer High levels of urea in the blood What is the most life-threatening of the fluid and electrolyte changes that occur in pt. w/ renal disturbances? - Correct answer Hyperkalemia S&S Chronic Renal Failure - Correct answer Less than 15ml/min GFR > Neurological weakness, fatigue and confusion > Increased BP, pitting edema, periorbital edema, increased CVP, and pericarditis > SOB, depressed cough, and thick sputum > Withdrawn, behaviour changes, depression > Anemia, bleeding tendencies, increased K+ > Flaky dry skin, pruritus, ecchymosis, purpura, yellow-gray skin colour > Cramps, renal osteodystrophy and bone pain > Ammonia odour to breath, metallic taste, N&V, anorexia and mouth/gum ulcerations Tip for Hemodialysis - Correct answer Evaluate access site for patency and signs of infection; DO NOT take BP or obtain blood samples from extremity that has access site Clinical S&S: CKD - Correct answer > Result of retained substances: uremia, polyuria, oliguria, anuria > Metabolic disturbances -- Waste product accumulation > As GFR decreases, *BUN increases* and *Creatinine increases* -- Not only by kidney failure but by protein intake, fever, corticosteroids, and catabolism -- N&V, lethargy, fatigue, impaired thought processes, and headaches occur -- *Metabolic Disturbances* > Defective carbohydrate metabolism -- Caused by impaired glucose use -- Clients w/ diabetes who become uremic may require less insulin than they did before onset of CKD > Elevated triglycerides -- Hyperinsulinemia stimulates hepatic production of triglycerides Clinical S&S: Electrolyte/Acid-Base Imbalances (CKD) - Correct answer > Potassium: hyperkalemia - fatal dysrhythmias can occur if K+ reaches 7-8 mmol/L > Sodium: hyponatremia and hypernatremia alterations > Magnesium alterations > Metabolic acidosis Effects of Renal Failure on Electrolyte Imbalance - Correct answer *Hyperkalemia* > Retained w/ oliguria > Could cause cardiac dysrhythmias/asystole -- Assess and report signs and symptoms of increased K+ > Slow, irregular pulse > Muscle weakness, diarrhea > EKG changes > Treat or prevent metabolic acidosis -- *Treatment* > Monitor serum potassium daily > *Kayexalate*: PO or rectal for hyperkalemia > Regular IV insulin mixed in 5-50% dextrose to move K+ back into cells > IV calcium gluconate > Dialysis Clinical S&S: Hematological System (CKD) - Correct answer > Anemia > Bleeding tendencies > Infection > Increased incidence of cancer Clinical S&S: Cardiovascular (CKD) - Correct answer > HyperTN > HF > Left ventricular hypertrophy > Peripheral edema > Dysrhythmias > Uremic pericarditis Clinical S&S: Resp. (CKD) - Correct answer > Kussmaul respirations (deep and laboured breathing) > Dyspnea > Pulm. edema > Uremic pleuritis > Pleural effusion > Predisposition to resp. infections > Depressed cough reflex > "Uremic lung" Clinical S&S: GI (CKD) - Correct answer Every part of GI is affected; d/t excessive urea > Mucosal ulcerations > Stomatitis > Uremic fetor (urinous odour of the breath) > GI bleeding > Anorexia > N&V Clinical S&S: Neurological (CKD) - Correct answer > Expected as renal failure progresses > Altered mental ability, seizures, coma > Dialysis encephalopathy and peripheral neuropathy > Restless leg syndrome and muscle twitching > Irritability and decreased ability to concentrate Clinical S&S: Musculoskeletal (CKD) - Correct answer Renal Osteodystrophy > Syndrome of skeletal changes > Result of alterations in calcium and phosphate metabolism > Two types associated w/ ESRD --1. Osteomalacia (bone softening) --2. Osteitis Fibrosa (become weak and deformed) > Metastatic calcifications Clinical S&S: Integumentary (CKD) - Correct answer > Yellow-grey skin > Pruritus > Uremic frost (severe azotemia) > Brittle hair > Thin nails > Petechiae > Ecchymoses Clinical S&S: Reproductive (CKD) - Correct answer > Infertility > Decreased libido > Low sperm counts > Sexual dysfunction Clinica S&S: Endocrine (CKD) - Correct answer > Hypothyroidism > Low levels of T3 and T4 NM: Diagnostic Studies (CKD) - Correct answer > History and physical examination > Laboratory tests > Renal ultrasound Uremic signs and symptoms affecting all body systems > N & V, severe anorexia, increasing lethargy, and mental confusion -- *Hyperkalemia*, fluid overload not responsive to diuretics and fluid restriction, and a general lack of well-being Peritoneal Dialysis - Correct answer Dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood > *Goal*: to remove toxic substances and metabolic wastes and to re-establish normal fluid and electrolyte balance > Choice for patients unable or unwilling to undergo hemodialysis or renal transplantation > Fewer problems than hemodialysis -- *NOT AS EFFICIENT AS HEMODIALYSIS* -- Peritoneal access is obtained by inserting a catheter through the anterior wall > The peritoneal membrane serves as a *semi-permeable membrane* > Urea and creatinine and other waste products are cleared from the blood by equilibrium (dwell phase) and ultrafiltration > Usually done via surgery -- Infusion period for a continuous ambulatory peritoneal dialysis is available Complications of Peritoneal Dialysis - Correct answer > Exit site for infection > Peritonitis > Abdominal pain > Outflow problems > Hernias > Lower back problems > Bleeding > Pulm. complications > Protein loss > Carbohydrate and lipid abnormalities > Encapsulating sclerosing peritonitis > Loss of ultrafiltration The movement of solute (waste products) from an area of higher concentration to an area of lower concentration is: A. Anuria B. Diffusion C. Osmosis D. Ultrafiltration - Correct answer B. *Diffusion* Hemodialysis - Correct answer Dialyzer (artificial kidney) serves as a synthetic semipermeable membrane that replaces the glomeruli > Prevents death for patients w/ ESRD > 3 times/week for 3-4 hours per treatment > Dialyzer is a long plastic cartridge that contains thousands of parallel hollow tubes or fibres (the semi-permeable membrane) Complications of Hemodialysis - Correct answer > Clotting > Narrowing > Infection > Bleeding > HypoTN > Muscle cramps > Hepatitis > Sepsis > Disequilibrium syndrome Vascular Access Site (Hemodialysis) - Correct answer Obtaining vascular access is one of the most difficult problems -- Minor surgical procedure (types include) > Shunts > Internal arteriovenous fistulas and grafts > Temporary vascular access Fistula - Correct answer > Dr. creates by joining an artery to a vein > The fistula begins to mature > The vein increases in size and may look like a cord under your skin > Whole process takes about *3-6 months*, some longer > Once mature it is ready for dialysis Graft - Correct answer > A man made tube that connects an artery to a vein > Can usually graft in *2-6 weeks*, when it is healed sufficiently > *Fistulas are preferred to grafts* because fistulas are constructed using your own tissue, therefore more durable and resistant to infection Knowledge Deficit r/t Vascular Access Care - Correct answer > Emphasize patient's crucial role in protecting vascular access > Assess several times per day to make sure the access is functioning > Monitor bleeding after dialysis and notify any unusual bleeding -- *Explain Restrictions* > No constricting clothing > Do not carry heavy objects > Do not sleep on that arm > Do not allow injections to be given into the fistula or graft •No BP, IV insertion or venipunctures to affected arm NM: Patient on Dialysis - Correct answer > Protect vascular access; assess site for patency and signs of potential infection, and do not use it for blood pressure or blood draws > Monitor fluid balance indicators and monitor IV therapy carefully; keep accurate I&O and IV administration pump records > Assess for signs and symptoms of uremia and electrolyte imbalance; regularly check laboratory data > Monitor cardiac and respiratory status carefully > Monitor blood pressure; antihypertensive agents must be withheld on dialysis days to avoid hypotension > Monitor all medications and medication dosages carefully; avoid medications containing potassium and magnesium > Address pain and discomfort > Implement stringent infection control measures > Monitor dietary sodium, potassium, protein, and fluid; address individual nutritional needs > Provide skin care: prevent pruritus; keep skin clean and well moisturized; trim nails and avoid scratching A patient receiving peritoneal dialysis is complaining of pain with rebound tenderness. The dialysate drainage is cloudy. This is indicative of which acute complication? A. Hernia B. Bleeding C. Leakage D. Peritonitis - Correct answer D. *Peritonitis*