Fluid and Electrolytes: Understanding Acute Kidney Injury (AKI), Exams of Nursing

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NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A the syndrome or group of symptoms associated with end-stage renal disease in which fluid and electrolyte balance is altered, the regulatory and endocrine functions of the kidney are impaired, and accumulated metabolic waste products affect essentially every other organ system - CORRECT ANSWERUremia a urine-like breath odor often associated with a metallic taste in the mouth - CORRECT ANSWERUremic Fetor crystallized deposits of urea on the skin from high levels of urea in the sweat - CORRECT ANSWERUremic Frost kidneys unable to remove accumulated metabolites from blood --> altered fluid, electrolyte, acid base balance - CORRECT ANSWERRenal Failure increased levels of nitrogenous waste seen in acute or chronic failure - CORRECT ANSWERAzotemia silent disease progresses slowly with dew symptoms - CORRECT ANSWERChronic Kidney Disease Ischemia: insufficient blood supply exposure to nephrotoxins -other causes major surgery sepsis severe pneumonia - CORRECT ANSWERCause of Acute Kidney Injury Prerenal- obstructive Intrarenal (Intrinsic)- acute damage to the renal parenchyma and nephrons Postrenal- obstructive causes - CORRECT ANSWERCauses and Patho of AKI categories most common type *results from conditions that affect renal blood flow and perfusion* Trauma (surgery/ critically ill pt.) - *watch for hypertension and hematuria* GFR falls when cardiac output drops - CORRECT ANSWERPrerenal AKI reverses rapidly when blood flow restored and renal parenchyma undamaged - CORRECT ANSWERAKI can lead to tubular cell necrosis, nephron damage - CORRECT ANSWERunresolved ischemia *characterized by acute damage to renal parenchyma and nephrons* NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A -Etiology- acute tubular necrosis *most common cause* acute glomerulonephritis- reduces renal blood flow vascular disorders affecting the kidney- vasculitis, malignant hypertension, arterial or venous occlusion - CORRECT ANSWERIntrarenal AKI *can result from an condition that prevents urine excretion* Benign Prostatic Hyperplasia most common factor or renal tumors, urinary tract calculi -children may have oliguria or normal or increased urine output - CORRECT ANSWERPostrenal AKI renal failure without oliguria - CORRECT ANSWER=Less severe injury sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness - CORRECT ANSWERother Prerenal AKI causes direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply - CORRECT ANSWERother Intrarenal AKI causes sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury - CORRECT ANSWERother Postrenal AKI causes 5% of all hospitalized patients develop 4.5% of children in ICU and up to 8% of infants in NICU up to 75% mortality rate in seriously ill patients (older adults, critically ill) can occur at any time of life - CORRECT ANSWEREtiology AKI major trauma or surgery infection hemorrhage severe heart failure severe liver disease lower urinary tract obstruction drugs and radiologic contrast media that are toxic to kidney older adults child with renal insufficiency - CORRECT ANSWERRisk Factors of AKI counteracting vasoconstriction enhancing blood flow through the nephron providing protection against injury by oxygen free radicals knowledge of adverse effects associated with infusion of contrast media - CORRECT ANSWERPreventative Strategies AKI last hours to days NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A with improvement: 3-4 sessions/week not used for hemodynamically unstable patients complications: hypotension, hemorrhage, infection - CORRECT ANSWERHemodialysis 2 for patients who are unable to tolerate hemodialysis -allows gradual fluid, solute removal -blood continuously circulated for 12 or more hours -helps to maintain hemodynamic stability -avoid complications associated with rapid changes in the composition of ECF - CORRECT ANSWERContinuous Renal Replacement Therapy continuous arteriovenous hemofiltration continuous arteriovenous hemodialysis continuous venovenous hemodialysis - CORRECT ANSWERCommon types of CRRT double lumen catheter -subclavian, jugular or femoral veins - CORRECT ANSWERShort Term Vascular Access Dialysis and CRRT ateriovenous fistula -nondominant arm used in chronic kidney disease: arteriovenous graft - CORRECT ANSWERLong Term Dialysis and CRT Access complications, mortality higher with catheter access than with AV fistulas, grafts -infection -clotting or thrombus -aneurysm -psychologic impact of AV fistula or graft failure - CORRECT ANSWERRisk with Dialysis Access dialysate instilled into peritoneal cavity -peritoneal membrane serves as dialyzing surface less risk for unstable patient -fluid, solutes removed more gradually -increased risk of peritonitis contraindications -recent abdominal surgery -significant lung disease -peritonitis - CORRECT ANSWERPeritoneal Dialysis most commonly preterm infants causes NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A -hemolytic uremic syndrome -acute glomerulonephritis -sepsis -poisoning -hypovolemia -obstructive uropathy -complication of cardiac surgery - CORRECT ANSWERAKI in Infants health child suddenly ill with significant nonspecific symptoms -initial treatment: rapid fluid replacement, albumin when blood loss causes circulatory depletion if oliguria persist, intrinsic renal damage suspected *caution with Step bacteria, causes the glomerulus tubules to inflame* - CORRECT ANSWERChildren and Adolescents AKI Placenta Previa, HTN, Preeclampsia, Eclampsia, hemorrhage, N&V -physiologic hydronephrosis of pregnancy -promotes urinary stasis - leads to urinary tract infection - ultimately can leak to AKI AKI associated with sepsis following illegal abortion - CORRECT ANSWERPregnant Women AKI decreased renal reserve, declining function interfere with ability to recover for AKI changes of aging increase risk of AKI Etiology: sepsis, polypharmacy *especially nephrotoxic drugs such as NSAID's* heart valve or bypass surgery increase risk of AKI - CORRECT ANSWEROlder Adults AKI urine output of 30 mL/hr in adult patients should be reported nephrotoxic drug awareness assessment, observation and patient interview complaints --> anorexia, nausea, weight gain, edema recent exposure to nephrotoxins transfusion reaction chronic disease --> diabetes, HF, kidney disease physical exam vital signs urine output, weight, skin color, peripheral pulses, edema, lung, heart, and bowel sounds - CORRECT ANSWERNursing Process AKI weight will return to baseline urine output will be >30 mL/hr hemoglobin, hematocrit will be within normal limits NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A serum electrolytes will be within normal limits pulse rate, volume, rhythm will return to baseline - CORRECT ANSWERGoals AKI care varies based on cause of AKI -maintain hourly I&O -weight pt daily -assess vitals every 4 hours assess breath and heart sounds, neck veins for distention, back and extremities for edema patient in semi-fowlers report abnormal electrolyte values --> HYPERkalemia, HYPOnatremia, HYPERphosphatemia turn frequently restrict fluids administer medications with meals - CORRECT ANSWERImplementation AKI monitor and record food intake, weigh daily, consult dietitian, include patient and family in meal planning provide small frequent meals, between meal snacks administer antiemetic medications administer parenteral nutrition - CORRECT ANSWERAddress Nutrition Imbalances AKI assess knowledge and understanding teach patient and family about the diagnostic test and therapeutic procedures discuss dietary and fluid restrictions teach signs and symptoms of complications teach the patient how to monitor weight, blood pressure, pulse instruct patient to avoid nephrotoxic drug and chemicals - CORRECT ANSWERProvide Patient Teaching AKI patient maintains fluid, electrolyte, acid-base balance patient's nutritional needs are met as evidenced by dietary recall, return to appropriate weight, absence of signs and symptoms of nutrition imbalance patient acquires no secondary infections - CORRECT ANSWEREvaluation AKI a type of renal failure that progresses slowly with few symptoms until the kidney are severely damaged and unable to meet the excretory needs of the body. - CORRECT ANSWERChronic Renal Failure 90% of normal kidney function - CORRECT ANSWERStage 1 Chronic 60-89% or normal kidney function - CORRECT ANSWERStage 2 Chronic 30-59% of normal kidney function - CORRECT ANSWERStage 3 Chronic NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A fatigue/ weakness easy bruising, bleeding anemia thirst cramps skin color changes making little. no urine kidney dialysis kidney transplant - CORRECT ANSWERStage 5 CKD urinalysis urine culture BUN creatinine creatinine clearance GF Serum Electrolytes CBC Albumin Renal Ultrasound Kidney Biopsy - CORRECT ANSWERDiagnostic Test CKD most medication primarily excreted by kidney -absorption decreases with administration of phosphate-binding agents -proteinuria increases risk of toxicity for highly protein bound drugs -loop diuretics --> decrease edema, hypertension -antihypertensive agents -electrolyte replacement bicarbonate/glucose/insulin to decrease hyperkalemia folic acid, iron supplements - CORRECT ANSWERPharm Therapy CKD restrict protein intake increase carbs regulate water and sodium intake in later stages, potassium and phosphorus restricted avoid- salt substitutes and food high in phosphorus (eggs, dairy, meat) - CORRECT ANSWERNutrition CKD used when pharm and dietary strategies are no longer effective most common hemodialysis, peritoneal dialysis, transplant - CORRECT ANSWERRenal Replacement Therapy CKD in dialysis center or home for ESRD: three times a week, total of 9-12 hours - CORRECT ANSWERHemodialysis CKD NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A no BP's no Blood Draws no IV's no Pressure Dressings no Tight Clothing no Carrying Heavy Objects *arterio-venous fistula* - CORRECT ANSWERAccess for Dialysis CKD treatment of choice for ESRD improves survival, quality of life -most from deceased donors: Cadaver increasing numbers from living donors close match of blood, tissue types desired success of well-being matched *living donor transplants is higher than that for diseased donor transplants* major surgery for living donor with risk of having only one remaining kidney - CORRECT ANSWERKidney Transplant immunosuppressive agents -adverse effects: hepatotoxicity, nephrotoxicity Glucocorticoids for maintenance of immunosuppression and to treat acute rejection episode -side effects of long-term use: impaired wound healing, emotional disturbances, osteoporosis, Cushingoid effects - CORRECT ANSWERPharmacology CKD can happen even with immunosuppressive medications acute rejection develops within months chronic rejection develops months to years - CORRECT ANSWERRejection of Kidney increase in serum creatinine fever higher than 100 degree F "flu-like" symptoms: chills, aches, headache, dizziness, N&V new pain or tenderness around the kidney fluid retention sudden weight gain greater than two-four pounds within a 24 hour period significant decrease in urine output - CORRECT ANSWERWarning Signs of Possible Rejection avoid herbal supplements dietary changes palliative care for emotional support of patient, family spiritual support - CORRECT ANSWERComplementary Health Approaches CKD NSG 252 Fluid and Electrolytes (Midterm) LATEST 2024 GRADED A encourage patient to participate in developmentally appropriate activities physical activity to promote strong bones -participation in age appropriate activities to minimize psychologic consequences of chronic disease - CORRECT ANSWERChildren and Adolescents CKD maintain normal serum albumin levels maintain blood pressure at a normal level if the patient is on dialysis may need 5 or more times a week *anemia of particular concern* preeclampsia common with even rigorous intervention having a low-birth-weight infant associated with - CORRECT ANSWERPregnant Women CKD manifestations of renal failure often missed -may be attributed to other causes -serum creatinine levels may rise slowly -BUN may remain within normal limits Treatment options same as for younger people - CORRECT ANSWEROlder Adults CKD promote early and effective treatment of all infection -*streptococcal skin and pharyngeal infections* -discuss how to reduce risk for UTI ensure that all patients with suboptimal renal function are well hydrated- especially if nephrotoxic drug is prescribed encourage patients with ESRD to investigate options for early transplantation - CORRECT ANSWERNursing Process CKD anorexia, nauseam weight gain, edema current treatment history of dialysis or kidney transplant Chronic Diseases -diabetes -heart failure -kidney disease - CORRECT ANSWERObservation and Patient Interview CKD mental status vital signs urine output skin color, moisture, condition edema bowel tones AV fistula