NUR 213 EXAM 5 - Answer Filters waste called urea Regulates elec...

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NUR 213 EXAM 5

• 6 functions of the kidneys

Answer Filters waste called urea Regulates electrolytes Na, K, Ca, Mg, Phos Balances H2O in the body (absorbs and excretes) Helps control Blood Pressure through rennin Helps build red blood cells by producing erythropoetin Helps build strong bones by producing active vitamin D

• Acute Kidney Injury (AKI)

Answer Rapid-onset disease of the kidneys resulting in a failure to produce urine Reversible Days to months to recover

• ROOM 1 - Patient H.C.

52 year old male, medical history of HTN and DM, developed AKI s/p elective Heart Cath.

Answer Risks Prerenal- chronic conditions HTN, DM Causes Intrarenal- Contrast dye

• ROOM 2- Patient B.F.

75 yo female with recent N/V due to stomach virus, admitted to hospital 2 days ago due to syncopal episode and fall. Today she was diagnosed with AKI. Cause

Answer

Prerenal- Dehydration

• ROOM 3- Patient R.C.

30 yo male with history of GERD, kidney stones, admitted to hospital with AKI.Cause Postrenal- Obstruction 1 / 4

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• 3 causes of AKI

Answer prerenal- before kidneys something has occured in the body before the kidneys become effected Intrarenal- inside the kidneys

postrenal (obstruction)- after the kidneys urethra, bladder

• Prerenal AKI

Answer Cause is "before" MOST COMMON AKI Reduced renal artery blood flow Lack of perfusion to the kidneys Hypotension, Low CO, Hypo-perfusion, Cardiogenic Shock, Sepsis, Burns NSAIDS OTC- Aspirin, Naproxen, Ibuprofen

• NSAIDs

contrast dye Aminoglycoside (antibiotics)

Answer Meds to Avoid in Renal Injury/ Failure

• Calcium gluconate Kayexalate

Insulin/d50

Answer What can we give to reduce potassium levels?

• Intrarenal AKI

Answer Direct damage to the kidneys inflammation(Lupus) nephrotoxic drugs(aminoglycosides) "mycin" contrast dye infection (Glomerulonephritis) reduced blood supply(Hypertension) 2 / 4

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Glomerulonephritis is most common infection

• Postrenal AKI

Answer Due to obstruction of urine flow - can occur anywhere post kidney (ureter, bladder, urethra) Kidney stones Tumors Enlarged prostate Bladder retention

• Initially asymptomatic

Progression-significant fall in GFR, Oliguria (NORMAL GFR 125ml/min) Azotemia- waste in blood Elevated BUN/Cr (>20,1) Edema Electrolyte imbalances -hyperkalemia (3.5-5.3) -hyperphosphatemia (2.5-4.5) -hypocalcemia (8.5-10.2) Metabolic acidosis Fever/ chills Hypertension Tachycardia LOC will decline over time- Irritable, Confusion, lethargic Chest pain, SOB Loss of appetite (Anorexia), N/V Renal function may take up to 1 year to fully recover

Answer Signs and Symptoms of AKi

• Urinalysis

Proteinuria If pt has protein, WBC, or RBC in urine the kidney is not filtering properly Specific Gravity <1.010 diluted in tubial injury >1.035 concentrated in glomular injury (tubular necrosis) Epithelial and CASTS show up in urine- tubial is sloughing off

Serum BUN/CR > Electrolytes K+ > Ca < Phos > 3 / 4

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RBC's < ABG metabolic acidosis PH < 7.35 HCO3 < 24

Ultrasound

Answer Kidney Diagnostic Tests

• IV fluids- NS 0.9%

Blood volume expanders (albumin) Diuretics (lasix/Furosemide) Reduction of potassium -Sodium Polystyrene (Kayexalate) Blood pressure management Peptic ulcer prevention Medications may need a dose reduction based on kidney function

Answer Medications for AKI

• Show no signs of increased fluid overload

Show no S/S azotemia Have a UOP > 30ml/hr Appropriate Renal diet

Answer Patient Goals

• Foods high in water content

-Fruits -Vegetables -soups, broths, stew -Chicken -Fish -Milk

-Yogurt -Jell-O

Fluid retention

• Less

Answer

Potasium- potatoes, sweet potatoes, canned salmon, bananas, avocado, lima beans]

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