Disorders of the Kidney

is blood reaching the kidney? (perfusion)
can the kidney clean the blood? (filtration)
can the urine get out? (elimination)

what are our big three kidney question?

acute kidney injury

this kidney problem is sudden and can be reversed

pre-renal: volume depletion, shock, heart failure
intrarenal: dye, medication, renal infections
post renal: stones, BPH, tumors

what are some causes of acute kidney injury (split into 3 categories, 3 per category)?

oliguria, rising creatinine/BUN, hyperkalemia, fluid overload, metabolic acidosis

what are some symptoms of AKI? (5)

<100mL/day

anuria is considered what output?

<500mL/day

oliguria is considered what output?

>3L/day

polyuria is considered what output?

strict I&O, daily weights, monitor K+, ECG monitoring when indicated, assess fluid status, avoid nephrotoxins, dose-adjust medications, treat underlying cause

what are nursing interventions for AKI? (8)

prerenal: replace volume
intrarenal: avoid further damage, fluids
post renal: remove obstruction

what are our treatments for AKI separated by categories?

DM or HTN

75% of CKD patients have what?

chronic kidney disease

kidney damage or decrease in GFR > 3 months; progressive loss of renal failure

GFR

CKD is staged using…

False

True or False: CKD can be reversed

diabetes (primary cause), HTN (second leading cause), pyelonephritis, heredity/congenital, renal cancers

what are some risk factors for CKD? (5)

elevated serum creatinine & BUN, electrolyte abnormalities, anemia, metabolic acidosis, fluid retention, heart failure

signs and symptoms of CKD (6)

prevent of slow the progression of failure and treat underlying causes

what is the initial goal of treatment for CKD?

renal diet, control HTN, control glucose levels, assess medications

what are some interventions for CKD? (4)

decrease production of metabolic wastes and regulate electrolytes

what is the goal of a renal diet?

low protein, low potassium, low sodium, low phosphorus, fluid restrictions in late stages (1000-1500 mL/day)

what is included in a renal diet (what can you not eat)? (5)

salt substitutes, potatoes, oranges/OJ, bananas, prune juice, tomato, dried beans/lentils, nuts, chocolate, coconut

what are some examples of high potassium foods (10)

milk, milk products, fish, chicken, beef liver, legumes, whole grain bread, peanut butter, colas

what are some examples of foods high in phosphorus (9)

ACE inhibitors, many common antibiotics (aminoglycosides), thiazide diuretics, furosemide, NSAIDs

what are some examples of nephrotoxic medications? (5)

diuretics, ACEi/ARBS, aminoglycosides, metformin, NSAIDs

what meds are considered nephrotoxic for acute kidney injury according to the acronym DAAMN?

edema, HTN, pulmonary edema

What happens when the kidney can no longer do fluid regulation? (3)

hyperkalemia

What happens when the kidney can no longer do potassium excretion? (1)

metabolic acidosis

What happens when the kidney can no longer do acid excretion? (1)

uremia

What happens when the kidney can no longer do waste removal? (1)

anemia

What happens when the kidney can no longer make erythropoietin? (1)

bone disease

What happens when the kidney can no longer activate vitamin D? (1)

stage 3

what stage of CKD will you start to have symptoms but they could be put off as something else?

stage 4

at what stage of CKD should you be discussing plans for kidney failure?

stage 5

what stage of CKD are you dialysis dependent?

less sodium and phosphorus

what food restrictions does the chart recommend for stage 3 CKD?

less potassium, sodium, phosphorus

what food restrictions are recommended for stage 4 CKD?

end stage kidney disease

stage 5 of CKD is really the beginning of…

AKI

is this AKI or CKD? sudden onset/reversible

AKI

is this AKI or CKD? causes: pre-renal, intra-renal, post-renal, and nephrotoxins

AKI

is this AKI or CKD? goal to keep patients alive until renal lesion heals

40-60%

what is the mortality rate for AKI?

CKD

is this AKI or CKD? slow progression/irreversible

CKD

is this AKI or CKD? diabetes, HTN

CKD

is this AKI or CKD? goal to slow or prevent progression with dialysis or transplant

100%

what is the mortality rate for CKD without treatment?

False

True or False: intrarenal failure may be caused by medications such as metoprolol

ACE inhibitors, antibiotics, thiazide diuretics, loop diuretics, NSAIDs

list 5 medications that may cause kidney damange

C.

Which food is included in a renal diet?

A. fish
B. tomato
C. pasta
D. milk

RISKY

right or risky: the patient with AKI has a potassium of 6.4 mEq/L. I’ll document it and discuss it during rounds.

hemodialysis, peritoneal dialysis, renal transplant

what are the possible interventions for ESKD? (3)

100%

what is the mortality rate for untreated ESKD?

blood leaves body → filtered → returned

how does hemodialysis work (flow)?

removes excess fluid, corrects acidosis, removes the waste products, maintains safe electrolytes

what does hemodialysis do?

hemodialysis

which type of dialysis can be controlled to adjust specific values of eletrolytes, fluid, etc.?

osmosis, diffusion, ultrafiltration

how does dialysis work? (3)

AV fistula or synthetic graft

how do you gain hemodialysis access?

bruit & thrill, distal pulse, capillary refill

what things need to be assessed for someone with a bruit? (3)

hemodialysis catheter

what dialysis access is temporary?

14 days

a hemodialysis catheter should not be used for more than _____

not very pliable, short term use only, must be sutured in place, if femoral pt should not be up in chair d/t possibility of ruptured vessel, typically in neck, DO NOT TOUCH

important points about hemodialysis catheters (6)

hypotension, N/V, hemorrhage, muscle cramps, cardiac dysrhythmias, clotted access

what are some complications of hemodialysis? (6)

False, the fistula must mature months before use

True or False: a fistula can be used right after being created

monitor dry weight, assess vital signs (hypoTN post HD), assess fistula/graft, monitor diet/fluid intake, patient/family education, monitor electrolytes, little to no urine output

nursing considerations for hemodialysis (7)

erythropoietin, vitamin D, renal vitamins, calcium and phosphate binders, iron replacement, electrolyte modifiers

common medications for someone on hemodialysis (6)

peritoneal dialysis

the dialyzing fluid is instilled (roughly 2-3L) into the peritoneal cavity via a catheter placed in the abdomen using the peritoneum as the dialyzing membrane

continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD)

what are the two primary types of peritoneal dialysis (2)

CAPD

this is the type of PD that you instill fluids, let dwell, and then drain

CCPD

this is the type of PD where you hook up to a machine at night and let it do it for you

steady state blood chemistries, patient/family can be taught process (do at home), fewer dietary restrictions, more control over daily life, can be used for hemodynamically unstable patients, circulatory system remains intact

what are the benefits of peritoneal dialysis? (6)

peritoneal dialysis

this type of dialysis isn’t as accurate/customized because there isn’t blood work and dry weight being done right before it

peritonitis, bleeding, leaking

what are some acute complications of peritoneal dialysis? (3)

redness, fever, abdominal tenderness

what are some s/sx of peritonitis (3)

abdominal hernias, hiatal hernias, hypovolemia/hypervolemia, pain, respiratory distress, self concept

what are some long-term problems/complications of PD? (6)

monitor dry weight, assess vital signs, assess catheter insertion site, assess effluent (color, consistency, amount), I&Os, patient and family education (s/sx peritonitis, sterile procedure, not for life)

what are some nursing interventions for PD (6)?

more out than in

when doing I&Os for peritoneal dialysis it is normal to have…

B, C, D

When assessing an AV graft the nurse should look at all of the following (select all that apply)

A. pedal pulse
B. radial pulse
C. capillary refill
D. bruit & thrill

A

What lab values would I expect to find after dialysis?

A. decreased BUN
B. increased Cr
C. decreased Hbg
D. increased Phos

C.

What is the most common complication with PD?

A. hypotension
B. electrolyte imbalances
C. peritonitis
D. bleeding

5%

renal cancer is __% of all cancers in the US

renal pelvis and ureters

renal cancer typically develops where?

bladder cancer

renal cancer is associated with…

later

renal cancer is usually found in the ____ stages

physical exam, labs, UA, X-rays (cystoscopy, renal biopsy, ultrasound, CT scan)

diagnostic tests for renal cancer (4)

surgery, radiation, chemotherapy (biological response modifiers & immunotherapy)

what are some treatments for renal cancer? (3)

comfort measures, tubes/drain management, assess incision, monitor for infection, I&O, cough and deep breath

nursing interventions/education for renal cancers (6)