medsurge test 2 renal pt 2

acute kidney injury

defined as an abrupt decrease in kidney function, measured by increased serum creatinine or decreased urine output.

stage 1 of aki

Increase in serum creatinine ≥ 0.3 mg/dL within 48 hours or 1.5–1.9 times baseline within 7 days and Urine output < 0.5 mL/kg/hr for 6–12 hours

stage 2 of AKI

Serum creatinine 2.0–2.9 times baseline. Urine output < 0.5 mL/kg/hr for ≥12 hours

stage 3 of AKI

Serum creatinine 3.0 times baseline or ≥ 4.0 mg/dL. Urine output < 0.3 mL/kg/hr for ≥24 hours or anuria for ≥12 hours

prerenal (decreased perfusion)

what is the most common cause of AKI

brown

if someone has Rhabdomyolysis there urine will be

oliguria, anuria, fluid overload, electrolyte imbalances, uremic ss(nausea, confusion, pruritus, fatigue)

what are some key signs and symptoms of AKI

sodium bicarbonate

what can be administered for Metabolic acidosis 

fluid resuscitation (1 L)

If AKI patient is hypovolemic what treatment do you give?

strict Is and Os, daily weights, assess for signs of fluid overload (crackles, edema, S3)

how should you monitor for fluid balance in AKI patients

acidosis, electrolyte imbalances, intoxication, overload, uremia

what are the indications for renal replacement therapy (dialysis).

uremia

a condition in which the kidneys fail to adequately filter waste products from the blood, leading to their accumulation and potential toxicity. 

encephalopathy

 a general term for brain damage or disease that affects brain function or structure. It can occur due to a number of possible causes, including reduced blood flow or oxygen to the brain. 

output from before, add 600

what is the formula for fluid restriction

creatinine

what lab to monitor in in AKI

chronic kidney disease

Is a progressive, irreversible loss of kidney function over months or years. 

<15

what is GFR in end stage renal disease

diabetes mellitus

what is the most common cause of Chronic kdiney disease

diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, repeated acute kidney injury, autoimmune disorders, obstructive causes

what are some causes of CKD

edema, hypertension, hyperkalemia, metabolic acidosis

what are fluid and electrolyte imbalance SS of CKD

fatigue, pruritus, anorexia, nausea, confusion, memory issues

what are uremic(toxin buildup) SS of CKD

anemia, (low erythropoietin), osteodystrophy (bone pain/fractures)

what are hematologic and bone change SS of CKD

proteinuria, hematuria, casts

what will be seen in a urinalysis of someone with CKD

small, shrunken

what do kidneys look like on a renal ultrasound in CKD

130/80

what is the target blood pressure to slow CKD progression

ace inhibitors and ARBS

what medications can be given to control BP with CKD

<7

what should the goal for A1C be for patients with CKD

2g/day

what is the sodium max/day for those with CKD

sodium, potassium, phosphorus, but get adequate protein

what food should be avoided in patients with CKD

protein

what nutrient do dialysis patients need more of

kayexalate, insulin+dextrose, calcium gluconate

how is hyperkalemia managed in CKD patients

erythropoietin stimulating agents, iron supplement

how is anemia managed in CKD patients

phosphate binders (calcium acetate), vitamin D supplements

what can be used to treat bone disease from CKD

renal transplant

what is the best treatment for Longterm end stage CKD

3-5 lbs in 1-2 days

what weight gain is a sign of worsening CKD

dialysis

a life-sustaining treatment for patients with end-stage renal disease (ESRD) or acute kidney injury (AKI) when kidney function is severely impaired. 

hemodialysis

Blood is filtered through a dialyzer ("artificial kidney") to remove waste, electrolytes, and excess fluid. can also give blood and meds with it.

vascular access

hemodialysis requires:

3-4 times per week, 3-5 hours per session

how often is hemodialysis performed

dialysis center or home

where can hemodialysis be done at

heparin

what medication do you have to give someone going through hemodialysis

peritoneal dialysis

Uses the peritoneal membrane as a filter, with dialysate fluid infused into the abdomen. Need a vascular access

at HOME via Continuous Ambulatory Peritoneal Dialysis (CAPD), or Automated Peritoneal Dialysis (APD) 

where is peritoneal dialysis performed

machine-assisted at night.

Automated Peritoneal Dialysis (APD)  is

daily

how often does peritoneal dialysis need to be done

hemodialysis

what type of dialysis has a stricter diet restriction (Low K, Na, P, fluids)

hypotension, infection, muscle cramps, complications with access

what are the complications with hemodialysis

peritonitis, hyperglycemia

what are the complications with peritoneal dialysis

Arteriovenous(AV) fistuala

Surgical connection between an artery and a vein. preferred in hemodialysis bc its the best long term option due to low infection and clot risk. takes 4-6 weeks to mature before use

Ateriovenous (AV) Graft

a Synthetic tube connecting an artery and a vein. used when veins are weak or fistula is not an option. higher clot and infection risk than fistula

central venous catheter

temporary option for urgent dialysis (AKI). inserted into jugular, subclavian or femoral vein. high risk for infection and thrombosis

thrills, bruit

what should nurses assess for AV fistula/graft

BP readings, IVs, blood draws,

what should nurse avoid near a av fistula or graft

slow fluid removal and give saline bolus

what nursing action for hypotension related to hemodialysis

warm compresses, slow fluid removal

what nursing action for muscle cramps related to hemodialysis

culture blood, start antiobitics

what nursing action for infection (sepsis) related to hemodialysis

slow dialysis rate, monitor neuro status

what nursing action for disequilibrium syndrome related to hemodialysis

send culture, give antibiotics

what nursing action for peritonitis related to peritoneal dialysis

monitor glucose, adjust dialysate dextrose

what nursing action for hyperglycemia related to peritoneal dialysis

educate on avoiding heaving lifting

what nursing action for hernia related to peritoneal dialysis

glucose

what should be monitored in peritoneal dialysis for everyone due to dextrose in dialysate

kidney transplant

a life-saving treatment for patients with end-stage kidney Disease.

blood type, HLA compatibility, cross match, infection screening, psychosocial assessment, comorbidity management

what type of testing.evaluation do kidney transplant patients need to be carefully evaluated for

active infection or sepsis, uncontrolled malignancy, severe cardiovascular disease, non-adherence to medical treatment

what are the contraindications to kidney transplant

hourly

how often do nurses need to monitor urine output in kidney transplants

kidney transplant

high urine output is expected initially in _____________ patients

rejection or renal artery thrombosis

in kidney transplant patients, Sudden drop in urine output may indicate

hypokalemia & hypomagnesemia 

what kind of electrolyte imbalances are expected due to diuresis in kidney transplant patients

BP and temp

what vitals should be measured very frequently in kidney transplant patients

bleeding, anastomosis leaks, thrombosis

what kind of surgical complications can happen in kidney transplant patients

immunosuppressive meds given on schedule

what is critical to prevent acute rejection in kidney transplant patients

hyperacute kidney transplant rejection

transplant rejection that happens in minutes to hours. We see immediate graft failure, no urine output, thombosis.

requires emergency graft removal

what is the nursing action for hyperacute kidney transplant rejection

acute kidney transplant rejection

type of rejection happens in days to months. We see fever, decreased urine output, swelling at the graft site, and elevated creatinine.

Increase immunosuppressants, increase IV steroids, possible biopsy

what is the nursing action for acute kidney transplant rejection

chronic kidney transplant rejection

type of rejection happens in months to years. we see a gradual loss of kidney function, proteinuria, hypertension

supportive care, may require return to dialysis

what is the nursing action for someone with chronic kidney transplant rejection

monitor creatinine, bun, potassium. Check for fever, tenderness, report signs IMMEDIATELY to transplant team

what are nursing actions for kidney transplant patients

tacrolimus, cyclosporine

what immunosuppressive drugs for transplant patients are nephrotoxic and need levels monitored often

Antimetabolites: Mycophenolate, Azathioprine

which immunosuppressive meds can cause bone marrow suppression

mTOR inhibitors; sirolimus, everolimus

which immunosuppressive meds can cuase Risk of delayed wound healing, Hyperlipidemia

prednisone

which immunosuppressive drug do we Watch for hyperglycemia, osteoporosis, weight gain

bactrim (for PCP pneumonia) or Valganciclovir (for CMV prevention).

what might transplant patients receive as prophylactic antibiotics and antivirals

Subtle symptoms like fatigue, malaise, or slight temperature

what are the signs of infection in tranpslant patients

hypertension, diabetes, osteoporosis, cancer, graft failure

what are some longterm complications with immunosuppressants