Medsurg Kidney Shit

patients will ED will present with muscle wasting

AKI

  • global content: trauma, toxins, HTN, ischemia, diabetes…
  • SUDDEN
  • ^^azotemia-- the accumulation of nitrogenous waste products^^
  • elevated K+, creatinine, and BUN
  • high mortality rate   * leaves you with other life-threatening issues (comorbidities)
  • pre-renal azotemia   * ^^circulation is the problem^^ that causes a reduction in renal blood flow which results in oliguria ( <400, but not <100)     * hypovolemia       * may exacerbate AKI       * decreased UO causes fluid retention         * JVD         * bounding pulses         * edema         * HTN       * increased risk for dehydration and imbalances in electrolytes     * cardiac failure     * hepatorenal syndrome   * oliguric phase     * leukocytosis     * they will appear hazy, have seizures stupor, or coma   * diuretic phase     * urine is not concentrated     * urine is clear       * maybe frothy due to high UO         * up to 5 L   * ^^recovery phase may take up to 12 mo for kidneys to stabilize^^
  • intra-renal   * problems that cause ^^direct damage^^ to the kidney tissue ^^(toxins + ischemia)^^   * provide education on certain meds that cause nephrotoxicity by doubling what they drink daily     * renal artery       * artery occlusion       * large or medium vasculitis     * small vessel disease       * thrombotic microangiopathy       * renal atheroembolism       * small vessel vasculitis     * glomerular disease     * acute tubular necrosis (ATN)       * patients are septic         * ischemia         * nephrotoxins         * rhabdo           * potentially reversible     * acute interstitial nephritis       * drugs       * infection       * systemic disease
  • post-renal obstruction
  • bladder outlet obstruction
  • tumors; prostate
  • renal calculi
  • papillary necrosis
  • retroperitoneal fibrosis
  • trauma   * relieve obstruction in 48 hr for an increased chance of recovery
  • anuria < 100 mL
  • oliguria <400 mL in 24 hr   * but not less than 100 mL   * occurs within 1-7 days after injury and lasts 10-14 days   * ^^UA may show casts, RBCs, and WBCs^^
  • polyuria > 2500 mL/day
  • GFR > 60 mL/min
  • ^^normal UO 800-2,000 mL^^   * 1-3 L
  • ^^BUN is the breakdown of protein in the liver^^   * BUN 5-20 mg/dL   * the concentration of urea in blood can rise due to infection, liver damage, fever, trauma, athletics, etc
  • Creatinine is more reliable than BUN
  • education   * ^^2-3 L^^
  • ^^most common cause is ATN^^   * COD is infection
  • ^^catch it early and treat the underlying cause^^   * reversible
  • RIFLE   * Risk   * Injury   * Failure   * Loss   * End-stage kidney disease
  • diagnostics   * thorough history   * serum creatinine, BUN, and electrolytes   * UA   * kidney US   * renal scan   * CT   * renal biopsy
  • care goals   * eliminate cause   * manage s/s   * prevent complications     * electrolyte imbalances     * dehydration
  • indication for RRT-- Renal Replacement Therapy   * volume overload   * elevated K+   * metabolic acidosis   * high BUN   * significant LOC change   * pericarditis     * pericardial effusion       * cardiac tamponade
  • types of RRT   * peritoneal dialysis (PD)   * intermittent hemodialysis (HD)   * continuous renal replacement therapy (CRRT)     * cannulation of artery and vein
  • health promotion   * monitor daily weight and I+O’s   * adequate nutrition   * teach s/s of electrolyte imbalance   * control exposure   * prevent prolonged episodes of __hypo__tension and __hypo__volemia   * proper hygiene care     * oral
  • gerontologic considerations… more susceptible to AKI   * GFR decreases with age   * decreased ability to recover   * RRT is still an option     * dehydration       * due to loss sense of thirst       * polypharmacy         * diuretics         * laxatives     * polypharmacy     * hypotension     * diuretic     * aminoglycoside therapy     * obstructive disorders     * surgery     * infections     * contrast medium

\ CKD

  • ==METABOLIC ACIDOSIS==
  • most common cause is diabetic neuropathy   * not reversible   * ==death by CAD==     * MI due to ischemia secondary to diabetes     * hyper/hypoKALEMIA
  • diet   * low protein   * low sodium   * low phosphorus     * to avoid bone damage   * high iron

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  • after hemodialysis, a patient is at risk for hemodynamic instability   * hypotension   * dysrhythmias   * hemorrhage     * as a nurse, you sure also recheck the patient’s weight to compare weight before and after hemodialysis to determine fluid loss
  • ^^cyclosporine^^   * an immunosuppressant and antirheumatic     * used to prevent reject of organ transplants       * must be taken daily for LIFE         * if not, patient will be at risk for organ rejection       * increases the risk of infection
  • NSAID increases kidney damage
  • @@a rapid decrease in fluid and electrolytes during hemodialysis can result in cerebral edema and increased ICP which places them at a risk for seizures; disequilibrium syndrome@@
  • %%pyuria-- WBCs in the urine%%
  • ==salt substitutes contain potassium chloride which can result in HYPERkalemia==
  • low potassium foods:   * a large raw apple   * bread   * eggs   * butter   * green beans
  • cloudy/opaque drainage is an early manifestation of peritonitis for PD treatment
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