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

  • 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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