AKI/ CKD/ ESKD/Dialysis/ Kidney Transplant/ Cirrhosis
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| Acute Kidney Injury is... | show 🗑
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| Risks of developing ATN are... | show 🗑
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| show | Risk: <0.5ml/kg/hr > 6hrs
Injury: <0.5 >12hrs
Failure <0.3 >24hrs (oliguria <400ml/day)
Loss: Persistent >4weeks Kidney Function LOss
End-Stage: Complete loss >3 months aka CKD
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| show | Oliguric phase to diuretic, then recovery. If not CKD results requires dialysis & transplant.
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| show | Caused by external factors: burns, shock, dehydration, MI, ↓CO, renal thrombosis, cirrhosis fluid shift
↓ circulation
↓ UOP (oliguria or <.3ml/kg/hr for 24hrs)
↓ renal perfusion
↓ GFR
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| show | NO
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| show | ↓ excretion in sodium = ↑NA/H2O Retention =↓ UOP
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| show | Caused by direct dmg to kidney tissue impairing nephrons- prolonged ischemia, nephrotoxins, sepsis, allergic reactions, AGN, SLE
ATN most common cause
Nephrotoxicity causes blockage of tubules
*potentially reversable
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| show | Contrast, mycins, glycosides, antibiotics, sporins, NSAIDs, amphotericin, crush injury, chemical exposure to lead/ethanol/arsenic
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| show | Caused: BPH, prostate or bladder cancer, trauma to pelvis region, extrarenal tumors, calculi, spinal cord disease
Bilateral ureter obstruction leads to hydronephrosis- if relieved w/48hrs poss recovery
Prolonged obstruction irreversible
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| Oliguric Phase is defined as... | show 🗑
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| show | ↑ creat> 0.6-1.2
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| show | the end product of protein metabolism in kidneys
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| show | Caused by High Urea and GFR- Kideneys can excrete nut not concentrate
Lasts 1-3wks 1-5L daily in UOP
ML for ML replaced
bun/creat normalize at the end
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| show | Hyponatremia, hypokalemia, & dehydration
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| show | Thorough PMH
Serum creat
urinalysis- casts, rbcs, wbcs, specific gravity 1.010, urine osmo 300
Kidney US
Renal Scan
CT w/o contrast
Renal Biopsy
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| Hyperkalemia in AKI treatment | show 🗑
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| show | Determine if adequate intravascular vol & CO to perfuse kidneys bc diuretic therapy may be used if AKI is not established loop diuretics lasix bumex mannitol
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| show | 600ml + previous 24hr loss = intake restriction for the day
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| Never give kayexalate to | show 🗑
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| show | Nephrotoxic drugs
age
trauma
surgery
burns
heart failure
sepsis
ob complications
pelvic trauma
pre-existing ckd
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| Azotemia is | show 🗑
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| show | Protein 1gm, K+ restriction, NA restriction, Phos restriction, Calcium supps or Phos binders, ↑Fat, 30-35kcal, cal 1000-1500mg, carbs
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| show | Fluid intake and output
Daily weight
UOP color, glucose, gravity,protein,blood,casts
skin color edema
JVD
bruising
inflammation
LOC
crackles
murmurs
ecg for dysrythmias
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| show | Contrast assoc neuropathy- reversed by hydration plus bicarb or sodium chloride and mucomyst
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| show | 1000ml
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| Leading cause of death in aki is | show 🗑
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| show | Progressive, irreversible loss of kidney function GFR <60ml/min/1.73 >3 months
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| show | 1- >90 GFR/
2- Mild GFR 60-89/
3- Mod GFR 30-59/
4- 15-29/
5- <15 dialysis w/uremia present (uremia <10)
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| Uremia indicated by | show 🗑
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| show | Fatigue EARLY
polyuria at night
fixed gravity 1.010
Anuria UOP ↓40ml/24hrs
Uremic pleuritis
Hypertensive retinopathy
encephalopathy
amenorrhea or vaginal bleeding
anemia
osteo
paresthesias
scaly, flaky skin
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| Metabolic Distrurbances | show 🗑
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| As GFR decreases... | show 🗑
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| show | Cardiovascular Disease
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| Fatal dysrhythmias can occur when K is.. | show 🗑
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| show | Kidneys produce a hormone EPO, prompts bone marrow to make RBCs so when dmg occurs so does anemia
Tx: Iron, erythropoietin epogen, folic acid 1mg/day, bleeding tendencies
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| show | Leukocytosis ↓ WBC
↑ Glucose- hyperglycemia- susceptible to infection
trauma
av/g site infection
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| You can feel a | show 🗑
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| You can hear a | show 🗑
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| Asterixis | show 🗑
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| Diagnostics of CKD | show 🗑
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| Drug therapy for CKD | show 🗑
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| CKD nutrition is | show 🗑
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| Drug therapy complications CKD | show 🗑
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| show | GFR<15ml >3months
FATIGUE, lethargy, proteinuria, pruritus, HTN
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| Nursing Mgt CKD | show 🗑
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| Calories allowed | show 🗑
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| CRRT | show 🗑
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| show | Volume overload
hyperkalemia
Metabolic Acidosis
Bun >120
↓LOC
Pericarditis
Peri-effusion
Cardiac Tamponade
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| show | 4hrs daily or every other day 3-4x wk
Used when rapid changes are needed in short time
Req special staff, heparin, and close hypotension monitoring, weight monitoring pre and post dialysis
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| Hypovolemia.. | show 🗑
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| show | Kidneys cant synthesize ammonia, bicarb ↓acidic, and pt may develop kussmaul's
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| show | Manual PD 30-50min- Auto 1-2 hrs
Less invasive then HD
Preferred in diabetic
issue infection/perotonitis
temporary cath
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| show | Site infection
Peritonitis
Hernias
Atelectasis, pneumonia, bronchitis
displacement of tube
protein loss 10-20g/day or .5g/l exchanged
lower back problems
bleeding
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| show | Fewer dietary restrictions
Greater mobility
Great for pt w/bad vascular access
Diabetics bc insulin can be given intraperitoneal
Heparin not required
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| show | Continuous Ambulatory Peritoneal Dialysis
1.5L-3L removed 4xday
Manual w/4hr dwell times
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| show | Meat, milk, icecream, cheese, yogurt, dairy in general, pudding, chicken, fish, nuts, beans
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| Food high in salt | show 🗑
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| show | Oranges, Bananas, melon, tomato, prune/raisin, deep green leafy veggies except kale, yellow veggies, white and sweet potato, beans, legumes, chocolate, granola, milk, PB, mushrooms, carrots, salt subs, salt-free broth
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| Why does hypocalcemia occur | show 🗑
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| show | Movement of fluid to LESSER to GREATER of solutes
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| Diffusion | show 🗑
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| Ultrafiltration | show 🗑
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| Dialysis Solution | show 🗑
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| show | 2L infused over 10min, flow rate can be ↓ for pain, close clamp after infused.
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| PD Dwell phase | show 🗑
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| show | Lasts 15-30 min may be facilitated w/gentle massaging or changing position
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| show | Automatic cycler times and controls equilibrium so pt can dialize while sleeping
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| show | Manual 1.5-3L exchanges x4day 7 12 5 10
risk for peritonitis
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| AV fistula | show 🗑
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| AV graft | show 🗑
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| Steal syndrome | show 🗑
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| Temp Vascular Access | show 🗑
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| show | Long plastic cartridge w/hollow tubes & filters - blood pumped into top fibers-dialysate pumped through bottom- clean blood then returns to pt
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| HD procedure | show 🗑
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| show | fluid status, site, temp, skin, WEIGHT, lungs
pre and post weight
no more than 1-1.5kg gain b/t tx
hypotension
vs q30-60min
HOLD MEDS PRIOR TO HD
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| show | d/t rapid removal hypovolemia, ↓CO, ↓vascular resistance,
s/s: dizziness, vision changes, chest pain
tx: ↓volume of fluids removed, increase saline 100-300ml
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| HD complication Muscle cramps | show 🗑
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| HD complication Blood Loss | show 🗑
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| show | Blood transfusions lack of precautions or blood screening for hep c
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| Diff between CVVH and CVVHD | show 🗑
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| show | Less than 25% ppl receive one
Eliminates need for dialysis
Pre-emptive if living donor avail
Persons <70 yr, that dont smoke, drugs, refractory CV diseases, chronic pulm, cancer that is wide spread
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| show | refractory HTN- bilateral nephrectomy
Polycystic Kidney Disease
CABG or stent
cholecystectomy
in general both kidneys in recipient are usually not removed.
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| show | Testing for HLA antigens for both donor and recipient
ABO - O universal donor
Test recipient for antigens- if negative that good match
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| show | deceased w/compatibility
blood relatives
emotionally related donors
paired organ donation
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| Expired donor | show 🗑
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| show | Min Cold time- immediate organ avail
Labs: 24hr clearance, creat, t protein, cbc, eletrolyte, aids/hep
nephrectomy- donor goes first 1-2hrs, kidneys flushed, takes 3hrs, lap
r illiac fossa preferred in recepient placed extraperotonealy
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| Post-op KT care | show 🗑
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| Sudden drop in UOP KT | show 🗑
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| Nrsg Mgt KT | show 🗑
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| show | Tacrolimus, Cyclosporine - nephrotoxic
Mycophenolate- thrombocytopenia, Prednisone/solumedrol- corticosteroids
Sirolimus- leukopenia, Imuran- Anemia, Cyclophosphamide- neutropenia
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| S/E Immuno drugs | show 🗑
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| show | CMV most common
candida, cryptococcus, aspergillus, epstein-barr, hsv, utis pneumocystis- occurs first month
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| KT CV complications | show 🗑
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| Most common malignancies in KT | show 🗑
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| Recurrence of Renal Disease in KT | show 🗑
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| Corticoid related complications | show 🗑
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| Hyperacute rejection | show 🗑
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| Acute rejection is | show 🗑
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| Chronic Rejection is | show 🗑
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| Cirrhosis in general | show 🗑
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| show | Biliary obstructive and cardiac from long standing right sided heart failure
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| show | Jaundice, thrombocytopenia, leukopenia, asteresis, edema/ascites, spider angiomas, palmar erythema, lesions, esophageal varices, libido, gynocomasteia, ammenorrhea, dec b12, dec folic
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| Causes of Cirrhosis | show 🗑
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| Decompensated cirrhosis is | show 🗑
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| show | ↑venous pressure
splenomegaly
large collateral veins in esophagus, abdomen, try to reduce ↑plasma load
HTN
varices
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| show | ↑AST ↑ALT ↓Stool bilirubin, ↓plt, ↓wbc, ↓alb/protein,
↑BUN ↑CREAT
↑Serum Bilirubin
↑ Urine Bilirubin
↑PT bleeding time
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| Hepatorenal Syndrome | show 🗑
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| show | Neurotoxic effect of ammonia
CHange in LOC impaired
asterexsis
fetor hepaticus
Tx: lactulose, rifaximin, antibiotic, prevent constipation, control gi bleeds
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| Cirrhosis diet w/o complication | show 🗑
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| show | 3rd spacing belly
tx: NA restriction, albumin, potassium sparing aldactone amilodrine, tolvaptan, paracentesis, TIPS, vasopressor samsca
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| Esophageal varices | show 🗑
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| show | rest, relief, teaching, nutrition
assess jaundice, ascites, loc, labs
relive pruitis
monitor stool, urine
girth measurement
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| show | void prior to procedure
high fowlers sitting position
monitor bp post procedure
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| Mgt of esophageal varices | show 🗑
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| show | Hypotension early, htn after fluid overload,memory impairment, anemia, dec plt, proteinuria, casts, rbcs, specific gravity 1.010, osmo 300, pulm edema, kussmaul, hypocalcemia, dysrhythmias, leukocytosis
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| show | Epogen/erythropoietin is being given
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| AKI Diet can have | show 🗑
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| show | K, phos 1.2g, protein, 25-35kcal
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| HD diet can have | show 🗑
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| show | carbs, low fat, water restriction
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| KT diet can have | show 🗑
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| show | High calorie 3000/day, high carb, 1500-2000, enteral protein nutrition prefferred
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| show | statins, beta blockers, tylenol, cillins, myacins, thiazides
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| show | confusion
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