NUR 265 Exam 1 (Answered) Complete Solution

NUR 265 Exam 1 (Answered) Complete Solution Acute Kidney Injury ●Risks: REDUCED PERFUSION (reduced blood flow to the kidneys) ○ blood/fluid loss ○Blood pressure drugs resulting in hypotension ○Heart attack/heart failure (low ejection fraction and low cardiac output) ○Infection (sepsis/septic shock) ○Liver failure ○Use of aspirin, NSAIDs (advil, motrin, naproxen) ○Severe allergic reactions (anaphylaxis) ○Severe burns ○ Severe dehydration ○Renal artery stenosis ○bleeding/clotting in the kidney blood vessels (coagulopathy) ○atherosclerosis/cholesterol deposits (block blood flow to the kidney) ■Get history ^ (surgery, transfusions, meds), recent contrast dye (damaging to kidneys), coexisting conditions (hypertension, diabetes, pre-existing lower GFR), acute illnesses ●Signs and Symptoms: oliguria, anuria, increased creatinine and BUN, urine concentrated (specific gravity greater than 1.030), azotemia (retention of nitrogenous wastes) ●Diagnostics: ultrasound of kidneys (obstruction of stones, patency of ureters), CT scan WITHOUT contrast, KUB X-ray, nuclear medicine -MAG3 (measures GFR), cystoscopy or retrograde pyelography (obstruction of lower tract), biopsy (prepare patient for hypotension/hypertension) ●Labs: BUN and creatinine (increased), serum electrolytes (especially K+→ ECG=bradycardia, peak T wave, wide QRS, ST elevation), serum osmolarity (low), urine specific gravity (high), GFR (not accurate during acute) ○IF ONLY BUN ELEVATED=DEHYDRATION →creatinine=#1 lab for kidney function ●Meds: ○Diuretics- increase UOP, get rid of retained fluid and electrolytes (used in the beginning, does not preserve kidney function or stop AKI) ○Fluid challenge: 500-1000 mL of N.S. bolus (to see how the kidneys are functioning) MONITOR FOR FLUID OVERLOAD (ESPECIALLY RESPIRATORY DISTRESS) ●Nursing interventions: ○ PRIORITY= PREVENTING AKI (promoting daily hydration) ■Evaluate fluid status ■Strict I&O ■Body weight ■Characteristics of urine ■REPORT IF UOP 0.5 mL/kg/hour (especially if persisting over 2 hours) ○Monitor MAP (maintain 80 mmHG in high-risk or critically ill) ○Reduce risk factors (nephrotoxic agents, contrast media) ○Diuretic and fluid challenge, hemodynamic monitoring (if fluid volume overload do not use) ●Diet: catabolism=protein breakdown=breakdown of muscle protein and increased azotemia ○NO dialysis: 0.6 g/kg of body weight or 40 g/day of protein ○Dialysis: 1-1.5 g/kg of protein ○Sodium: 60-90 mEq/kg ○If high K+: restricted to 60-70 mEq/kg ○Fluid: urine output + 500 mL Fluid volume overload ○Crackles ○Anasarca (swelling all over body) ○Decreased O2 sat ○Increased RR ○LOC changes (confusion) ○Restlessness (not normal to be restless for no reason) ■Treated with: diuretics, dialysis, or paracentesis (removal of excess fluids), fluid and sodium restrictions Hypoperfusion/hypoxia →reduced blood volume ○MAP 65 mmHg ○Tachycardiac ○Thready peripheral pulses ○Decreased cognition ■Treated with: IV fluids and possible blood transfusion Chronic Kidney Disease ●Risks: diabetes, hypertension, glomerulonephritis, PKD, gout, lupus, lead poisoning, pyelonephritis ●Signs and Symptoms: (CKD affect entire body →TOXINS LEFT IN BLOOD ) ○Reduced GFR ○Uremia (azotemia with symptoms)- metallic taste, anorexia, N/V, muscle cramps (hyperkalemia), uremic frost, pruritus, fatigue, hiccups, edema, dyspnea, paresthesia (gabapentin given) →end-stage (stage 4 and 5/maybe severe AKI) ○Metabolic: buildup of urea and creatinine (expected=increased BUN & creatinine), Na+ issues (hyponatremia=early polyuria, later=hypernatremia & oliguria/anuria), hyperkalemia (always monitored) →metabolic acidosis →pH and HCO3 decrease (WATCH RR- COMPENSATION=KUSSMAUL’S), Ca+/phosphorus/vitamin D concerns (phosphorus increase=Ca+ and vitamin D decrease= osteoporosis (fracture/cramps) →FALL RISK ○Cardiac changes: hyperlipidemia, hypertension, H.F.(F.V.O.)/S3 (S3=first sign of H.F.), crackles, pulmonary edema (pink frothy sputum=medical emergency), tachypnea, hyperpnea, peripheral edema, JVD, pericarditis, cardiac tamponade BP★ aldosterone= increase Na+ and fluid=increase ○Hematologic: anemia, low iron & folic acid, decreased immunity (erythropoietin made in the kidneys. EPO=stimulates production of RBC=H&H decreased=anemia) ○GI: uremic fetor (ammonia smelling bad breath), stomatitis, PUD →uremia symptoms (can cause constipation and diarrhea) ○Neurological: ataxia, peripheral neuropathy, tremors, seizure, coma ○Musculoskeletal: bone pain, muscle weakness, pathological fractures (decreased Ca+ and vitamin D) ●Diagnostics: kidney ultrasound or CT without contrast medium (obstruction), kidney EXPECTED to shrink with long-term ESKD (unless polycystic kidney disease) ●Labs: Severe= creatinine and BUN to determine if uremia is present, creatinine increases gradually over time reaching 15-30 mg/dL, BUN directly related to protein intake ●Meds: Antihypertensive (ACEs, calcium channel blockers, thiazides) →diuretics won’t help with ESKD (only if elimination is still present →Loop diuretics), vitamins and minerals (deficient in folic acid, vitamin B/D), Erythropoietin-stimulating agents, parathyroid hormone modulator (Cinacalcet) ●Nursing interventions: manage fluid volume ○Assesses for FVO Q 4 hours (lungs, heart, O2 sat) ○Strict I&O and daily weights (stick to routine) ■1 kg=1 L of fluid ○Diuretics →not helpful in ESKD ○Monitor serum electrolytes (treat high K+ →high potassium EXPECTED, but still need to treat) ○Treat hypertension →ACEs (-pril), calcium channel blockers (-dipine), thiazides (loop diuretic)