Exam Three Study Material - Practice Exam Solutions

Exam Three Study Material - Practice Exam Solutions Acute kidney Injury(AKI) - answer - abrupt decline in kidney function that occurs over hours to days and is usually reversible Think: Something suddenly damages the kidneys → filtration decreases → waste/electrolytes/fluid build up. causes of Acute kidney injury - answer - •Prerenal •Intrarenal •Postrenal Prerenal - answer - before the kidneys sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness Causes of prerenal - answer - Dehydration Hemorrhage Hypotension Shock Decreased renal perfusion Intrarenal - answer - within/inside the kidneys direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply Causes of intrarenal - answer - Acute tubular necrosis Nephrotoxic medications Glomerulonephritis Kidney tissue damage Postrenal - answer - after the kidneys sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury Causes of postrenal - answer - Urinary obstruction Kidney stones Enlarged prostate Tumors Expected findings of AKI - answer - ↑ BUN ↑ creatinine ↓ GFR Decreased urine output Fluid retention Edema Electrolyte abnormalities Hyperkalemia Hyperkalemia is a major priority. How to tell someone is experiencing hyperkalemia - answer - Muscle weakness Paresthesia Cardiac dysrhythmias Tall/peaked T waves Widened QRS with worsening hyperkalemia How to treat hyperkalemia? - answer - Calcium gluconate Regular insulin + dextrose Sodium polystyrene sulfonate Also know that dialysis can remove potassium. Calcium gluconate for hyperkalemia - answer - antagonize the potassium induced decrease in membrane excitability stabilizes heart, less likely to die from dysrhythmia Protects/stabilizes the cardiac membrane → Does NOT actually remove potassium. Regular insulin + dextrose - answer - → Moves potassium from the blood into the cells Kayexalate (Sodium polystyrene sulfonate) - answer - a medication used to reduce high serum potassium; exchanges sodium for potassium in the intestine → Removes potassium through the GI tract. Chronic Kidney Disease - answer - progressive, usually irreversible loss of kidney function. CKD laboratory findings - answer - ↑ BUN ↑ creatinine ↓ GFR Fluid overload Hyperkalemia Metabolic acidosis Anemia Bone/mineral problems Uremia Think: Waste products accumulating in the blood. CKD assessment findings - answer - Fatigue Nausea/vomiting Confusion Pruritus Metallic taste Pericarditis in severe cases Drug therapies for CKD - answer - •Loop diuretics •Phosphate binders •Multivitamins and B supplements •Iron salts •Vitamin D •Erythropoietin stimulating agents •Parathyroid hormone modulators peritoneal dialysis - answer - dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood Hemodialysis - answer - Know why dialysis is performed. It removes: Excess fluid Waste products Excess electrolytes AV fistula/graft - answer - Assess for: Bruit → Listen with a stethoscope. Thrill → Palpate. You should expect both. Protect the access What to avoid on a dialysis arm? - answer - No blood pressure No blood draws No IVs Avoid compression/tight clothing Major dialysis complications - answer - Hypotension --Very common --Monitor BP --May require fluid replacement depending on situation Dialysis disequilibrium syndrome --Headache --Nausea --Confusion --Seizures Infection --Redness --Drainage --Fever Bleeding --Because anticoagulation may be used during dialysis. Potassium - answer - Normal approximately 3.5-5.0 mEq/L Hypokalemia - answer - Muscle weakness Decreased bowel motility Dysrhythmias Flattened T waves/U waves Hyperkalemia - answer - Muscle weakness Dysrhythmias Peaked T waves Sodium - answer - 135-145 mEq/L Hyponatremia - answer - Headache Confusion Seizures Hypernatremia - answer - Thirst Restlessness Neurologic changes Flui