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Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease Outline

Terms in this set (35)

- Ask about recent surgery or trauma, transfusions, or other factors about recent surgery or trauma that might lead to reduced kidney blood flow
- Obtain drug history, especially antibiotcs and NSAIDs
- Coexisting conditions: advanced age, diabetes mellitus, long-term hypertension, systemic lupus, major or systemic infection (sepsis), systemic inflammation
- Anticipate AKI following hypotension, shock, burns, or heart failure exacerbation
- Hx of urinary obstructive problems
- Cancer history that may cause urinary obstruction

Physical Assessments:
- AKI progresses that patient may: Develop fluid overload, including pulmonary crackles, dependent and generalized edema, decreased oxygenation, increased respiratory rate and dsypnea.

Lab Assessment:
- Rising creatinine
- Rising BUN and abnormal electrolyte values
- Urine may be dilute with a specific gravity near 1.000 or concentrated with a gravity greater than 1.030

Imaging Assessment:
- Ultrasonography diagnoses kidney and urinary tract obstruction

- CT scans with dye can determine adequacy of kidney blood flow and identify obstruction or tumors

- X-Rays of the (KUB) may b used to provide initial screening

Other Diagnostic Assessment:
- Kidney biopsy is performed if the cause of AKI is uncertain and manifestations persist or an immunologic disease is suspected

- Current guidelines suggest that a mean arterial pressure (MAP) of 65 mm Hg be maintained to promote kidney perfusion
- Not all patients have oliguria
- During AKI, with high-volume urine output, hypovolemia and electrolyte loss are the main problems

Drug Therapy:
- In patients with fluid overload, 500 - 1000mL of nss may be infused over 1 hour

- Have a high catabolism of protein breakdown
- Catabolism causes the breakdown of muscle for protein and increases azotemia
- For the patient who does not require dialysis, 0.6g/kg of body weight or 40g/day of protein
- For patients who require dialysis, protein level needed with range from 1-15g/kg
- As a rule, special tube feedings or kidney patients are lower in NA, K, Phosphorous, and higher in calories than standard feedings