Acute Kidney Injury

Question 1

AKI - Pathophysiology

Answer 1

• Rapid reduction in kidney function; failure to maintain fluid/electrolyte balance & acid-base balance
• Reversible causes:
  > hypovolemia (will see high BUN/normal Cr)
  > hypotension
  > HF
  > urinary obstruction
  > renal artery obstruction

Question 2

Pre-Renal

Answer 2

• Conditions that impair PERFUSION
• Hemorrhage
• Renal losses (diuretic agents, osmotic diuresis)
• shock, dehydration, burns, sepsis

Question 3

Intra-Renal

Answer 3

• Prolonged renal ischemia
  > directly affect renal cortex or medulla
• Nephrotoxic agents
  > NSAIDs (ibuprofen), antibiotics
• allergic disorders, embolism or thrombosis of renal vessels
• glomerulonephritis

Question 4

Post-Renal

Answer 4

• Urinary tract obstruction
• tumors
• kidney stones
• strictures
• BPH
• CX: bladder, cervical, colon, prostate
• nerve damage to control of bladder
• blood clots in urinary tract

Question 5

AKI - Diagnostics

Answer 5

• Lab assessment
  > Incrd Cr (norm: 0.6-1.3mg/dL)
  > Incrd BUN (norm: 10-20mg/dL)
  > Electrolyte values; inrd Potassium (norm: 3.5-5.0mEq/L)
  > calcium may be low

Question 6

AKI - Medical Surgical Treatment

Answer 6

• Dialysis
  > GFR is going to be abnormal
• Remove/mitigate issue
  > remove obstructions (insert cath)
• Fluid restriction or challenge
• Electrolyte replacement or reduction
• Monitor weight
  > accurate indicator of fluid loss or gain
• Diuretics
  > lasix

Question 7

AKI - Nursing Diagnostics

Answer 7

• Fluid vol excess
• Risk for electrolyte disturbance
• Potential for injury

Question 8

AKI - Nursing Interventions

Answer 8

• Hourly urine output
  > less than 30mL/hr is bad
• Assess fluid overload
• Evaluate VS
  > hypoperfusion/hypoxemia
• Lab values
  > elevated K/Cr, BUN
• Monitor EKG
  > potassium; hyperkalemia
• Assess muscle function; paralysis
  > bc of high K & Mg lvls
• Nutrition therapy
  > lower Na, K, Ph
  > higher calories

Question 9

AKI - Health Promotion

once you have AKI

Answer 9

• Incrd fluid intake
• Changes in urinary characteristics
  > cloudy
• Avoid hypotension, maintain fluid balance
• Reduce exposure nephrotoxic agents
  > NSAIDs, antibiotics, chemo, aminoglycoside
• Monitor lab values
  > potassium
• Closely watch I&Os
• Meticulous care to pts w/ indwelling cath
• Metformin & contrast dye
  > will need extra fluids

Question 10

AKI - Collaborative Interventions

Answer 10

• Monitor dialysis effectiveness/comps
• Monitor EKG changes
  > peaked T waves indicated hyperkalemia
• Admin meds