Acute Kidney Injury

Question 1

Which electrolyte imbalance is most common for AKI?

Answer 1

Hyperkalemia d/t decreased renal excretion of potassium. It requires immediate attention to prevent cardiac dysrhythmias.

Question 2

Which person would be most likely to get AKI/risk factors?

Answer 2

AKI is more common as people age. People ages 80-89 are 55% more likely to develop AKI than people under age 50. Another factor is exposure to nephrotoxic drugs (vancomycin). Another factor is having episodes of hypotension or shock can cause AKI.

Question 3

What medications can contribute to AKI?

Answer 3

Nephrotoxic drugs like NSAIDs (ibuprofen). These can cause/worsen AKI by reducing renal blood flow though inhibition of prostaglandin synthesis.

Question 4

What can indicate treatment for AKI/hyperkalemia has been effective?

Answer 4

Cardiac arrhythmias are decreased on ECG. A serum potassium level within the normal range indicates that treatment was effective and it prevent potential cardiac complications.

Question 5

Nursing interventions for pt with AKI and at risk for fluid overload?

Answer 5

Monitor daily weights, assess lung sounds regularly, and place pt on a fluid restriction.

Question 6

A pt with AKI has decreased urinary output and what should the nurse prioritize?

Answer 6

Place the pt on a fluid restriction to prevent fluid overload/manage edema, especially when UO is decreased.

Question 7

What is an AKI?

Answer 7

Acute kidney injury that results is sudden/short term loss of kidney function. Causes failure to maintain waste elimination, fluid/electrolyte balance, and acid-base balance.

Question 8

What happens in the lab values with AKI?

Answer 8

Serum creatinine goes up or UO goes down (both can happen). BUN starts to rise as well. This can develop over hrs to days.

Question 9

Leading cause for kidney failure?

Answer 9

Diabetes

Question 10

What are some causes of AKI?

Answer 10

Follows several prolonged hypotension, hypovolemia (decreased amount of fluid in body), mechanical obstruction, and exposure to nephrotoxic agents.

Question 11

Pre-renal causes?

Answer 11

Causes by a source outside of the kidney that creates impaired renal perfusion/decreases glomerular filtration. Common causes are shock, dehydration, burns, and sepsis.

Question 12

Intra-renal causes (intrinsic)?

Answer 12

Occurs inside kidney by disorders that affect renal cortex/medulla. Examples- allergic disorders, embolism of renal vessels, nephrotoxic agents. Acute tubular necrosis is most common cause and it causes damage to basement membrane and tubular epithelium. Then the tubules can filter because they are filled with dead/damaged cells. It can be reversible if the tissues aren’t destroyed

Question 13

Post-renal causes?

Answer 13

Causes by urine flow obstruction like tumours (cancer), kidney stones (calculi), trauma or strictures (narrowing of bodily passage).

Question 14

Types of nephrotoxic drugs?

Answer 14

• Antibiotics
  • Anesthetics
  • ASA
  • Captopril
  • Contrast medium
  • Cimetidine
  • Lithium
  • Methotrexate
  • NSAIDS
  • Rifampin

Question 15

S+S of fluid overload?

Answer 15

Weight gain, pulmonary crackles, edema, decreased oxygenation, confusion, increased RR, and bounding pulses.

Question 16

Initiation phase of AKI?

Answer 16

Increase in creatinine/BUN and decreased in urine output. Can be causes by sepsis, hypotension, and nephrotoxic drugs.

Question 17

Maintenance phase?

Answer 17

Oliguria happens (UO >400 mLs in 24 hrs). In this phase there are exacerbations of S+S of oliguria. Causes fluid overload, metabolic acidosis, anemia, immunodeficiency, increased creatinine/BUN, neuro changes, hyperkalemia, hyponatremia, hypocalcemia, and hyperphosphalemia.

Question 18

Recovery phase?

Answer 18

Can take up to a year. Labs will return to normal. Need to monitor for fluid and electrolyte replacement.

Question 19

Diagnostics for AKI?

Answer 19

CT scans without contrast (can determine adequacy of kidney perfusion and identify obstructions). Expect to see rising creatinine/urea levels and changes in electrolytes. Could do renal ultrasound to see if it’s post-renal damage. MRI not recommended. Do urinalysis and urine cultures (presence of sediments may lead to kidney damage).

Question 20

What internveiton do you do when your patients is in oliguria phase (maintenance phase)

Answer 20

fluid restriction to prevent overload

Question 21

When do you give fluids and diuretics?

Answer 21

If they have low CO from hypovolemia.

Question 22

Renal replacement therapy?

Answer 22

May be need to help kidneys through the disease, could be temporary or permanent, machine does all the work that the kidneys usually do. May be started when pt is in fluid overload, electrolyte/acid base imbalances, or changes in mental status

Question 23

What is oliguria?

Answer 23

Urine output less than 400 mL/day. Decrease urine output

Question 24

Can dehydration lead to AKI?

Answer 24

Yes it reduces perfusion

Question 25

S+S of AKI?

Answer 25

Oliguria, azotemia (buildup of nitrogen wastes), fluid overload symptoms.