Acute Kidney Injury

Question 1

Acute Kidney Injury Etiology and Pathophysiology Prerenal

Answer 1

Causes are factors external to the kidneys that reduce renal blood flow
Severe dehydration, heart failure, ↓ CO
Decreases glomerular filtration rate- Best indicator
Causes oliguria

Question 2

Acute Kidney Injury Etiology and Pathophysiology Intrarenal Causes

Answer 2

Causes include conditions that cause direct damage to kidney tissue
Results from
Prolonged ischemia
Nephrotoxins such as Vancomycin
Hemoglobin released from hemolyzed RBCs- They can block the kidney tubules and cause vasostriction
Myoglobin released from necrotic muscle cells

Question 3

Intrarenal
Acute tubular necrosis (ATN) causes

Answer 3

Results from ischemia, nephrotoxins, or sepsis
Severe ischemia causes disruption in basement membrane
Nephrotoxic agents cause necrosis of tubular epithelial cells
Potentially reversible

Question 4

Postrenal
Causes include

Answer 4

Benign prostatic hyperplasia
Prostate cancer
Calculi
Trauma
Extrarenal tumors

Question 5

Oliguric phase

Answer 5

Urinary changes-Concentrated
Urine out put < 400 ml/day,- Causes fluid overload
Fluid volume overload-Pulmonary edema, Pericardial, pleural effusion

Sodium balance
Increased excretion of sodium
Hyponatremia can lead to cerebral edema-
Potassium excess
Usually asymptomatic
ECG changes-dysrhythmias

Question 6

Diuretic phase

Answer 6

Daily urine output is 1 to 3 L
May reach 5 L or more
Monitor for hyponatremia, hypokalemia, and dehydration

Question 7

Recovery phase

Answer 7

May take up to 12 months for kidney function to stabilize

Question 8

Diagnostic studies

Answer 8

Thorough history
Serum creatinine
GFR
Urinalysis
Kidney ultrasonography
Renal scan
Computed tomography (CT) scan
Renal biopsy

Question 9

Diagnostic studies
Contraindicated

Answer 9

Magnetic resonance imaging (MRI)
Magnetic resonance angiography (MRA) with gadolinium contrast medium
Nephrogenic systemic fibrosis
Contrast-induced nephropathy (CIN)

Question 10

Collaborative care

Answer 10

Ensure adequate intravascular volume and cardiac output
Forcing fluids are not effective 
Loop diuretics (e.g., furosemide [Lasix])
Osmotic diuretics (e.g., mannitol)
***Closely monitor fluid intake during oliguric phase- calculate how much output from all output and then + 600ml for daily intake***

Question 11

Collaborative care
Hyperkalemia

Answer 11

Insulin and sodium bicarbonate
Calcium carbonate
Sodium polystyrene sulfonate (Kayexalate)- bowel necrosis- Do not give if pt has paralytic ileus can cause necrosis

Question 12

Collaborative care
Indications for renal replacement therapy (RRT)

Answer 12

Volume overload
Elevated serum potassium level- Life threatening
Metabolic acidosis
BUN level higher than 120 mg/dL (43 mmol/L)
Significant change in mental status
Pericarditis, pericardial effusion, or cardiac tamponade

Question 13

Collaborative care
Renal replacement therapy (RRT)

Answer 13

Peritoneal dialysis (PD)- Will have questions on view on later slides
Intermittent hemodialysis (HD)
Continuous renal replacement therapy (CRRT)
Cannulation of artery and vein

Question 14

Collaborative care
Nutritional therapy

Answer 14

Maintain adequate caloric intake- Need for ? Come from carbohydrates and fat. Decrease protein to prevent ketosis
Restrict sodium
Increase dietary fat
Enteral nutrition-NG tube or GT

Question 15

Nursing assessment

Answer 15

Measure vital signs
Measure fluid intake and output
Examine urine
Assess general appearance- respiratory to check for fluid overload
Observe dialysis access site-bruit and thrill- arterial blood is going through

Mental status and level of consciousness- always a priority
Oral mucosa
Lung sounds
Heart rhythm
Laboratory values
Diagnostic test results

Question 16

Nursing implementation
Health promotion

Answer 16

Monitor intake and output
Monitor electrolyte balance
Measure daily weight- Know if Lasix or other medication is working. Weigh in the morning at the same time daily
Replace significant fluid losses
Provide aggressive diuretic therapy for fluid overload
Use nephrotoxic drugs sparingly

Question 17

Nursing implementation-Education

Answer 17

Ambulatory and home care
Regulate protein and potassium intake
Follow-up care
Teaching- regarding sticking to their dialysis schedule
Appropriate referrals

Question 18

Nursing implementation
Evaluation

Answer 18

The expected outcomes are that the patient with AKI will
Regain and maintain normal fluid and electrolyte balance
Comply with the treatment regimen
Experience no untoward complications
Have complete recovery