Acute Kidney Injury (AKI) Flashcards
1
Q
Pathophysiology of AKI
A
A rapid reduction in kidney function resulting in a failure to maintain waste elimination, fluid and electrolyte balance, and acid-base balance
2
Q
Risk Factors
A
- Advanced Age
- Chronic Kidney Disease
- Diabetes
- Long-term Hypertension
- Major or systemic infection (sepsis)
- Peripheral Vascular Disease
- Chronic Liver Disease
- AIDS
- Prior Kidney Surgery
3
Q
Diseases and Conditions that Contribute to AKI
A
- Perfusion Reduction (Pre-renal)
- Kidney Damage (Intra-renal)
- Urine Flow Obstruction (Post-renal)
4
Q
Perfusion Reduction (Pre-renal)
A
Caused by a source outside of the kidney that creates a condition that reduces or impairs perfusion
- Blood or fluid loss
- Blood pressure medication
- Heart Attack
- Heart Disease
- Infection (sepsis, septic shock)
- Liver Failure
- Aspirin, Ibuprofen, Naproxen
- Severe Allergic Reaction
- Severe burns
- Severe dehydration
- Renal Artery Stenosis
- Bleeding or clotting in the kidney blood vessel
- Atherosclerosis or Cholesterol deposits that block flow in the kidneys
5
Q
Kidney Damage (Intra-renal)
A
Caused by disorders that directly affect the renal cortex or medulla of the kidney; occurring right inside the kidney
- Blood clot in nearby vein and arteries
- Cholesterol deposits that block flow in the kidneys
- Glomerulonephritis
- Hemolytic Uremic Syndrome
- Local Infection
- Lupus
- Pharmaceutical (chemotherapy agents, antibiotics)
- Scleroderma
- Thrombotic Thrombocytopenia Purpura
6
Q
Urine Flow Obstruction
A
Caused by an obstruction of urine flow; occurring on the “outside” or “after” the kidney.
- Urinary Calculi
- Retroperitoneal Fibrosis
- Bladder, Cervical, Colon and Prostate Cancer
- Enlarged Prostate
- Kidney Stones
- Nerve Damage
- Blood Clots
7
Q
Health Promotion and Maintenance
A
- Dehydration reduces perfusion and can lead to AKI even in adults who have no known kidney disease*
- Urge all healthy adult to avoid dehydration by drinking 2 to 3L of water daily
- As nurses, be on the lookout for signs of impending kidney dysfunction through assessment and close monitoring of lab values
- Evaluate fluid status
- Measure I&Os
- Weight
- Characteristics of urine
- Be aware of nephrotoxic drugs
8
Q
Nursing Assessment: Health History
A
- Ask about changes in urine appearance, frequency, or volume
- Ask about recent surgery or trauma, transfusions, allergic reaction or other factors that might lead to reduced kidney perfusion
- Obtain a drug history; use of antibiotics and NSAIDS
- Ask about recent imaging procedures requiring injection of contrast medium
- Ask about history of urinary obstruction problem
- Any difficulty in starting the stream, changes in amount or appearance of the urine, narrowing of the urine stream, nocturia, urgency or symptoms of kidney stones
- Ask about cancer history that may cause urinary obstruction
Immunity-Medicated AKI - Ask about acute illnesses (influenza, colds, gastroenteritis, and sore throats
- Allergic reaction from a drug or food allergy may result in AKI
- Ask about rashes, hives, or fever and evaluate the WBC
9
Q
Nursing Assessment: Physical Assessment
A
- If patient has a urinary catheter, assess urine output every hour after surgery until stable, during fluid resuscitation for shock or hypotension and when the patient has a high risk of AKI
- Evaluate vital signs to recognize early hypo-perfusion and hypoxemia
> Symptom of reduced blood flow: MAP below 65, tachycardia, threads pulses, decreased cognition, SPO2 less than 88%
10
Q
Signs and Symptoms
A
- Oliguria defined as less than 0.5 mL/kg/hr or urine output for more than two hour
- Signs of fluid volume overload/excess – because fluid is not eliminated
> Pulmonary crackles
> Dependent and generalized edema
> Decreased oxygenation
> Confusion
> Increased respiratory rate
> Dyspnea
> Fatigue
11
Q
Laboratory Assessment
A
- Creatinine: Elevated
- BUN: Elevated
- Sodium: Normal, increased or decreased
- Potassium: Increased
- Phosphorus: Increased
- Calcium: Decreased
- Magnesium: Increased or decreased
- Hemoglobin: Decreased
- Hematocrit: Decreased
12
Q
Diagnostic Assessment
A
- Ultrasonography
> Useful in diagnosis and urinary tract obstruction
> Dilation of the renal calyces and collecting ducts, as well as stones
> Show kidney size and patency of the urethers - CT Scan
> Without contrast medium can determine adequacy of the kidney perfusion and identify obstruction tumors
> MRI may be used in place of a CT scan - X-ray
> Provide initial view of kidneys and the urinary tract to determine the cause of AKI - MAG3
> Determine the nature of the kidney failure and measure GFR - Renal Scan
> Determine whether perfusion of the kidney of sufficient - Cytoscopy
> Identify obstruction of the lower urinary tract - Kidney Biopsy
> Performed when the cause of AKI is uncertain and symptoms persist or an immunologic disease is suspected
13
Q
Nursing Interventions: Take Action
A
- Avoid hypotension and maintain normal fluid balance to prevent and manage AKI
- Reduce exposure to nephrotoxic agents and drugs that alter kidney perfusion
> When substance cannot be avoided, monitor drug levels and communicate with the pharmacist - Assess kidney before imaging test that include contrast media
> Ensure the radiologist and the requesting physician are aware of reduced kidney function before the contrast medium is given - Observation about new-onset or increased peripheral edema, increased weight and reduced urine output can identify patients with a positive fluid balance from AKI who may require treatment with FLUID RESTRICTION or DIURETIC THERAPY
14
Q
Nursing Intervention: Drug Therapy
A
- Consult with pharmacy about drug adjustment based on kidney function
- Diuretics may be used to increase urine output
> Diuretic-induced output does not preserve kidney function or stop AKI, but diuretics do rid the body of retained fluid and electrolytes in the patient - Fluid Challenge
> Used to promote kidney perfusion
> 500-1,000 mL NS infused over 1 hour for patients not in fluid overload
> Assess the patient’s response to fluid to prevent fluid overload
15
Q
Nursing Intervention: Nutrition Therapy
A
- Work with Registered Dietitian Nutritionist to establish a diet with specific amounts of PROTEIN, SODIUM, and FLUIDS
- Nutrition support aims to provide sufficient nutrients to maintain or improve nutrition status, preserve lean body mass, restore or maintain fluid balance and preserve kidney function
- Most specialty formulas are lower in sodium, potassium and phosphorus and higher in calories than are standard feeding (enteral feeding, supplemental feedings, parenteral feedings)
