Test 4/Week 12: AKI Flashcards
AKI Definition/Identification
Rapid loss of kidney function (hours to days)/increase in serum creatinine or UO/decreased perfusion to the kidneys
Azotemia
Early AKI: excess nitrogenous waste in blood (urea, creatinine)
Oliguria
Reduced UO <400mL/day
Uremia
Late CKF: “urine in the blood,” excess nitrogenous waste in blood
Decreased Kidney Perfusion Examples
hypotension, hemorrhage, dehydration, acute MI, liver failure, burns, traumatic injury, major surgery
AKI Direct Causes
toxins (vanco, contrast, chronic NSAID use), sepsis, urinary obstruction (stones, blood clots, BPH)
Pre-Renal
- “outside the kidney”
- hypoperfusion
- causes: hemorrhage, dehydration, shock/sepsis, HF, anaphylaxis
- findings: oliguria, increased BUN, slightly increased creatinine
Intra-Renal
- “damage to renal tissue”
- acute tubular necrosis
- causes: prolonged kidney ischemia (trauma, nephrotoxic agents, TxFx rxn, acute renal disease)
- findings: oliguria, increased BUN/Cr
Post-Renal
- “obstruction”
- outlet obstruction: acute bilateral ureteral/bladder
- causes: calculi, BPH, neurogenic bladder
- leads to hydronephrosis (correct within 2 days, no recovery after 12 weeks)
- findings: UO may be normal or decreased, increased BUN, Cr varies
3 most common reasons for increased mortality rate
hypotension, hypovolemia, nephrotixic agents
Phases of AKI
onset, oliguric/anuric, diuretic, recovery
Onset Phase
What are the precipitating events?
Oliguric/Anuric Phase
- minimal to no urine
- S/Sx: edema, HTN, wt. gain, fluid excess, metabolic acidosis, Kussmaul respirations
- Nursing diagnosis: fluid volume excess, risk for injury d/t hyperkalemia, metabolic acidosis
Diuretic Phase
- increased quantity of urine, but quality isn’t better (nephrons not fully recovered)
- S/Sx: increases UO, hypovolemia, dehydration, low lytes (K, Na, Mg)
- Nursing Diagnosis: fluid volume deficit, risk for injury r/t fluid/electrolyte imbalance
Recovery Phase
- improved renal function, but still vulnerable
- better quantity and quality of urine
- watch for infection (can be fatal)
- permanent partial reduction of GFR
AKI Nursing Priorities
- ABCs
- heart (tele)
- H/H
Hyperkalemia Assessment
Peaked T-waves, muscle cramps, twitching, arrythmias
Hyperkalemia Plan
- I/O and electrolytes
- maintain fluids, K/protein restriction
- insulin IV or dextrose (pull K)
- kayexalate
- dialysis
Low calcium/rising phosphorous Assessment/Plan
Paresthesia, tetany, Chvostek sign, calcification, seizures
Plan: monitor lytes, seizure precautions, phosphate binders with food, Vitamin D supplements, dialysis
Metabolic acidosis assessment/plan
Assessment: Kuszmaul respirations, altered LOC, hyperkalemia, pH<7.35 and HCO3<23
Plan: treat with nutritional support, oral/IV bicarb, dialysis
Fluid volume deficit assessment
Poor skin turgor, output>intake, orthostatic hypotension, dry mucous membranes
Fluid volume deficit plan
Monitor I/O trends, Daily weight, monitor for postural blood pressure changes, monitor lytes/BUN/creatinine imbalance, monitor for overload (dialysis less likely)
Fluid volume excess assessment
Rales/crackles, peripheral edema, intake > output, HTN and tachycardia, increased respiratory rate
Fluid volume excess plan
Lasix drip, daily weight, monitor for jugular vein distention, monitor I/O, restrict fluids (meds with fluids at meals, oral hygiene), regulate lytes/BUN/creatinine, dialysis
Chvostek Sign
Positive: tap under earlobe on jaw, mouth twitches toward tap
Indicates hypocalcemia
Orthostatic hypotension
Drop in BP when sitting/standing up: >20 systolic, >10 diastolic, or both
Symptoms: Faintness, light-headedness, dizziness, confusion, blurred vision
AKI neurological function Assessment/plan
Assessment: change in level of consciousness due to electrolyte imbalance
Plan: dialysis to keep BUN under 100, monitor for changes in an LOC, frequent neurochecks, family teaching that condition will improve with recovery
AKI Infection plan
Pan C&S, begin renal dose of antibiotics after specimen obtained, Foley unnecessary if no UO
Minimize the use of invasive lines, adequate nutrition, effective airway clearance, dietary consult
AKI Anemia
Low H/H, packed red blood cells to treat symptomatic anemia (lethargic, hypotension), epogen
