Acute Kidney Injury
-Sudden decrease in renal function, typically reversible
Causes:
Prerenal: Decreased perfusion to the kidneys. Kidneys are not getting
O2. Caused by sepsis, shock. Hypovolemia or renal vascular
obstruction.
Intrarenal: Damage directly to the kidneys. Main cause is CT
contrast, other causes are physical trauma, hypoxic injury, or
medications like gentamicin. (Creatinine over 1.3 = bad
kidneys, shows clogging)
Postrenal: Renal blockage after the kidneys, urine cannot get
out. Caused by a stone, tumor, or BPH. Urine backs up into the
kidney! (BUN over 20, Urine output 30 ml/hr or less= kidneys
in distress) METABOLIC ACIDOSIS
Stages:
Onset phase: Initial injury of the kidney from one of the causes above.
Oliguric phase (Low urine output): Less than 400 ml in 24 hours, High
specific gravity (Dry urine) at risk for pulmonary edema and
hypertension. During this time electrolyte imbalances are present:
Hyperkalemia (ECG dysrhythmias), and Hyponatremia (Cause
seizures)
Diuresis phase (Polyuric): Draining urine, increased urine output.
Liquidy urine with low specific gravity.
Recovery: Really slow recovery can take a year.
Risk Factors: Old age, CT contrast, Antibiotics ending in mycin, Strep
throat
Patients in AKI are at risk for hypervolemia. Assessment
findings include S3 gallop, lung crackled, tachycardia, 2-3lb
weight gain and hypertension.
Signs and Symptoms:
Oliguria
Edema (especially in lower extremities)
Fatigue
, Nausea and vomiting
Shortness of breath
Diagnostics: Hyperkalemia, Hyponatremia, Metabolic acidosis, CR over
1.3, BUN over 20, Anemia (kidneys produce erythropoietin)
Medications: Furosemide, Calcium gluconate, Antihypertensives
Treatment: Flush kidneys with furosemide and fluid bolus, Calcium
gluconate to bring down potassium levels.
Nursing Interventions: Implement seizure precautions, Monitor I&O and
daily weight. Restrict potassium, sodium, phosphate, magnesium intake due
to electrolyte imbalances
Chronic Kidney Disease
Gradual lose in kidney function in stages
Stages: GFR (How much blood is washed from the kidneys each
minute)
Stage 1: Over 90 ml per minute is normal
Stage 2: 60-89 GFR (MILD)
Stage 3: 59-60 GFR (MODERATE)
Stage 4: 15-29 GFR (SEVERE)
Stage 5: 15 or less GFR= (End of stage renal disease, must do a
kidney transplant and dialysis.)
Causes: Older age, Uncontrolled diabetes, Uncontrolled hypertension,
Uncontrolled autoimmune disease (lupus), AKI, Polycystic kidney disease
Critical Complications: Dangerously high blood pressure from fluid
volume overload. #1 priority monitor for hypertensive crisis (headache,
nausea and vomiting, mental status changes) report to HCP at once. Sodium
is high= high swelling, high phosphate leading to low calcium which causes
osteoporosis, potassium is high #1 electrolyte: peaked t waves (6-7) and st
elevations (7-8), wide QRS (over 8) leads to deadly dysrhythmias
Signs and Symptoms: Oliguria- low urine output
, Diagnostics: Cr over 1.3, Creatinine clearance test (measures how much
creatinine waste is being cleared from the body and into the potty.) The test
requires a urine specimen and blood specimen in 24hours, discard first
urine sample when test begins, put container on ice.
Medications: IV calcium gluconate, IV 50% dextrose + regular insulin,
Kayexalate
Treatment: Treatment for high potassium immediately is 1. IV calcium
gluconate for dysrhythmias. 2. IV 50% dextrose + regular insulin (Insulin
puts sugar and potassium into the cell, which lowers potassium.) 3.
Kayexalate (Polystyrene Sulfonate) 4. Dialysis
Nursing interventions: Check daily weight same time everyday, Avoid
NSAIDs, milk of magnesia, antibiotics ending in mycin, CT contrast dye
Procedures: Hemodialysis, Kidney transplant
Diet: Restrict fluid, sodium, and potassium, consume low phosphorus and
low protein. No canned or packed foods, no processed meats. No potassium,
no leafy veggies, avocados, carrots, tomatoes, strawberries, oranges,
bananas. Apples are the best choice.
Hemodialysis
Machine version of the kidney, used in end of stage renal failure
Hemodialysis cleans the blood 3-4 times a week. A shunt is
placed into the arm where blood is taken and washed in the
dialysis machine. Potassium is priority give calcium gluconate
and iv regular insulin.
Before Dialysis: Assess fluid status by checking weight
before and after dialysis, take vital signs and assess for
edema. Assess fistula(shunt) by feeling a thrill and hearing a
-Sudden decrease in renal function, typically reversible
Causes:
Prerenal: Decreased perfusion to the kidneys. Kidneys are not getting
O2. Caused by sepsis, shock. Hypovolemia or renal vascular
obstruction.
Intrarenal: Damage directly to the kidneys. Main cause is CT
contrast, other causes are physical trauma, hypoxic injury, or
medications like gentamicin. (Creatinine over 1.3 = bad
kidneys, shows clogging)
Postrenal: Renal blockage after the kidneys, urine cannot get
out. Caused by a stone, tumor, or BPH. Urine backs up into the
kidney! (BUN over 20, Urine output 30 ml/hr or less= kidneys
in distress) METABOLIC ACIDOSIS
Stages:
Onset phase: Initial injury of the kidney from one of the causes above.
Oliguric phase (Low urine output): Less than 400 ml in 24 hours, High
specific gravity (Dry urine) at risk for pulmonary edema and
hypertension. During this time electrolyte imbalances are present:
Hyperkalemia (ECG dysrhythmias), and Hyponatremia (Cause
seizures)
Diuresis phase (Polyuric): Draining urine, increased urine output.
Liquidy urine with low specific gravity.
Recovery: Really slow recovery can take a year.
Risk Factors: Old age, CT contrast, Antibiotics ending in mycin, Strep
throat
Patients in AKI are at risk for hypervolemia. Assessment
findings include S3 gallop, lung crackled, tachycardia, 2-3lb
weight gain and hypertension.
Signs and Symptoms:
Oliguria
Edema (especially in lower extremities)
Fatigue
, Nausea and vomiting
Shortness of breath
Diagnostics: Hyperkalemia, Hyponatremia, Metabolic acidosis, CR over
1.3, BUN over 20, Anemia (kidneys produce erythropoietin)
Medications: Furosemide, Calcium gluconate, Antihypertensives
Treatment: Flush kidneys with furosemide and fluid bolus, Calcium
gluconate to bring down potassium levels.
Nursing Interventions: Implement seizure precautions, Monitor I&O and
daily weight. Restrict potassium, sodium, phosphate, magnesium intake due
to electrolyte imbalances
Chronic Kidney Disease
Gradual lose in kidney function in stages
Stages: GFR (How much blood is washed from the kidneys each
minute)
Stage 1: Over 90 ml per minute is normal
Stage 2: 60-89 GFR (MILD)
Stage 3: 59-60 GFR (MODERATE)
Stage 4: 15-29 GFR (SEVERE)
Stage 5: 15 or less GFR= (End of stage renal disease, must do a
kidney transplant and dialysis.)
Causes: Older age, Uncontrolled diabetes, Uncontrolled hypertension,
Uncontrolled autoimmune disease (lupus), AKI, Polycystic kidney disease
Critical Complications: Dangerously high blood pressure from fluid
volume overload. #1 priority monitor for hypertensive crisis (headache,
nausea and vomiting, mental status changes) report to HCP at once. Sodium
is high= high swelling, high phosphate leading to low calcium which causes
osteoporosis, potassium is high #1 electrolyte: peaked t waves (6-7) and st
elevations (7-8), wide QRS (over 8) leads to deadly dysrhythmias
Signs and Symptoms: Oliguria- low urine output
, Diagnostics: Cr over 1.3, Creatinine clearance test (measures how much
creatinine waste is being cleared from the body and into the potty.) The test
requires a urine specimen and blood specimen in 24hours, discard first
urine sample when test begins, put container on ice.
Medications: IV calcium gluconate, IV 50% dextrose + regular insulin,
Kayexalate
Treatment: Treatment for high potassium immediately is 1. IV calcium
gluconate for dysrhythmias. 2. IV 50% dextrose + regular insulin (Insulin
puts sugar and potassium into the cell, which lowers potassium.) 3.
Kayexalate (Polystyrene Sulfonate) 4. Dialysis
Nursing interventions: Check daily weight same time everyday, Avoid
NSAIDs, milk of magnesia, antibiotics ending in mycin, CT contrast dye
Procedures: Hemodialysis, Kidney transplant
Diet: Restrict fluid, sodium, and potassium, consume low phosphorus and
low protein. No canned or packed foods, no processed meats. No potassium,
no leafy veggies, avocados, carrots, tomatoes, strawberries, oranges,
bananas. Apples are the best choice.
Hemodialysis
Machine version of the kidney, used in end of stage renal failure
Hemodialysis cleans the blood 3-4 times a week. A shunt is
placed into the arm where blood is taken and washed in the
dialysis machine. Potassium is priority give calcium gluconate
and iv regular insulin.
Before Dialysis: Assess fluid status by checking weight
before and after dialysis, take vital signs and assess for
edema. Assess fistula(shunt) by feeling a thrill and hearing a
