NUR 2502 Module 1-3 Study Concept Guide
AKI
Current definition
• Increase of creatinine >0.3 mg/dL within 48 hrs
• Increase in creatinine >1.5 x baseline
• Urine output less than 0.5 ml/kg/hr >6 hrs
Categories / causes
PRERENAL – Perfusion related!
• Injury to the kidney caused by interruption / disruption of flow TO the kidney
• This is reversible
• Hypovolemia
• Blood or fluid loss (trauma, sepsis, surgery)
• Hypotension
• MI
• Dehydration
• Renal artery stenosis
• Bleeding or clotting in renal blood vessels
POSTRENAL – Outflow related
• Injury to the kidney caused by interruption / disruption of flow OUT of the kidney
• Inability of the kidney to drain, increases hydrostatic pressure in the kidney damaging therenal pelvis
initially and progresses to renal tubules
• Can be reversed
• Obstruction
• BPH or prostate cancer
• Trauma
• Renal calculi
• UTI
INTRARENAL – injury to the kidney
• Damage to the internal structures of the kidney (either directly or as a result of pre or postrenal issues)
• Sepsis
• Nephrotoxic drugs
• Glomerulonephritis
• Acute tubular necrosis (Most common cause of intrarenal disease)
• Prolonged prerenal ischemia
• Bleeding in the kidney
• PKD, pyelonephritis
• Thrombus
• Cancers
• Toxin Three phases
Phases
Oliguric (constricting kidney blood vessels & activating RAAS & releasing ADH)Diuretic –
urine output of 1-3 L per day (urine is usually NOT concentrated) Recovery (BMP returns to
normal)
Prerenal (GFR <65 mmHg) is the most common cause of AKI
,Oliguria (the most common INITIAL sign of AKI) – Urine output <400ml/day
, Lab abnormalities
• Elevated K+, BUN, Creatinine, Mag, Phos (know your numbers!)
• Decreased Bicarb, Na+, calcium (know your numbers!)
• Elevated serum osmolarity and urine specific gravity
BPH
Signs and symptoms
• Difficulty starting urine stream
• Decreased velocity of urine stream
• Intermittent voiding
• Dribbling at the end
• Incomplete bladder emptying / retention
• Increased risk / recurrence of infection
• Urinary frequency / urgency / dysuria
• Nocturia / incontinence
• Bladder or urethra pain
Nursing care / education
• Education – alcohol and caffeine reduction (the diuretic effect increasesbladder
distention)
• Urinate every 2-3 hrs, or when they feel the urge, prevent stasis
• Catheter education if foley or coude’ required
• UTI medication completion
• Discuss concerns about sexual function
• CBI may be necessary
• Blood normal in first 24-36 hrs post op (large volume of bright red blood mayindicate
issues)
• Bladder spasms
• Observe for infection
• Pain management
• Ambulation
• May take 2 months for bladder to return to normal capacity – be aware and bepatient.
Drink plenty and urinate every 2-3 hours.
• Education: TURP- post op care: monitor urine output, control pain, watch forbleeding
Medications – all three types
Alpha blockers – relax the smooth muscles of the prostate and bladder neck to improve urineflow (improve
urethral diameter)
• Terazosin
• Doxazosin
AKI
Current definition
• Increase of creatinine >0.3 mg/dL within 48 hrs
• Increase in creatinine >1.5 x baseline
• Urine output less than 0.5 ml/kg/hr >6 hrs
Categories / causes
PRERENAL – Perfusion related!
• Injury to the kidney caused by interruption / disruption of flow TO the kidney
• This is reversible
• Hypovolemia
• Blood or fluid loss (trauma, sepsis, surgery)
• Hypotension
• MI
• Dehydration
• Renal artery stenosis
• Bleeding or clotting in renal blood vessels
POSTRENAL – Outflow related
• Injury to the kidney caused by interruption / disruption of flow OUT of the kidney
• Inability of the kidney to drain, increases hydrostatic pressure in the kidney damaging therenal pelvis
initially and progresses to renal tubules
• Can be reversed
• Obstruction
• BPH or prostate cancer
• Trauma
• Renal calculi
• UTI
INTRARENAL – injury to the kidney
• Damage to the internal structures of the kidney (either directly or as a result of pre or postrenal issues)
• Sepsis
• Nephrotoxic drugs
• Glomerulonephritis
• Acute tubular necrosis (Most common cause of intrarenal disease)
• Prolonged prerenal ischemia
• Bleeding in the kidney
• PKD, pyelonephritis
• Thrombus
• Cancers
• Toxin Three phases
Phases
Oliguric (constricting kidney blood vessels & activating RAAS & releasing ADH)Diuretic –
urine output of 1-3 L per day (urine is usually NOT concentrated) Recovery (BMP returns to
normal)
Prerenal (GFR <65 mmHg) is the most common cause of AKI
,Oliguria (the most common INITIAL sign of AKI) – Urine output <400ml/day
, Lab abnormalities
• Elevated K+, BUN, Creatinine, Mag, Phos (know your numbers!)
• Decreased Bicarb, Na+, calcium (know your numbers!)
• Elevated serum osmolarity and urine specific gravity
BPH
Signs and symptoms
• Difficulty starting urine stream
• Decreased velocity of urine stream
• Intermittent voiding
• Dribbling at the end
• Incomplete bladder emptying / retention
• Increased risk / recurrence of infection
• Urinary frequency / urgency / dysuria
• Nocturia / incontinence
• Bladder or urethra pain
Nursing care / education
• Education – alcohol and caffeine reduction (the diuretic effect increasesbladder
distention)
• Urinate every 2-3 hrs, or when they feel the urge, prevent stasis
• Catheter education if foley or coude’ required
• UTI medication completion
• Discuss concerns about sexual function
• CBI may be necessary
• Blood normal in first 24-36 hrs post op (large volume of bright red blood mayindicate
issues)
• Bladder spasms
• Observe for infection
• Pain management
• Ambulation
• May take 2 months for bladder to return to normal capacity – be aware and bepatient.
Drink plenty and urinate every 2-3 hours.
• Education: TURP- post op care: monitor urine output, control pain, watch forbleeding
Medications – all three types
Alpha blockers – relax the smooth muscles of the prostate and bladder neck to improve urineflow (improve
urethral diameter)
• Terazosin
• Doxazosin
