Learning about Acute Kidney Injury
Every nursing student should understand that acute kidney injury (AKI) is a rapid decline in kidney function, potentially leading to life-threatening complications. Knowledge of its common causes, such as dehydration, medications, and sepsis, along with recognizing early signs and implementing prompt interventions, is crucial for improving patient outcomes.
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Acute kidney injury (AKI) represents a sudden and critical deterioration in kidney function, demanding immediate medical attention. This condition can arise from various factors such as severe infections, certain medications, dehydration, or underlying diseases.
When the kidneys are unable to effectively filter waste and excess fluids from the blood, harmful substances accumulate, disrupting the body's delicate balance. AKI may manifest as decreased urine output, fluid retention, fatigue, and nausea.
Timely intervention is essential, as untreated AKI can lead to serious complications like electrolyte imbalances, fluid overload, and even kidney failure. Healthcare professionals work to address the underlying cause while managing the AKI through careful monitoring, medication adjustments, and appropriate interventions to restore kidney function and mitigate potential long-term consequences.
Overview of Acute Kidney Injury
1. Sudden onset of renal damage
2. Loss of renal function due to poor circulation or renal cell damage
3. Usually reversible may resolve on its own, but can lead to permanent damage if not reversed quickly
General Information on Acute Kidney Injury
1. Causes
a. Prerenal
i. Decreased blood flow to the kidneys, accounts for a majority of cases→ Hypotension, Hypovolemia, ↓ Cardiac Output (i.e. Heart Failure, Shock)
b. Intrarenal
i. Damage within the kidney itself→ Tubular necrosis, infection, obstruction, contrast dye, nephrotoxic medications
c. Postrenal
i. Damage between the kidney and urethral meatus backs up, causing damage to kidneys→ due to infection, calculi, or obstruction
2. Phases
a. Onset→ Note a decrease in baseline urine output
b. Oliguric→ Decreased urine output <400 mL/ day. This is the sickest phase where there is a ↑ BUN/Creatinine and ↓ Glomerular Filtration Rate (GFR)
c. Diuretic→ Beginning to recover, there is a gradual increase in urine output followed by diuresis
d. Recovery→ has decreased edema, electrolytes normalize, and GFR increases
Nursing Assessment for Acute Kidney Injury
1. Signs and symptoms result from the inability of the kidneys to regulate fluid and electrolytes2. Azotemia (retention of nitrogen wastes in the blood) → ↑ BUN/Creatinine
3. ↓ Glomerular Filtration Rate (GFR)
4. Decreased urine output in the oliguric phase which should see an increase in diuretic phase
5. Signs of volume overload (HTN, peripheral edema, pulmonary edema)
6. s/s infection if that was the source
7. Metabolic acidosis→ Kidneys not holding HCO3–
8. Electrolyte abnormalities→ ↑ Potassium, ↓ Sodium, ↑ Phosphate, ↓ Calcium
Therapeutic Management for Acute Kidney Injury
1. Oliguric Phase
a. Restrict fluid intake because there is volume overload, give diuretics for volume overload, and identify & treat the cause
2. Diuretic Phase
a. Replace fluids and electrolytes and especially watch potassium & sodium levels
3. If not recovering, may need dialysis
Nursing Case Study for Acute Kidney Injury
Patient Profile:
Name: Mr. Sam SmithAge: 65 years old
Gender: Male
Medical History: Hypertension, diabetes
Presenting Symptoms:
- Decreased urine output
- Swelling in the legs and ankles
- Fatigue and weakness
- Elevated blood pressure
Medical Examination and Diagnostics:
- Physical Examination: Mr. Smith displayed edema in the lower extremities and elevated blood pressure
- Laboratory Tests: Elevated serum creatinine and blood urea nitrogen (BUN) levels, indicating impaired kidney function
- Renal Ultrasound: Revealed acute kidney injury with reduced kidney perfusion
Medical History:
Mr. Smith had a history of hypertension and diabetes, which may have contributed to his acute kidney injury
Diagnosis:
Mr. Smith was diagnosed with acute kidney injury, a sudden decrease in kidney function, resulting in impaired filtration and waste-elimination
Treatment Plan:
Monitored Mr. Smith’s fluid balance and electrolyte levels closely, adjusting IV fluids accordingly
2. Medication Review:
Reviewed all medications for potential nephrotoxicity and adjusted doses as needed
3. Blood Pressure Control:
Administered antihypertensive medications to maintain target blood pressure levels
4. Nutritional Support:
Collaborated with a dietician to provide a kidney-friendly diet to manage electrolyte imbalances
5. Dialysis Consultation:
Consulted the nephrology team for potential dialysis if kidney function did not improve
Outcome:
With diligent nursing care and medical management, Mr. Smith’s kidney function showed signs of improvement. His urine output increased, and his blood pressure was stabilized. Gradually, his serum creatinine and BUN levels began to decline.
Conclusion and Free Download
This Acute Kidney Injury (AKI) review provides essential knowledge for confidently approaching the NCLEX. Understanding its prevention, management, and interventions empowers nurses to provide effective care and save lives.
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