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Outline
Overview
Pathophysiology
Acute kidney injury, also known as acute renal failure, is when the kidneys stop working over the period of a few hours or a few days. People at risk for AKI are those who have high blood pressure, a chronic illness such as heart or liver disease or diabetes, or those who have peripheral artery disease. AKI requires immediate treatment but is usually reversible if treated quickly.
Etiology
Acute kidney injury is a result of direct kidney damage, decreased blood flow or blockage of the urinary tract. Direct damage may be a result of sudden trauma to the kidneys, sepsis, scleroderma or allergic reaction. Other, more common, causes include a blockage in the ureters such as kidney stones, blood clots, enlarged prostate or multiple myeloma. Hypotension, severe diarrhea, infection, overuse of NSAIDs, dehydration or severe burns may cause decreased blood flow.
Desired Outcome
Restore kidney function to optimal state, patient will maintain hydration and be free from infection or chronic kidney damage.
Acute Kidney Injury Nursing Care Plan
Subjective Data:
- Feeling tired
- Feeling confused
- Nausea
- Pain or pressure in the chest
- Shortness of breath
Objective Data:
- Dependent edema
- Periorbital edema
- Seizures
- Tachycardia with hypertension
- Decreased urine output
- Electrolyte abnormalities
- ↑ Potassium
- ↓ Sodium
- ↑ Phosphate
- ↓ Calcium
- ↑ BUN/Creatinine
- ↓ GFR
Nursing Interventions and Rationales
- Monitor vitals
- Heart rate
- Blood pressure
- Perform 12 lead EKG
- Asses heart and lung sounds for adventitious breath sounds or extra heart sounds
- Monitor mentation and changes in level of consciousness
- Assess dependent and periorbital edema
- Monitor diagnostic studies
- Radiology: Chest x-ray, ultrasound or CT of kidneys
- Lab: urine, blood
- Chest x-ray may show increase in cardiac size, pleural effusion or pericardial congestion due to fluid overload
- Urinalysis- urine creatinine usually decreases as serum creatinine increases
- Serum- BUN, creatinine – monitor ratio, if >10:1, dialysis may be indicated
- Sodium– may indicate hyponatremia (fluid overload) or hypernatremia (total body fluid deficit)
- Potassium– elevation indicates kidney disease from lack of excretion or selective retention and leads to hyperkalemia
- Insert indwelling urinary catheter unless contraindicated for infection
- Monitor I & O for fluid retention
- Measure for decreased output <400 mL/24 hr period may be evident by dependent edema
- Daily weights at the same time on the same scale each day, >0.5kg/day is indicative of fluid retention
- Note changes in characteristics of urine to include odor, blood, mucus or sediment present
- Administer medications as ordered
- IV Fluids- may be given for lack of fluid volume, but may be withheld in cases of fluid overload
- Diuretics- furosemide, mannitol may be given to flush kidneys of debris and reduce fluid overload, reducing hyperkalemia
- Calcium channel blockers-given early can help reduce influx of calcium in kidney cells to maintain cell integrity – if calcium level is too low, calcium may be infused
- Antihypertensives- clonidine, methyldopa may be given to counteract the effects of decreased renal blood flow
- Cation-exchange resins- sodium polystyrene sulfonate (Kayexalate) help reduce levels of potassium and treat hyperkalemia
- Nutrition management and education
- Limit intake of excess fluids
- Limit sodium intake – avoid adding salt to foods and limit processed or canned foods that contain hidden sodium
- Increase fresh fruits and vegetables
- Limit foods high in potassium such as beans, rice, bananas, oranges, potatoes and tomatoes
- Limit intake of whole grain breads, bran cereals, nuts and sunflower seeds due to their high phosphorus content
- Refer patient to dietitian if further counseling is required
- Prepare patient for dialysis if indicated
- Peritoneal
- Hemodialysis
- Continuous Renal Replacement Therapy
- Elevate the head of the bed to reduce pressure on the diaphragm and aid in respiration
- Monitor for signs and symptoms of clot or infection at shunt site
- Assess for thrill/bruit of shunt for patency
References
- http://www.kidneyfund.org/kidney-disease/kidney-problems/acute-kidney-injury.html#Who_gets_acute_kidney_injury
- https://www.mayoclinic.org/diseases-conditions/kidney-failure/diagnosis-treatment/drc-20369053
- https://www.kidney.org/atoz/content/AcuteKidneyInjury
- http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/kidney-friendly-diet-for-ckd.html
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