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Questions and Answers
What should be the first step in managing low urine output and elevated creatinine levels?
What is a potential cause of intrarenal acute kidney injury?
What dietary considerations should be made for a patient with acute kidney injury?
In cases of postrenal acute kidney injury, what is a typical intervention?
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What sign should be monitored to assess for volume overload in a patient with acute kidney injury?
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What is the primary cause of prerenal acute kidney injury?
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Which of the following is a common clinical manifestation of acute kidney injury?
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What minimum urine output per hour indicates potential acute kidney injury?
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Which type of acute kidney injury is characterized by obstruction in structures leaving the kidney?
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An elevation in blood pressure can lead to which type of acute kidney injury?
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What is a potential consequence of post-obstruction in the kidneys?
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Which of the following medications is known to be nephrotoxic?
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What laboratory finding would indicate acute kidney injury?
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Which of the following factors are recognized as risk factors for Chronic Kidney Disease (CKD)?
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What is a common clinical finding associated with the progression of Chronic Kidney Disease?
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What is the normal range for estimating GFR in mL/min/1.73m2?
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Which of the following is NOT a part of the treatment considerations for Chronic Kidney Disease?
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What is a key nursing consideration when caring for a patient with a dialysis fistula?
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Which of the following conditions would typically indicate the need for dialysis?
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In the event of end-stage renal disease (ESRD), which treatment option is considered necessary for patients?
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What are the possible complications that can occur with Peritoneal Dialysis?
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What is the recommended amount of hydration for patients with no fluid restrictions?
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Which medication is used as a potassium eliminator in patients with CKD?
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Study Notes
Acute Kidney Injury (AKI)
- Sudden loss of kidney function, determined by reduced urine output and increased serum creatinine.
- AKI can progress to Chronic Kidney Disease (CKD) and eventually End-Stage Renal Disease (ESRD).
- Oliguria: Urine output < 100-400ml.
- RIFLE classification: Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease.
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Types:
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Prerenal AKI: Caused by reduced blood flow to the kidneys.
- Common causes: Hypovolemia (blood loss, dehydration), Hypoperfusion (heart failure, hypotension).
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Intrarenal AKI: Direct damage to the kidneys.
- Causes: Hypoxic injury (renal artery stenosis, thrombosis, hypertensive emergency), Chemical injury (nephrotoxins), Immunologic injury (infection, vasculitis, glomerulonephritis).
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Postrenal AKI: Obstruction of the urinary tract.
- Causes: Stones, tumors, BPH, urethral strictures.
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Prerenal AKI: Caused by reduced blood flow to the kidneys.
Management of AKI
- Correct underlying cause.
- Monitor vital signs, telemetry, fluid intake and output, daily weight, and laboratory values (BUN, SCr, electrolytes, H/H).
- Educate on diet restrictions (low potassium, phosphate, fluid restriction).
- Treat with fluid balance (replacement for perfusion compromised, diuretics for filtration), electrolyte management, possibly dialysis (intermittent, CRRT, HD).
Health Promotion and Disease Prevention for AKI
- Adequate hydration (2L).
- Stop smoking, maintain active lifestyle, and eat healthy.
- Caution with NSAIDS and other nephrotoxins (including contrast dye).
- Control diabetes and hypertension.
- Take antibiotics as directed for infections.
Chronic Kidney Disease (CKD)
- Long-term, irreversible loss of kidney function due to kidney damage.
- Etiologies: Unresolved AKI, long-standing damage to kidneys (hypertension, diabetes).
- Risk factors: Age, AKI, diabetes, nephrotoxic medications, hypertension, autoimmune disorder, polycystic kidney disease, pyelonephritis, renal artery stenosis.
- Diagnosis: Estimating GFR (normal 90-120 mL/min/1.73m2) using serum creatinine, urine testing for albumin or protein.
Clinical Findings of CKD
- May initially be asymptomatic except during periods of stress.
- Symptoms become more apparent as kidney function declines.
- Common symptoms: Nausea, depression, fatigue, lethargy, involuntary leg movements, symptoms related to volume overload (neurological, cardiovascular, respiratory, renal, musculoskeletal, hematological).
Treatment of CKD
- Nursing Considerations: Monitor I+O, weights, vitals, telemetry, vascular access or peritoneal dialysis insertion sites, educate on dietary restrictions, provide mouth and skin care.
- Medications: Diuretics, potassium eliminators (sodium polystyrene), epoetin alfa, ferrous sulfate, phosphate-binders.
End-Stage Renal Disease (ESRD)
- Requires dialysis (hemodialysis, peritoneal dialysis) or kidney transplantation.
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Dialysis fistulas: Surgically created access for dialysis.
- Nursing considerations: Assess patency, avoid BP measurements, risks for bleeding and infection.
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Dialysis indications: Toxins, fluid overload, electrolyte abnormalities, uremia.
- Nursing considerations: Bleeding, hypotension, electrolyte abnormalities, infection.
Peritoneal Dialysis
- Dialysate fluid fills abdominal cavity, using peritoneum as exchange membrane.
- Advantages: Done at home, gentler fluid shifts.
- Risks: Infection (peritonitis).
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Description
This quiz covers the essentials of Acute Kidney Injury (AKI), its classification, causes, and management strategies. Understand the distinction between prerenal, intrarenal, and postrenal AKI, and learn how to identify and address the underlying factors contributing to kidney dysfunction.
