PowerPoint Presentation

Nutrition/EliminationChapter 71: Kidney Disorders1Acute Kidney InjuryEtiology and PathophysiologyPrerenalCauses are factors external to the kidneys that reduce renal blood flowIntrarenalCauses include conditions that cause direct damage to kidney tissuePostrenalInvolve mechanical obstruction in the outflow of urine. As the flow of urine is obstructed, urine refluxes into the renal pelvis, impairing kidney function.

2J.K. is a 37-year-old man who fell off the roof of a house he was constructing. He sustained severe lacerations of his face and left leg, with substantial blood loss.Which type of kidney injury is J.K. at risk for?

3What are the contributing factors for this?

4What signs and symptoms of renal involvement would you assess for?

5Acute Kidney InjuryClinical ManifestationsRIFLE classificationRisk (R)Injury (I)Failure (F)Loss (L)End-stage kidney disease (E)

6Acute Kidney InjuryClinical ManifestationsOliguric phaseUrinary changesFluid volumeHypovolemia may exacerbate AKIWith decreased urine output, fluid retention occursMetabolic acidosisSodium balance?Potassium?

7J.K.s injuries have been repaired, but his urine output has dropped below 350 mL/day.J.K.s laboratory results reveal BUN 53 mg/dL and serum creatinine 2.7 mg/dL.He complains of fatigue.His BP has risen to 178/98.

8What other manifestations should you observe for?

9What other laboratory results should you monitor?

10J.K.s urine output suddenly increases to 2 L overnight. Is this a positive sign?

11Acute Kidney InjuryClinical ManifestationsDiuretic Phase

Recovery Phase12Audience Response Question

Which assessment would indicate to the nurse that a patient has oliguria related to an intrarenal acute kidney injury?

Urinary sodium levels are low. The serum creatinine level is normal. Oliguria is relieved after fluid replacement. Urine testing reveals a specific gravity of 1.010.

13Acute Kidney injuryDiagnostic studies Thorough history

Serum creatinine

Urinalysis

Kidney ultrasonography

Renal scan

Computed tomography (CT) scan

Renal biopsy

14Acute Kidney injuryDiagnostic studiesContraindicatedMagnetic resonance imaging (MRI)Magnetic resonance angiography (MRA) with gadolinium contrast mediumNephrogenic systemic fibrosis Contrast-induced nephropathy (CIN)

15J.K.s urinalysis reveals slight hematuria and a low specific gravity.Renal ultrasound findings are normal.What is the overall goal in the management of J.K. at this point?

16Acute kidney injuryCollaborative care Indications for renal replacement therapy (RRT)Volume overloadElevated serum potassium levelMetabolic acidosis BUN level higher than 120 mg/dL (43mmol/L)Significant change in mental statusPericarditis, pericardial effusion, or cardiac tamponade17J.K. continues to improve, but he has lost 6 lb since admission. He expresses concern regarding maintaining muscle mass and his ability to perform his job as a construction worker after discharge.Nursing assessment?

18Nursing assessment?19Nursing diagnoses?20Nursing implementation Acute intervention21J.K. progresses well and is preparing for discharge.His BUN is 19 mg/dL, serum creatinine is 1.4 mg/dL, and urinalysis is normal.J.K. has gained 2 lb since his nutritional needs were addressed.

22Acute Kidney Injury Gerontologic ConsiderationsAcute Kidney Injury More susceptible to AKIPolypharmacyHypotensionDiuretic therapyAminoglycoside therapyObstructive disordersSurgeryInfection

23