Question

Acute Kidney Injury (Questions: 2,8)

Patient Profile

A.S. is a 70-year-old female who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness
• Reported that she had not been taking her medications regularly at home because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
• 24-hour urine output = 380 mL
• Laboratory Tests:
  • Hemoglobin 8 g/dL
  • Hematocrit 23.8%
  • RBC 2.57 million/mm³
  • WBC 4.7 mm³
  • Sodium 132 mEq/L
  • Potassium 5.2 mEq/L
  • Calcium 9 mg/dL
  • BUN 36 mg/dL
  • Creatinine 4.9 mg/dL
  • BNP 182 pg/mL

Discussion Questions

2) What is the most likely cause of A.S.’s AKI?

8) What are the goals of conservative therapy for a patient with AKI?

Answer 1

INTRODUCTION

-AKI is stands for acute kidney injury.AKI is a serious clinical syndrome charactrized by the structural damage and the impairement of kidney functions.AKI is a medical problems ,if you are not treating properly may leads complications such as;

-uremia

-hypervolemia and hypovolemia

-hyponatremia

-hyperkalaemia

-hyperphosphatemia

-hypocalcemia

-bleeding

-infections

-cardiac problems

-malnutrition

MEANING-AKI

-AKI is a group or spectrum of injury which may result in organ failure and in a failure to maintain fluid balance,electrolyte and acid-base homeostasis

-AKI is a clinical syndrome,kidney it occurs when your kidneys stop working suddenly

CAUSES OR ETIOLOGICAL FACTORS

-The causes of AKI is listed below according to their priorities

1-ISCHEMIA

-This is the most important one etiological factors

-it may cause CELLULAR DAMAGE ,VASO-CONSTRICTION ,ENDOTHELIAL DAMAGE and the ACTIVATION OF CELLULAR DAMAGE

-Due to endothelial injury ,epithelial cells unable to mainatin adequate intracellular ATP for essential process

2-PRE-RENAL CAUSES

-It means causes other than renal disorders

-Pre renal causes may leads to sudden drop of blood pressure or interruption of blood flow to the kidneys from severe injury or illness

-Pre renal causes are categorized into three

1-CARDIOVASCULAR

-Congestive cardiac failure

-Myocardial infarction

-Cardiogenic shock

-Cardiac tamponade

-Pulmonary embolism

2-VASODIALATION

-Sepsis

-Anaphylaxis

3-HYPOVOLEMIA

-Hemorrhage

-Gastro-intestinal loss

-Renal loss

3-INTRA -RENAL CAUSES

-It may cause direct damage to kidneys by inflammation,toxins,drugs,infection or reduced blood supply

-Cause are categorized into

1-GLOMERULONEPHRITIS

-Post streptococcal infection

-Systemic lupus erythematosus

2-VASCULAR

-Vasculitis

-Hyperyension

Renal artery stenosis

-Renal cein thrombosis

3-PROTEIN

-Myeloma

4-CRYSTALS

-Nephrotoxins

4-POST -RENAL CAUSES

-Sudden obstuction of urine flow due to enlarged prostate,kidney stone,bladder tumour or injury

-It is categorizesd  into

1 -OBSTRUCTION OF LOWER URINARY TRACT

2 -OBSTRUCTION OF UPPER URINARY TRACT

GOALS OF CONSERVATIVE THERAPY

-Conservative therapy is defined as therapy used non-invasive procedures

-The main conservative therapies are

1-SUPPORTIVE CARE-It includes

-symptom management

-expert communication

-interdisciplinary team support

-comprehensive nursing care

-end life care

2-PHYSICA THERAPY

-Therapy used to reduce complications

-blodd pressure and blood glucos control

-diet management-restriction of proteins,sodium,phosphoros and fluid

-smoking cessation

  

3-RRT (renal replacement therapy)

-is a therapy ,used to prevent morbidity and support the kidneys during its recovery stage

4-NUTRITIONAL THERAPY

-Use to prevent protein energy wasting

-preserve organ functions

-repair tissue damage

-maintain fluid and electrolyte levels

GOALS OF CONSERVATIVE THERAPY

1-Slow progression

2-manage renal comlications

3-manage cardio-vascular risk

4-prepare for renal replacement therapy

5-enhance recovery

6-potassium restrictions

7-sodium restrictions

8-phosphate restrictions

10-restoration of renal perfusion

11-minimizing toxic effects

12-correction of metabolic acidosis

NURSING DIAGNOSIS

-Excess fluid volume related to fluid retention

-Risk for infection related to uremic toxins

-Imbalanced nutritional status less than body requirements related to altered metabolism

-Impaired hydration status related to fluid overload

CONCLUSION

Kidney diseses are the major cause of mortality and morbidity across the world.So we have to assess by using criteria that is RIFLE ,RIFLE means is the stages of AKI depends on the etiological factors

R-RISK

I-INJURY

F-FAILURE

L-LOSS

E-END STAGEVDISEASE

  

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