Week 6c Acute Kidney Failure

Acute Kidney Failure Notes

Definition and Overview

  • Acute Kidney Failure (AKI): A sudden decrease in kidney function resulting in the accumulation of waste products, electrolyte imbalances, and fluid disturbances.

Causes of AKI

  • Prerenal Causes: Due to inadequate renal perfusion leading to decreased urine output.

  • Intrarenal Causes: Damage to kidney tissue from various factors.

  • Postrenal Causes: Obstruction of urine flow from kidneys.

Phases of AKI

Oliguric Phase

  • Urinary changes: Oliguria (reduced urine output).

  • Fluid volume overload: Retention of excess fluid.

  • Metabolic Acidosis: Impaired acid-base balance.

  • Sodium balance: Issues related to sodium retention.

  • Potassium excess: Hyperkalemia; elevated potassium levels.

  • Waste product accumulation: Toxic buildup in the body.

  • Neurologic disorders: Possible cerebral effects leading to confusion or seizures.

Diuretic Phase

  • Urinary output: Increases to 1-3 liters daily; may exceed 5 liters.

  • Monitor for: Hyponatremia, hypokalemia, dehydration.

Recovery Phase

  • Duration: May take up to 12 months for kidney function stabilization.

Diagnostic Assessments

  • Laboratory Tests:

    • Serum creatinine.

    • Glomerular Filtration Rate (GFR).

    • Blood Urea Nitrogen (BUN).

    • Urinalysis: Average urine volume, electrolytes, and waste products.

Fluid and Electrolytes

  • Inadequate blood flow can lead to:

    • Decreased perfusion and urine output,

    • Retention of fluid and sodium,

    • Accumulation of waste products,

    • Electrolyte disturbances.

Impact of AKI on Organs

  • Uremic Toxins: Build-up causing systemic issues.

  • Acid/Base and Electrolyte Imbalances: Affect cellular and physiological function.

  • Systems Affected:

    • Nervous System: Uremic encephalopathy, potential dementia, stroke risk.

    • Cardiovascular System: Congestive heart failure, arrhythmias.

    • Pulmonary System: Acute lung injury, pulmonary edema.

    • Liver: Altered metabolism and synthesis.

    • Immune System: Systemic inflammation.

Role of the Nurse in AKI

  • Environmental Management: Ensure proper hydration and education on kidney health.

  • Nursing Process:

    • Recognition of Cues: Assessment of clinical manifestations (history, vital signs, weight gain, edema).

    • Analysis: Identify complications (fluid overload, hyperkalemia).

    • Prioritize: Assess urgency for intervention.

    • Planning: Aim for recovery without loss of function; maintain balance and reduce anxiety.

    • Implementation: Monitor I&O, daily weights, dietary restrictions, medication management.

    • Evaluation: Assess effectiveness of interventions.

Treatment and Medications

Treatment by Cause

  • Fluid Challenge: For prerenal causes.

  • Nephrotoxic Medication Management: Avoidance and adjustment based on condition.

Medications for Managing AKI

  • Loop Diuretics (Furosemide): Increases excretion of electrolytes.

  • Cation-Exchange Resins (Sodium Polystyrene Sulfonate): Lowers serum potassium levels.

  • Calcium Gluconate: Stabilizes heart function during hyperkalemia.

  • Beta-2 Agonists (Albuterol): Lowers potassium by shifting it into cells.

  • Insulin: Promotes uptake of potassium into cells.

Nephrotoxic Medications to Avoid

  • Common nephrotoxins include:

    • Vancomycin

    • Methotrexate

    • Lithium

    • Corticosteroids (Cortisone)

    • Acetaminophen (and others).

Acute Kidney Failure (AKI) NCLEX/ATI Style Quiz (20 Questions)

  1. What is the definition of Acute Kidney Failure (AKI)?a) Gradual decline in kidney functionb) Sudden decrease in kidney functionc) Irreversible renal diseased) None of the above

  2. Which of the following is a prerenal cause of AKI?a) Tubular necrosisb) Urinary obstructionsc) Dehydrationd) Renal stones

  3. What is a common symptom during the oliguric phase?a) Diuresisb) Oliguriac) Polyuriad) Hypervolemia

  4. During AKI, hyperkalemia is a condition characterized by:a) Low sodium levelsb) High potassium levelsc) High calcium levelsd) Low phosphate levels

  5. Which lab test is primarily used to assess kidney function during AKI?a) Liver function testb) Serum creatininec) Complete blood countd) Electrolyte panel

  6. In the diuretic phase, what is the expected urinary output?a) 100-300 mL/dayb) 1-3 liters/dayc) Less than 100 mL/dayd) Variable output depending on fluid intake

  7. What are uremic toxins?a) Medications used in treatmentb) Waste products accumulating in the bodyc) Electrolytes balanced in urined) Nutritional supplements

  8. Which of the following systems can be affected by AKI?a) Nervous systemb) Cardiovascular systemc) Pulmonary systemd) All of the above

  9. What is the primary nursing intervention in managing a patient with AKI?a) Immediate dialysisb) Maintain strict I&Oc) Increase dietary potassiumd) Administer nephrotoxic drugs

  10. What is the purpose of calcium gluconate in the management of AKI?a) Decrease sodium levelsb) Stabilize heart function during hyperkalemiac) Promote diuresisd) Increase phosphate excretion

  11. Which medication is indicated for the management of hyperkalemia?a) Sodium polystyrene sulfonateb) Metoprololc) Amiodaroned) Acetaminophen

  12. In the recovery phase, how long might it take for kidney function to stabilize?a) Few daysb) Weeksc) Up to 12 monthsd) 24 hours

  13. What should the nurse assess for to identify complications in a patient with AKI?a) Hypotension and feverb) Fluid overload and hyperkalemiac) Increased appetited) Weight loss

  14. What is an expected outcome for a patient undergoing the diuretic phase of AKI?a) Persistent edemab) Decreased weightc) Low urine outputd) Stable potassium levels

  15. Which of the following medications should be avoided in AKI?a) Loop diureticsb) Vancomycinc) Calcium carbonated) Insulin

  16. What defines the oliguric phase of AKI?a) Overproduction of urineb) Significant fluid retentionc) Retention of excess electrolytesd) Increased sodium excretion

  17. Which complication can arise from uremic toxins?a) Dehydrationb) Systemic inflammationc) Muscle gaind) Weight stabilization

  18. What role does education play in managing AKI?a) It is not necessaryb) Ensures proper hydration and kidney healthc) Delays diagnosisd) Focuses solely on medication management

  19. When prioritizing patient care for AKI, what should the nurse focus on first?a) Diet educationb) Fluid balance and signs of complicationsc) Patient discharged) Laboratory test scheduling

  20. Why is it important to monitor daily weights in patients with AKI?a) To manage medication dosesb) To assess for fluid overloadc) To determine diet choicesd) To estimate urine output