ELMINATION
1. Renal Failure (Acute vs. Chronic)
Layman’s Terms:
Acute Kidney Injury (AKI): sudden kidney shutdown (hours–days), often reversible.
Chronic Kidney Disease (CKD): long-term, progressive loss of kidney function.
Key Points:
Kidneys remove waste + balance fluids/electrolytes.
Failure → waste buildup (BUN/Cr high), fluid overload, electrolyte imbalance (esp. potassium).
ADPIE Priority:
A: Labs (BUN, creatinine, GFR), urine output (<30 mL/hr danger), edema, weight gain, potassium levels.
D: Fluid overload, electrolyte imbalance, risk for arrhythmias, impaired elimination.
P: Maintain fluid/electrolyte balance, prevent complications (esp. hyperkalemia, acidosis).
I: Monitor I&O, daily weights, restrict fluids/sodium/potassium, prepare for dialysis if severe.
E: Stable labs (K+, Cr, BUN), controlled BP, adequate urine or managed on dialysis.
2. Fluid & Electrolyte Concepts
Layman’s Terms: Kidneys act like filters + faucets, controlling body’s water and “salts” (Na, K, Ca, Mg). When they fail → imbalance.
Priorities:
High K+ = heart rhythm issues.
Low Ca/Mg = cramps, seizures.
Too much fluid = swelling, high BP, lung fluid.
ADPIE Priority:
A: Daily weights, edema, lung sounds, electrolytes, strict I&O.
D: Risk for fluid overload or dehydration, electrolyte imbalance.
P: Prevent dangerous shifts, maintain balance.
I: Replace deficits (IV fluids, electrolytes), restrict excess, diuretics.
E: Balanced labs, stable vitals, no fluid overload.
3. ABG Compensation
Layman’s Terms: Kidneys + lungs balance acids and bases. If lungs fail (respiratory), kidneys help fix. If kidneys fail (metabolic), lungs help.
Example:
Kidney failure = can’t remove acid → metabolic acidosis. Lungs try to help = deep rapid breathing (Kussmaul’s).
ADPIE Priority:
A: ABGs, breathing pattern, mental status.
D: Risk for acid-base imbalance, impaired gas exchange.
P: Maintain near-normal ABGs.
I: Treat cause (dialysis, O2, fluids), monitor breathing.
E: ABGs improve, pt breathing easier.
4. Dialysis Types
Layman’s Terms:
Hemodialysis: blood cleaned with machine (3x/week).
Peritoneal dialysis: belly lining acts as filter using catheter + dialysate.
ADPIE Priority:
A: Access site (fistula, graft, or catheter), bruit/thrill, infection signs, weight, BP.
D: Risk for infection, fluid imbalance, electrolyte imbalance.
P: Keep patient safe during/after dialysis, avoid complications.
I: Hold BP meds before HD, monitor for hypotension, bleeding, infection.
E: Stable weight, labs, BP, no access complications.
5. Nephritis (Pyelonephritis)
Layman’s Terms: Kidney infection → bacteria climbed up urinary tract → fever, flank pain, burning pee.
ADPIE Priority:
A: Fever, flank pain, cloudy urine, WBCs, positive cultures.
D: Infection, pain, impaired elimination.
P: Clear infection, prevent damage.
I: IV antibiotics, fluids, antipyretics, teach prevention (hygiene, hydration).
E: No fever, negative culture, improved urine output.
6. Acute Glomerulonephritis
Layman’s Terms: Immune system attacks kidneys (often after strep throat). Causes swelling, blood in urine, high BP.
ADPIE Priority:
A: Cola-colored urine, proteinuria, edema, HTN, recent infection.
D: Fluid overload, risk for renal impairment.
P: Manage fluid, control BP, protect kidneys.
I: Sodium/fluid restriction, antihypertensives, diuretics, antibiotics if infection.
E: BP stable, urine clears, edema decreases.
7. Nephrosclerosis
Layman’s Terms: Hardening of kidney blood vessels (like scarring pipes). Often from long-term high BP → kidney damage.
ADPIE Priority:
A: Hypertension, protein in urine, decreasing GFR.
D: Risk for renal impairment, ineffective tissue perfusion.
P: Control BP, slow kidney damage.
I: Strict BP control (ACE inhibitors, diuretics), monitor labs, educate lifestyle changes.
E: Stable BP, slower CKD progression.