Disease teaching
TOPIC: Acute kidney injury
Write the following summary of the disease, making sure to include all of the points below. Your lesson should include:
ANSWER:-
PATHOPHYSIOLOGY:-
The driving force for glomerular filtration is the pressure gradient from the glomerulus to the Bowman space. Glomerular pressure depends primarily on renal blood flow (RBF) and is controlled by the combined resistances of renal afferent and efferent arterioles. Regardless of the cause of AKI, reductions in RBF represent a common pathologic pathway for decreasing glomerular filtration rate (GFR). The etiology of AKI consists of 3 main mechanisms: prerenal, intrinsic, and obstructive.
In prerenal failure, GFR is depressed by compromised renal perfusion. Tubular and glomerular function remain normal.
Intrinsic renal failure includes diseases of the kidney itself, predominantly affecting the glomerulus or tubule, which are associated with the release of renal afferent vasoconstrictors. Ischemic renal injury is the most common cause of intrinsic renal failure. Patients with chronic kidney disease may also present with superimposed AKI from prerenal failure and obstruction, as well as intrinsic renal disease.
Obstruction of the urinary tract initially causes an increase in tubular pressure, which decreases the filtration driving force. This pressure gradient soon equalizes, and maintenance of a depressed GFR then depends on renal efferent vasoconstriction.
CLINICAL MANIFESTATIONS:-
Skin
Skin examination may reveal the following in patients with AKI:
Livedo reticularis, digital ischemia, butterfly rash
Palpable purpura: systemic vasculitis
Maculopapular rash: Allergic interstitial nephritis
Track marks (ie, intravenous drug abuse): Endocarditis
Eyes
Eye examination may reveal the following:
Keratitis, iritis, uveitis, dry conjunctivae: Autoimmune vasculitis
Jaundice: Liver diseases
Band keratopathy (ie, hypercalcemia): Multiple myeloma
Signs of diabetes mellitus
Signs of hypertension
Atheroemboli: Retinopathy (ie, Hollenhorst plaque in cholesterol microembolism)
Ears
Examination of the patient’s ears may reveal the following signs:
Hearing loss: Alport disease and aminoglycoside toxicity
Mucosal or cartilaginous ulcerations: granulomatosis with polyangiitis (Wegener granulomatosis)
Cardiovascular system
Cardiovascular examination may reveal the following:
Irregular rhythms (ie, atrial fibrillation): Thromboemboli
Murmurs: Endocarditis
Pericardial friction rub: Uremic pericarditis
Increased jugulovenous distention, rales, S3: Heart failure
Abdomen
The following signs of AKI may be discovered during an abdominal examination:
Pulsatile mass or bruit: Atheroemboli
Abdominal or costovertebral angle tenderness: Nephrolithiasis, papillary necrosis, renal artery thrombosis, renal vein thrombosis
Pelvic, rectal masses; prostatic hypertrophy; distended bladder: Urinary obstruction
Limb ischemia, edema: Rhabdomyolysis
Pulmonary system
Pulmonary examination may reveal the following:
Rales: pulmonary edema, infectious pulmonary process
Hemoptysis: ANCA vasculitis, anti–glomerular basement membrane (anti-GBM, Goodpasture) syndrome
NURSING DIAGNOSIS :- 1. risk of ineffective gastrointestinal perfusion
2. risk of ineffective kidney perfusion
TREATMENT PLAN :-
Risk of infection | Promotion against infection | ||||
Control of infection | |||||
Maintenance of dialysis access | |||||
Risk of inefficient gastrointestinal perfusion | Hydroetrolitic control | ||||
Urinary elimination control | |||||
Inefficient risk of renal perfusion | Acid-base control | ||||
Hemofiltration therapy | |||||
Hemodialysis therapy | |||||
Urinary elimination control | |||||
Eletrolyte control | |||||
Hidroeletrolyte control | |||||
Excessive fluid volume | Hypervolemia control | ||||
Hydric control | |||||
Hydric monitoring | |||||
Risk of electrolytic imbalance | Acid-base control | ||||
Eletrolyte control | |||||
Risk for imbalanced fluid volume | Hydric control | ||||
Hypervolemia control | |||||
Impaired gas exchange | Breathing physiotherapy | ||||
Breathing monitoring | |||||
Risk of bleeding | Bleeding reduction | ||||
Precaution against bleeding | |||||
Blood products Administration | |||||
Impaired skin integrity | Positioning | ||||
Injuries care | |||||
Pressure ulcer prevention | |||||
Skin supervision |
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