Mr. Smith, age 66 years, had coronary bypass graft
surgery and two days postoperative he was treated for hypovolemic
shock in the Surgical Intensive Care Unit. During this time his
serum creatinine level rose to 4.2 mg/dL and he was diagnosed with
acute kidney injury.
Describe the pathophysiology of acute kidney injury in
Mr. Smith’s situation. Be specific.
Explain how prerenal acute kidney injury is different
than intrarenal (intrinsic) acute kidney injury.
What will be the treatment goals and medical care
rendered by the nurse practitioner? Be specific.
Acute kidney injury was called acute renal failure previously, acute loss of kidney functioning is seen within a few days or a week.
Acute kidney injury is due to damage of the kidney tissues and lack of blood flow which causes ischemia, it can be developed due to persistent low blood pressure, obstruction in the urinary tract, exposure to the substances which is harmful to the kidney, and also due to some inflammation in the kidney.
normal serum creatinine level in an adult is 0.6 mg/dl to 1.2 mg/dl.
pathophysiology of acute kidney injury
there is three different causes of acute kidney disease.
1. pre-renal - it occurs due to the cut down of blood flow to the kidney
it is due to the obstruction in the blood flow to the glomerulus and it interferes with the ability of nephrons to perform its function and it causes decrease blood flow to the afferent arterioles,
and chief causes are
1. Decrease in cardiac output ------ it is due to hypotension and the congestive cardiac failure.
2. VASOCONSTRICTION ------ it is caused by derangement of prostaglandin, the function of prostaglandin is vasodilation at afferent arterioles but a disruption in prostaglandin may lead to vasoconstriction that further leads to acute kidney injury.
3. VASO OCCLUSION ---- it is caused by the formation of emboli and the arteriosclerosis of the arterioles which feeds the kidney.
2. post renal - it is due to the obstruction in the kidney and it is beyond blood flow.
it is due to the obstruction in the bladder and the various parts of the kidney which forms kidney stone and other obstructive damages.
3. Intra-renal - it is caused by the damage to the nephron itself there may be damaged to the glomerulus and can lead to the glomerulus nephritis, it is due to the damage in one of the parts or various parts of the kidney such as damage to the glomerular causes glomerular nephritis, kidney tubule, and the interstitium.
DIFFERENCE BETWEEN PRE RENAL FAILURE AND INTRA RENAL FAILURE
PRERENAL KIDNEY DAMAGE is the gradual process where symptoms of acute kidney injury occur gradually and it takes time. it is due to the underlying conditions such as persistent low blood pressure and the heart diseases for a longer period of time, due to lack of blood supply to the kidney leads to damage to the nephrons and the ischemia occurs, that further leads to acute kidney injury.
INTRA RENAL KIDNEY DAMAGE is a sudden loss in function of the kidney, there are no warning signs such as low blood pressure and other symptoms, it is due to the sudden injury and inflammation to the parts of the kidney that damages the various part of a kidney such as a glomerulus and the nephrons.
TREATMENT OF ACUTE RENAL INJURY
1. MAINTAIN FLUID VOLUME
If there are fewer fluids in your body, iv fluids are recommended, and if there are more fluids then diuretics such as Lasix and frusemide is prescribed.
2. CALCIUM, GLUCOSE, AND SODIUM are PRESCRIBED TO PREVENT ACCUMULATION OF POTTASIUM IN HE BODY.
3. CALCIUM INFUSION IS NEEDED WHEN THERE IS LESS CALCIUM IN THE BLOOD.
4. DIALYSIS IS NEEDED WHEN IT IS NOT BEING TREATED WITH THE MEDICATIONS TO REMOVE TOXINS.
CARE GIVEN TO THE PATIENT IS
1. MANAGE PATIENTS HIGH AND LOW BLOOD PRESSURE BY ADMINISTERING MEDICATION.
2. MANAGE PATIENTS DIABETES BY CHECKING IT AND BY ADMINISTERING ANTI DIABETIC MEDICINES.
3. INSTRUCT CLIENT NOT TO CONSUME ALCOHOL.
4. INSTRUCT CLIENT TO PERFORM EXERCISE DAILY FOR 30 MINUTES.
5. PROVIDE FOOD LOW IN FAT ANDALSO LOW IN SODIUM.
6. DO NOT TAKE TOO MANY ANALGESICS AS IT MAY HURT YOUR KIDNEY BADLY.
7. MONITOR PATIENT WEIGHT DAILY.
8. ADMINISTER MEDICATION ON TIME AS PRESCIBED.
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