Question

Describe the pathophysiology, clinical manifestations, nursing care and collaborative management of patient whom have problems due to Acute Kidney injury.

Answer 1

ACUTE KIDNEY INJURY: Acute kidney injury is described as the failure of kidneys and unable to remove waste from the blood, thus causing fluid & electrolyte imbalance. It is also known as acute renal failure and develops usually within a few hours or days.

PATHOPHYSIOLOGY: Depending on the cause, AKI can be prerenal, intrinsic or post renal.

• PRERENAL INJURY: It is the failure to receive an adequate blood supply resulting from sepsis, bleeding etc. This leads the kidney function to decrease. The kidneys are deprived of nutrients to function properly and the amount of blood it can filter.
• INTRINSIC/RENAL: This is acute damage of renal cells (nephron). When the nephrons are damaged the kidneys can’t filter the blood, maintain electrolyte levels, and remove excessive waste and fluid from the body.
• POST RENAL: It is the blockage in the urinary tract. This prevents urine from draining out of the kidneys increasing the pressure in the kidney. Renal calculi & enlarged prostrate can be the cause of obstruction.

Acute Kidney Injury has got four phases or stages:

• Onset phase- Urine output is below 0.5ml/kg/hour. This stage lasts few hours to days. The common triggering events can be significant blood loss, fluid loss, DI, burns.
• Oliguric Phase- Urine output below 400ml/day or as low as 100ml/day.This stage lasts from a week to 2 weeks. Dialysis can be needed in this stage.
• Diuretic Phase- This stage occurs when cause of AKI is corrected. This stage lasts from 7-14 days and is characterized by Increased GFR, Daily urine output above 400ml/day, Real tubule scarring & edema, electrolyte depletion from excretion of more water.
• Recovery Phase-This stage starts when GFR returns to normal and the kidney starts to function normally. Urine output returns to normal along with BUN, creatinine and other electrolytes. This stage can last from several months to a year depending on the patient's age and the amount of damage doe to the kidneys.

CLINICAL MANIFESTATIONS: The following are the various clinical manifestations:

• Decrease in urine output.
• Fluid retention causing edema in legs, ankles or face.
• Fatigue or confusion
• Shortness of breath
• Slow & Sluggish movement
• Blood in the urine
• In severe/extreme cases, seizures or coma can happen.

NURSING CARE & COLLABORATIVE MANAGEMENT OF AKI:

• Strict Intake & output charting: Intake & output monitoring is very important in patients with AKI. Assessment of urine should also be done for blood, odor or mucus.
• Fluid therapy: Monitor fluid & electrolyte imbalance. Also, daily weight monitoring is done.
• Diet changes: Patient needs to be educated on decreasing sodium intake as well as reducing fluid intake. Adequate Protein intake is required in diet.
• Monitoring Lab investigations; Careful and regular monitoring of BUN, Creatinine is essential. Monitoring Potassium normal range. Hyperkalemia is one of the complications of AKI.
• Infection prevention: If the patient is having invasive lines & catheters, it is very important to maintain asepsis in order to reduce infection.
• Assessment of Lung sounds & Monitoring of vital signs: Crackling sounds in the lungs can indicate fluid retention so careful assessment is needed. Also, nurses should encourage respiratory exercises.
• Medications administration: Loop diuretics are the choice of drugs in AKI to treat fluid retention. Calcium Channel blockers and antihypertensives are also given.
• Skin care: Nurses need to make sure that regular skin care is being given to prevent skin breakdown or excoriation.