Please enable JavaScript.
Coggle requires JavaScript to display documents.
Acute kidney injury & Chronic kidney disease (CKD (Stages (Kidney…
Acute kidney injury & Chronic kidney disease
AKI
Phases
Oliguric
Characteristics:
Extremely low Urine output
<400 mL/day
pt. will manifest other system disorders (toxic waste accumulates in body) High BUN, Creatinine, Ammonia; Electrolyte imbalances; Blood pressure goes up; Hypervolemia (tubular vein dysfunction & EDEMA EVERYWHERE)
Diuretic
Characteristics:
Eliminates fluids all of fluids; may require hemodialysis during this phase
Onset
Characteristics:
reduced functioning of kidneys (reduced urine), GFR is reduced; Slight increase of BP
Recovery
Acute syndrome may be reversible w/ prompt intervention
Pathophysiology
Causes
Hypovolemic Shock
Nursing interventions
Nutritional considerations; Electrolyte imbalances; Dosing implications
Heart Failure
Prerenal azotemia
Nitrogenous waste
Types
Intrarenal
Hypertension from obstruction of renal blood flow
Postrenal
Kidney Stones; Drugs; PBH; Obstruction starting from ureters down
Prerenal
stenosis; MI; Shock; Hyper/hypotension; Hyptensive meds
Rapid decrease in kidney function lead to collection of metabolic wastes in the body
CKD
Clinical Manifestations
Neurologic; Cardiovascular; Respiratory; Hematologic; GI; Skeletal; Urinary; Skin
Stages
Reduced GFR
Stage ONE-FIVE
ESKD
After Stage FIVE
Reduced renal reserve
Stage ONE
Kidney Changes
Electrolyte Changes
Sodium, Potassium, Acid-Base imbalance, Calcium & Phosphorus
Metabolic Changes
Urea & Creatinine
Cardiac Changes
Hypertension, Hyperlidiemia, Heart Failure, Pericarditis
Hematologic Changes
GI Changes
Assessments
Psychosocial; Laboratory; Imaging
Progressive, irreversible kidney injury; kidney function does not recover; End-stage kidney disease
(ESKD)
Azotemia; Uremia; Uremic syndrome
Priority Nursing Care
Dietary restrictions (low potassium, low protein, low sodium diet); Uremic frost; Muscle strength, energy; Family members; Excess fluid volume; Decreased cardiac output; Recombinant human erythropoietin (EPOgen); Interdisciplinary team
Stages 1-5
BASED on GFR
30-59
Evaluation and treatment of complications
15-29
Preparation for renal replacement therapy (dialysis, kidney transplant)
60-89
Estimation of progression
<15 or dialysis
Renal replacement therapy (if uremia present and patient desires treatment )
>= 90 ML/min
Diagnosis and treatment CVD; Risk reduction; Slow progression
Hemodialysis
Patient selection; Dialysis settings; Procedure; Anticoagulation
Complications
Dialysis disequilibrium syndrome; Infectious disease; Hepatitis B & C; HIV
Vascular Access
Arteriovenous fistula or graft for long-term permanent access; Hemodialysis catheter, dual or triple lumen or AV shunt for temporary access; Precautions; Complications
#
Complications
Drugs; Post dialysis assessment
(Hypotension, Nausea, Vomiting, Headache, Malaise, Dizziness, Muscle cramps or bleeding)
Normal GFR
125 mL/min
Peritoneal Dialysis
Nursing Care
:star: Before treatment- Evaluate baseline vital signs, weight, laboratory tests; :star: Continual monitor patient for Respiratory Distress, Pain and Discomfort; :star: Monitor prescribed dwell time, initiate outflow; :star: Observe outflow amount and pattern of fluid
Complications
Peritonitis; Pain; Exit site/Tunnel infections; Poor dialysate flow; Dialysate leakage;
Types
Continuous ambulatory (CAPD); Automated; Intermittent; Continuous-cycle
Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate
Kidney Transplant
Candidate selection criteria; Donors; Preoperative care; Immunlogic studies; Surgical team; Operative procedure
Complications
Rejection; Acute tubular necrosis; Thrombosis; Renal artery stenosis
Postoperative Care
Urologic management; Assessment of hourly urine output x 48 hours; Immunosuppressive drug therapy; Psychosocial preparation