Developing Critical Thinking Through Understanding Pathophysiology

Write Worksheet Topic: Acute Kidney Injury

1. Define and describe in your OWN WORDS, the pathophysiology of the primary problem of your patient:
Acute kidney injury is where there is sudden onset of reduced renal function. It can lead to electrolyte imbalances, HTN,
acid-base disorders, and anemia.

2. How would you explain and teach your patient about the pathophysiology of this medical problem using non-medical
terminology?
AKI is an abrupt onset- within 48 hours- where their kidneys are not working well. It can lead to high blood pressure,
electrolyte imbalances, and low blood counts.

3. What body system(s) are directly impacted by this disease and how are those systems affected?

Body System(s): How Body System(s) is Affected:

Kindeys Low urine output, changes in urinary composition

ABN renal lab values Decreased filtration- GFR, increased BUN, Creatinine

Electrolytes High potassium, high phosphorus, low calcium, acidosis

Blood Anemia, lack of adequate erythropoiesis

Hemodynamics HTN

Fluid imbalances Weight gain

4. PRIORITY nursing assessments with this disease? (refer to body system that is most affected). What assessment findings
may be abnormal as a result of this illness?

Priority Assessments: Expected Abnormal Assessments:

Urine output oliguria- less than 500ml/day

Non oliguria- greater than 500m/day
Anuria- less than 50ml/day

Weight and Fluid volume status Increased weight , edema, Assess for s/s of fluid volume
excess, keep accurate I&O, and daily weights

Lab values High potassium, high phosphorus, low calcium, acidosis

Low HGB/HCT, high serum osmolality, increased urine
specific gravity, sediment may be present, urine sodium
 may be elevated
Blood Pressure
Watch for hypertension
Neuro Watch for confusion as toxins build up in their
bloodstream

fever and infections can increase metabolic and catabolic

Obtain blood and urine cultures as needed rate

may be dry, scaley, susceptible to breakdown due to

Skin edema

can be short of breath with fluid overload, increased resp

Respiratory/Lung sounds rate

5. What lab tests are altered by this problem? How are those lab tests affected? Does the altered lab test affect any physical
assessment findings?

Abnormal Lab Tests: How Lab Tests Affected: Does it Impact Assessment?

Urine tests helpful in diagnosing Patient may need IVFs

etiology Patient may need dialysis
Urine sodium, osmolality, and
specific gravity distinguish AKI from Pre-renal- increased Distinguish AKI from ATN
ATN Post renal- varies
ATN- 250-300

Helps distinguish pre-renal AKI from

+
Fractional excretion of Na (FENa) Pre-renal- <1% and ATN and or post renal AKI
Post-renal- >1%
ATN- >1% (often >3%)

Bun/Creat ratio Pre-renal- >20:1 Patient may need IVFs

Fractional excretion of BUN and Post-renal- 10:1 to 15:1 Patient may need dialysis
creatinine distinguish prerenal AKI ATN- 10:1 to 15:1
and ATN or postrenal AKI

Pre-renal- normal , few casts Helps distinguish pre-renal AKI from

Sedimentation Post-renal- normal may be crystals and ATN and or post renal AKI
ATN- granular casts, yubular
epithelial cells

GFR GFR decreased Patient may need IVFs

Patient may need dialysis

6. What medications are most commonly used to manage this problem? Consider the medications you might use, how it
works, and why you are using it….
 Medications: Mechanism of Action (Own Words):

Rehydrates kidneys and patient

administer IV fluid Encourages urine output
This medication is used to treat a high level of potassium in

therapy your blood.

Calcium gluconate for hyperkalemia
Insulin and glucose can shift potassium into the cells
-diuretics Helpful after contrast medium, cardiac surgery, or liver
transplant can reduce the incidence of AKI. It’s a base
substance that helps kidney not get worse
-nephrotoxicity Manages HTN

-sodium
polystyrene
-sorbitol
-IV medications
(dextrose, insuline,
and calcium)
-sodium
bicarbonate
-hyperphosphatemi
a
administer IV fluid therapy -
diuretics –
sodium polystyrene –

IV medications (dextrose, insulin, potassium, and calcium) –

sodium bicarbonate –

CCB along with renin angiotensin aldosterone inhibitors

7. Are there any surgical, procedural, or diagnostic interventions for each topic that are important to note? If there are, list 1
or 2 below and why they are used.
Renal ultrasonography- R/O obstruction
CT and MRI- Evaluate for masses, vascular disorders and filling defects
Renal angiography- Evaluate for renal artery stenosis
Renal biopsy- Diagnosis, prognosis, and therapy evaluation

continuous renal
replacement therapy,
hemodialysis, peritoneal
dialysi
continuous renal replacement therapy – better for a slower treatment when patient is not HDS enough to tolerate HD. CRRT
differs from hemodialysis and peritoneal dialysis in that it is intended to be utilized for 24 hours or longer, continuous and slower
(removing fluid at a much slower pace than traditional hemodialysis or peritoneal dialysis) which is better for hemodynamically
unstable patients. For this reason, CRRT is usually administered in the critical care units.
hemodialysis- good for HDS patients with long term dialysis needs
peritoneal dialysis- good for home dialysis and less acute/unstable cases
______________________________________________________________________________________________

On Your Own Time:

Consider the Clinical Judgement Measurement Model and try to order your knowledge and understanding of this disease process:
 Recognize
Cues

Evaluate Analyze
outcomes Cues

Generate
Take Action
Solutions

Prioritize
Hypotheses