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Nursing Management of AKI

The document summarizes the nursing management of patients with acute kidney injury (AKI) or chronic kidney disease (CKD) in the intensive care unit. It discusses the causes, signs/symptoms, diagnosis and treatment of AKI and CKD. It also outlines the nursing assessments, diagnoses, and interventions for managing complications of fluid overload, electrolyte imbalances, nutritional deficiencies and preparing patients for dialysis. The goal of nursing care is early detection and treatment of AKI, management of CKD symptoms and complications, and helping patients cope with their chronic illness.

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134 views24 pages

Nursing Management of AKI

The document summarizes the nursing management of patients with acute kidney injury (AKI) or chronic kidney disease (CKD) in the intensive care unit. It discusses the causes, signs/symptoms, diagnosis and treatment of AKI and CKD. It also outlines the nursing assessments, diagnoses, and interventions for managing complications of fluid overload, electrolyte imbalances, nutritional deficiencies and preparing patients for dialysis. The goal of nursing care is early detection and treatment of AKI, management of CKD symptoms and complications, and helping patients cope with their chronic illness.

Uploaded by

heenamaharjan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Nursing Management of

AKI/CKD patient in Intensive


Care Unit

SARITA MANANDHAR
NURSING OFFICER
Acute Kidney Injury
 Sudden episode of kidney failure or damage
that happens within a few hour or a few days.
 It is common in patients who are in the

hospitals , in intensive care unit and


especially in older adults.
Causes of AKI
Pre renal-hypovolemia, NSAIDS, congestive
heart failure
Intra renal-ischemia, sepsis,nephrotoxins
Postrenal-bladder obstructions due to stones
Pathophysiology
Damaged tubules cannot conserve sodium normally

Activate renin angiotensin aldosterone system

Redistribute renal vascular supply by increasing both afferent


and efferent arterioles

Results ischemia that increase vasopressin, cellular swelling and


inhibition of prostaglandin synthesis and further stimulation
of renin angiotensin system

Reduced blood flow decrease glomerular pressure, GFR and


tubular flow
oliguria occurs
Sign & symptoms of AKI
 Oliguria
 Edema of legs, ankles and around the eyes.
 Fatigue or tiredness
 Shortness of breath
 Confusion
 Nausea
 Seizures or coma in severe cases
Diagnosis
 Measuring urine output
 Urine tests
 Blood tests: Renal function tests
 GFR
 Imaging tests : USG to detect abnormal

kidney
 Kidney biopsy
Management of AKI
 3 Rs for good outcome of AKI patient
according to causes.
 Recognition- early detection
 Response- early identification and swift

treatment of the underlying cause


 Referral-timely escalation using the principles

of “right patient, right professionals, right


time.”
Treatment
 Adequate hydration to prevent hypotension and
shock .
 Correct acidosis with bicarbonates.
 Diuretics
 Electrolyte replacement
 Withhold nephrotoxic drugs: NSAIDS,

chemotherapeutic agents.
 CVP monitoring & ECG monitoring.
 Vasodilators in small doses: dopamine
 Lithotripsy,stent placement for postrenal ARF.
Chronic kidney disease
 Irreversible kidney damage leading to
structural abnormality with proteinuria or
hematuria or GFR<60 ml/min/1.73m2.
Stages
 Satge1: GFR normal. However, evidence of
kidney disease has been detected
 Stage 2: GFR<90ml & evidence of kidney

disease has been detected.


 Stage 3: GFR<60ml, regardless of whether of

evidence of kidney disease has been detected.


 Stage4: GFR<30ml, regardless of whether of

evidence of kidney disease has been detected.


 Stage5: GFR<15ml. Renal failure has

occurred( End Stage Renal Disease)


Causes
 Type 1 or 2 diabetes
 High blood pressure
 Glomerulonephritis
 Polycystic kidney disease
 Prolonged obstruction of urinary tract
 Recurrent kidney infection
Sign & symptoms
 Nausea & vomiting
 Loss of appetite & fatigue
 Mental status changes
 Muscle twitching & cramps
 Edema of feet & ankles
 Shortness of breath
 Persistent itching
Diagnosis
 Same as in AKI
Treatment
 High blood pressure
 ACE inhibitor to preserve kidney function
 Diuretic
 Low salt diet
 Fluid restriction
 Lipid lowering drugs-Statin
 Calcium & vitamin D supplementation
 low protein diet
For end stage renal failure
 Dialysis
 Kidney transplant
Nursing management
 Assessment:
 History taking: exposure to medications,family

history and other associated disease such as


HTN, DM).
 Physical examinations: General conditions, CNS

functions, breath odor and systematic


examinations.
 Assess urine output and specific gravity

 Assess lab results: BUN , creatinine and sodium


 Carefully assess the complications : pleural

effusion, pericarditis, acidosis, uremia.


Nursing diagnosis
 Fluid volume excess related to compromised
regulatory function of kidney with urinary
retention.
 Electrolyte imbalance related to impairement

in filtration of fluid and electrolyte by kidney.


 Imbalanced nutrition less than body

requirement related to restricted intake of


nutrients along with nausea and vomiting.
 Ineffective coping mechanism related to loss

of kidney function.
Interventions
 Hypervolemia management
 Electrolyte management- hyperkalemia and

hypocalcemia
 Nutritional monitoring
 Preparations for dialysis and assisting in the

procedure
 Coping enhancement
Hypervolemia management
 Monitoring respiratory pattern (dyspnea,
tachypnea, SOB) to detect fluid excess.
 Monitoring weight daily and evaluating
changes.
 Monitoring intake and output to determine

effect of treatment on kidney function.


 Provide low salt diet and fluid intake on the

basis of previous day urine output plus


400ml during 24 hrs period and may add
amount of loss from diarrhea and vomiting.
Electrolyte management- hyperkalemia and
hypocalcemia

1. Hyperkalemia
 Monitoring renal function tests
 Monitoring cardiac manifestations of

hyperkalemia (i.e decreased output,


peakedbTwave, fibrillation, asystole) to
initiate ACLS if needed.
 Preparing patient for dialysis and monitoring

haemodynamic response to dialysis.


2. Hypocalcemia
 Monitor bones and mineral indices(calcium,

phosphorous)
 Administer prescribed calcium salt.
 Provide adequate intake of vitamin D.

3. Monitor for manifestations of electrolyte


imbalance routinely.
Nutritional monitoring
 Monitor nausea and vomiting to intervene as
necessary.
 Monitor weight gain or loss to detect change in
status.
 Monitor albumin,total protein, hemoglobin,
hematocrit level as indicators of nutritional
status.
 Provide oral care to prevent stomatitis and
increase intake.
 Provide adequate nutrition as per requirement.
Dialysis therapy
 Draw blood samples and review blood
chemistries.
 Record baseline vital signs.
 Prepare for dialysis and institute and

discontinue dialysis according to protocol.


Coping enhancement
 Explain about disease conditions to patient
and family members.
 Encourage family member to assist patient in

coping strategies.
 Assist patient to grieve & work through

chronic illness.

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