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Acute Kidney Injury PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Acute Kidney Injury".

This medical PowerPoint presentation talks about acute Kidney Injury (AKI) (previously known as acute renal failure), a medical condition in which there is a sudden and rapid decline in kidney function. The kidneys are responsible for filtering waste products from the blood and removing excess fluids from the body. When the kidneys are not functioning properly, waste products can build up in the blood and cause a range of symptoms and complications.

AKI can be caused by a variety of factors, including dehydration, reduced blood flow to the kidneys, infections, medications, and certain medical procedures. The condition can range in severity from mild, with no noticeable symptoms, to severe, requiring dialysis or kidney transplant.

Tags : Acute Kidney Injury, AKI, Acute Renal Failure, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2914 | Downloads : 13

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Slide 2-

Anatomy and Physiology Kidneys Location Retroperitoneal area Structure Cortex Medulla Nephron Receives 20% to 25% of cardiac output Performs numerous functions Copyright © 2017 Elsevier Inc. All rights reserved. 2
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Fluid and Electrolytes; Wastes Glomerular filtration rate (GFR) Result of pressure gradient 80 to 125 mL/min Reabsorption Secretion Hormonal control Aldosterone Antidiuretic hormone Copyright © 2017 Elsevier Inc. All rights reserved. 4
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Acute Kidney Injury Sudden deterioration of renal function Oliguria: low urine output Azotemia: accumulation of nitrogenous wastes Acid-base disturbances Copyright © 2017 Elsevier Inc. All rights reserved. 10
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Prerenal Etiology Diminished blood flow; hypoperfusion of the kidney Volume depletion Vasodilation Decreased cardiac output Can progress to intrarenal damage Copyright © 2017 Elsevier Inc. All rights reserved. 13
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Intrarenal Etiology(Cont.) Acute tubular necrosis (ATN) Ischemia Nephrotoxic agents Antibiotics Nonsteroidal antiinflammatory drugs (NSAIDs) Contrast-induced Rhabdomyolysis Copyright © 2017 Elsevier Inc. All rights reserved. 15
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Quick Quiz! A treatment for postrenal etiology of AKI is: Diuretic administration Fluid administration Nephrectomy Ureteral stent placement Copyright © 2017 Elsevier Inc. All rights reserved. 18
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Course of AKI Initiation phase Time from event to signs of decreased renal perfusion Several hours to 2 days Potentially reversible Copyright © 2017 Elsevier Inc. All rights reserved. 19
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Course of AKI (Cont.) Maintenance phase (oliguric/anuric) BUN and creatinine increase daily Oliguria is common Urine output less than 400 mL/day Fluid overload, electrolyte imbalances, and acidosis Renal replacement therapy required Copyright © 2017 Elsevier Inc. All rights reserved. 21
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Course of AKI(Cont.) Recovery phase Return of tubular function 4 to 6 months for BUN and creatinine to return to normal Residual impairment of GFR Early dialysis may prevent the traditional “diuretic” phase of AKI Copyright © 2017 Elsevier Inc. All rights reserved. 22
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Assessment - Patient History Predisposing factors Disease states Hypertension Diabetes Immunological disease Hereditary disorders Hypotensive episodes Exposure to nephrotoxic agents Copyright © 2017 Elsevier Inc. All rights reserved. 23
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Clinical Presentation of AKI Vital signs may be altered Blood pressure changes, depending on etiology Hyperventilation to compensate for metabolic acidosis Body temperature may be altered Assess for volume depletion and volume overload Copyright © 2017 Elsevier Inc. All rights reserved. 24
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Physical Findings of AKI The patient’s general appearance is assessed for: Signs of uremia (malaise, fatigue, disorientation, and drowsiness) Color and texture of skin Bruising, petechiae, and edema Current and admission body weight and intake and output Dehydration/fluid overload Copyright © 2017 Elsevier Inc. All rights reserved. 25
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Laboratory Tests for AKI Serum creatinine Serum BUN Affected by catabolism, bleeding, and dehydration BUN:creatinine ratio Normal 10:1 to 20:1 More than 20:1, suspect nonrenal causes of laboratory abnormalities Copyright © 2017 Elsevier Inc. All rights reserved. 26
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Laboratory Tests for AKI(Cont.) Urine creatinine clearance Estimate of GFR 24-hour urine; specific collection protocol Normal 84 to 138 mL/min Can calculate an estimated value with serum lab values (Cockcroft and Gault formula) Copyright © 2017 Elsevier Inc. All rights reserved. 27
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Laboratory Findings Specific gravity Urine osmolality Urine sodium Microscopic examination BUN/Creatinine ratio FENa (the factional excretion of sodium) Copyright © 2017 Elsevier Inc. All rights reserved. 28
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Diagnostic Studies for AKI Noninvasive tests X-ray of kidneys, ureter, and bladder (KUB) Size, shape, and position of kidneys Calculi, cysts, and tumors Renal ultrasound Size of kidneys Obstruction MRI Copyright © 2017 Elsevier Inc. All rights reserved. 30
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Diagnostic Studies for AKI(Cont.) Invasive tests IV pyelogram Computed tomography Structures, accumulation of fluid Renal angiography Abnormalities in blood flow; infarction; masses Renal scan Renal uptake of isotopes Renal biopsy Histological changes Copyright © 2017 Elsevier Inc. All rights reserved. 31
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Quick Quiz! Which intervention is most important in assessing fluid balance in the patient with AKI? Daily weight Intake and output Serum creatinine Estimated GFR Copyright © 2017 Elsevier Inc. All rights reserved. 32
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Nursing Diagnoses Assessment of overload or deficit Excess fluid volume Daily weight 1 kg approximately 1000 mL fluid 1 pound approximately 500 mL fluid Intake and output (I&O) Copyright © 2017 Elsevier Inc. All rights reserved. 33
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Nursing Diagnoses(Cont.) Imbalance fluid volume Electrolyte imbalance Risk for infection Strict aseptic care with IV lines Not all patients need urinary catheters; avoid use if not required Prevent progression of AKI with antibiotics Monitor peak and trough drug levels Copyright © 2017 Elsevier Inc. All rights reserved. 34
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Nursing Diagnoses(Cont.) Imbalanced nutrition Small feedings Oral hygiene Intake in collaboration with dietitian Avoid fluid overload and electrolyte imbalance Anxiety Deficient knowledge Copyright © 2017 Elsevier Inc. All rights reserved. 35
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Fluid and Electrolyte Imbalances Hyperkalemia Low excretion Hyponatremia Fluid retention Hypocalcemia Low excretion of phosphorus Decreased level of vitamin D Hyperphosphatemia Low excretion Hypermagnesemia Low excretion Copyright © 2017 Elsevier Inc. All rights reserved. 37
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Medical Management—Prerenal Early recognition Fluid or volume replacement Caution in patients with underlying cardiac disease May require inotropes, antidysrhythmic agents, preload/afterload reducers, intraaortic balloon pump May require hemodynamic monitoring to guide treatment Copyright © 2017 Elsevier Inc. All rights reserved. 38
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Medical Management—ATN Medications Dietary control Protein and electrolyte restrictions Management of fluid and electrolyte imbalances Dialysis or CRRT Copyright © 2017 Elsevier Inc. All rights reserved. 40
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Diuretic Therapy Controversial Convert oliguria to nonoliguric state Hypovolemia corrected first Loop (furosemide) Osmotic (mannitol) Copyright © 2017 Elsevier Inc. All rights reserved. 41
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Drug Therapy Dopamine May increase renal blood flow Efficacy questioned in current research Acetylcysteine, fenoldopam, theophylline Prevent contrast-induced AKI Epoetin alfa Treat anemia Must adjust dosages and timing of medication if patient is on dialysis Copyright © 2017 Elsevier Inc. All rights reserved. 42
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Dietary Management Higher-than-normal basal requirement Provide adequate energy, protein, and micronutrients 25 to 35 kcal/kg of ideal body weight per day Restricted Protein Sodium Potassium Fluid intake (output + 600-1000 mL) Copyright © 2017 Elsevier Inc. All rights reserved. 43
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Hyperkalemia (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 45 Figure 16-5. Electrocardiographic (ECG) changes seen in hyperkalemia. (From Weiner D, Linas S, Wingo C. Disorders of potassium metabolism. In Feehally J, Floege J, Johnson R, eds. Comprehensive Clinical Nephrology. Philadelphia: Mosby. 2007.)
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Hyperkalemia(Cont.) Shift intracellularly Glucose and insulin Alkali (sodium bicarbonate) Antagonize cellular membrane effect Calcium gluconate Copyright © 2017 Elsevier Inc. All rights reserved. 47
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Acid-Base Imbalance Metabolic acidosis Treatment based on severity of imbalance May need IV bicarbonate Monitor ionized calcium as hypocalcemia can occur as pH is corrected Copyright © 2017 Elsevier Inc. All rights reserved. 49
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Renal Replacement Therapy Lifesaving treatment Classification Hemodialysis Continuous renal replacement therapy (CRRT) Peritoneal dialysis Copyright © 2017 Elsevier Inc. All rights reserved. 50
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Vascular Access (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 54 Figure 16-6. Central venous catheter used for hemodialysis. (From Headley CM. Acute kidney injury and chronic kidney disease. In Lewis SL, Dirksen SR, Heitkemper MM, et al, eds. Medical-Surgical Nursing: Assessment and management of clinical problems. 9th ed. St. Louis: Mosby, 2014.)
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Vascular Access (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 55 Figure 16-7. Hemodialysis access devices. A. Arteriovenous fistula. B. Arteriovenous graft. (From Headley CM. Acute kidney injury and chronic kidney disease. In Lewis SL, Dirksen SR, Heitkemper MM, et al, eds. Medical-Surgical Nursing: Assessment and management of clinical problems. 9th ed. St. Louis: Mosby, 2014.)
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Critical Thinking Challenge What are important nursing interventions for the patient with a percutaneous dialysis catheter? Can the dialysis catheter be used to draw blood samples or give medications? What are appropriate interventions if the patient has a graft or shunt? Copyright © 2017 Elsevier Inc. All rights reserved. 56
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Hemodialysis Usually done at the bedside in the ICU Pre- and postdialysis labs and weight Monitor for complications Volume depletion Dysrhythmias Hypoxemia Disequilibrium syndrome Vascular access infections Copyright © 2017 Elsevier Inc. All rights reserved. 57
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Critical Thinking Challenge Which medications should be given before dialysis? Which should be withheld until after dialysis? How can you determine whether to give medications before dialysis? Copyright © 2017 Elsevier Inc. All rights reserved. 58
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Continuous Renal Replacement Therapy (CRRT) Used with patients too unstable for hemodialysis Advantages More gradual solute removal Flexible fluid administration Minimal heparin Can be done by staff nurses at the bedside Disadvantages Bed rest One-to-one nursing care Copyright © 2017 Elsevier Inc. All rights reserved. 59
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Hemodialysis/CRRT (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 60 Figure 16-8. A. Schematic diagram of continuous venovenous hemofiltration (CVVH). B. Schematic of continuous venovenous hemodialysis (CVVHD). (From Urden L, Stacy K, Lough M, eds. Thelan’s Critical Care Nursing: Diagnosis and Management. 5th ed. St. Louis: Mosby, 2005.)
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CRRT—Types CAVH—continuous arteriovenous hemofiltration CVVH—continuous venovenous hemofiltration CAVHD—continuous arteriovenous hemodialysis CVVHD—continuous venovenous hemodialysis Copyright © 2017 Elsevier Inc. All rights reserved. 61
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Critical Thinking Challenge How does CRRT work? What are nursing responsibilities during the procedure? What assessments indicate potential problems with the procedure? Copyright © 2017 Elsevier Inc. All rights reserved. 63
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Peritoneal Dialysis Removal of solutes and fluids using the peritoneal membrane as a filter Rarely used in the critical care setting because it is less efficient High risk of peritonitis Copyright © 2017 Elsevier Inc. All rights reserved. 64