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Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)

Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)

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Outline

Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD)

Definition/Etiology:

Renal Failure – Caused by acute and/or chronic conditions
AKI
- Definition -Acute kidney injury, also known as acute renal failure, is when the kidneys stop working over the period of a few hours or a few days.
  - Cause Pre/Intra/Post renal
  - Sudden onset & usually reversible
CKD – Gradual Loss
- Definition – Chronic kidney disease includes conditions that damage the kidneys and decrease their ability to effectively filter waste products from the blood. Chronic kidney disease (CKD) develops slowly over time.
  - Cause – uncontrolled hypertension and diabetes mellitus
  - Slow onset & rarely reversible

Pathophysiology:

Acute Renal Failure (AKI)
- Pre-Renal (Decreased blood flow)
  - Low BP, Sepsis, etc
- Intrarenal (Direct Injury to kidney)
  - Vancomycin, Contrast Dye, etc
- Post-Renal (Decreased outflow)
  - Prostate disease, Stones
Chronic Renal Failure
- No stages, rather persistent impairment of kidney function that results renal fibrosis
- Leads to ESRD & Dialysis

Noticing: Assessment & Recognizing Cues:

AKI – symptoms are sudden/severe and are easily recognized
- History of acute illness or toxic medication
- ↑ HR & ↑ BP
- Oliguria
  - 50 – 400 ml/day
- Edema in lower extremities
CKD – symptoms develop slowly and are easily mistaken for other conditions
- History of HTN/DM
- Vitals normalized
- Anuria
  - Less than 50ml/day
- Periorbital Edema
- Chronic changes
  - Grey Skin – toxins
  - Anemic signs/sx

Interpreting: Analyzing & Planning:

Labs
- Bun/Creatinine – AKI specific
  - 20/1.3
- Glomerular filtration rate (GFR) – CKD specific
  - 90
- Potassium
  - High in both
- Calcium
  - CKD = Low related to ↓D levels
- Hemoglobin
  - erythropoietin
- UA – Protein & Blood
Diagnostics
- ABD Xray – Renal Stones
- Renal Ultrasound
  - AKI – Normal/Enlarged Kidney
  - CKD – Small Shrunken Kidney
- 12 Lead
  - Arrhythmias
- CXR
  - Pleural Effusion
  - Uremic Pericardial Congestion

Responding: Patient Interventions & Taking Action:

Pharmacological Interventions
- Withhold Nephrotoxic drugs
- Fluids vs Diuretics
  - Is the patient Oliguric?
  - Do they need Kidneys flushed?
- Epoetin alfa = synthetic erythropoietin
- Hyperkalemia
  - Insulin/Glucose
  - Calcium gluconate ↑K + Arrhythmia
- Flomax – Prostate
Non-Pharmacological Interventions
- Daily Weight
- Foley
  - Goal = ↑ 400 ml/24 hours
- Dialysis
  - Short vs long term

Reflecting: Evaluating Patient Outcomes:

Monitor KCL Levels
- Hyperkalemia → EKG changes (peaked T waves, flat P, wide QRS, blocks, asystole)
- Continuous cardiac monitoring
- Low potassium diet
- Potassium lowering medications
Immediate Dialysis
- Severe Hyperkalemia
- Acidosis
- Uremic Pericarditis
- Encephalopathy

Linchpins (Key Points):

Notice AKI or CKD = Renal Failure
- Is this acute or a chronic issue? Patient’s will present a little differently, especially labs.
Interpret
- Labs & Imaging
  - Is there something we can immediately fix?
Respond
- KCL Interventions
Reflect
- KCL & Dialysis Watch

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Transcript

References

AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and
Critical Care Nursing (8th ed.). Elsevier Health Sciences (US). Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences(US).
Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive,
and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide
and Practice Test Questionsfor the Progressive Care Certified Nurse Exam.

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