Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
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
- 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.
- 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
- 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.
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
- Pre-Renal (Decreased blood flow)
- 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
- Bun/Creatinine – AKI specific
- 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?
- Labs & Imaging
- Respond
- KCL Interventions
- Reflect
- KCL & Dialysis Watch
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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