ACUTE KIDNEY INJURY
NON- MODIFIABLE
-Age (60 yrs old) MODIFIABLE
-Existing kidney problem
-Genetics  Major Hemorrhage
 Vomiting
 Diarrhea
 Severe Burns
 Congestive Heart Dse
PRE- RENAL INJURY
Decreased blood flow in to
the kidneys
Less blood being filtered by
the glomeruli
PRECIPITATING
MODIFIABLE
FACTORS
 Nephrotoxin drugs MODIFIABLE
-Low socioeconomic
 Chemotherapy drugs
 Intra-abdominal tumors -Knowledge deficit
 Kidney Problems e.g.
AGN, Nephrotic  Benign prostatic
Syndrome hyperplasia
 Trauma  Ureterolithiasis
INTRA- RENAL INJURY
POST- RENAL INJURY
Decreased O2 and
nourishment in the kidneys Bilateral obstruction
Damaged to tubules,
Buildup of urine and
glumerolus and interstitium
pressure backups into the
kidney
Ischemia/ Necrosis
High tubular pressure
Death of epithelial cells
Damaged to the endothelial
Obstruction in the tubules cells
High pressure in the
arterioles and tubules
 Sudden loss of kidney function

Decreased GFR

OLIGURIC PHASE
GFR 25%
Duration: Lasts for 1-3 weeks

Decreased
Inability to maintain electrolytes Erythropoietin
secretion
Inability of the kidney
to produce urine
Reduced RBC
production production
Unable to excrete Inability to excrete Failure to regulate sodium
by bone marrow
potassium magnesium balance
Edema Oliguria

Anemia
NSG. DIAGNOSIS NSG. DIAGNOSIS Hypo/Hypernatremia
Fluid volume excess r/t Hyperkalemia Hypermagnesemia
Fluid volume excess r/t
inability to excrete excess
inability to excrete
water NSG. DIAGNOSIS
excess water
NSG. DIAGNOSIS NSG. DIAGNOSIS Ineffective tissue
DIAGNOSTIC EXAM Risk for cardiac arrest r/t NSG. DIAGNOSIS Fluid volume excess/ deficit perfusion r/t decreased
 Pitting test hyperactive muscle Fatigue r/t decreased hemoglobin
DIAGNOSTIC EXAM
 Blood test acetylcholine
 Urinalysis
 History Taking DIAGNOSTIC EXAM
DIAGNOSTIC  Blood Test DIAGNOSTIC
EXAM EXAM
NSG. MANAGEMENT DIAGNOSTIC EXAM
NSG. MANAGEMENT  Blood Test  CBC
 Monitor VS
 Monitor VS  Blood Test
 Monitor daily
 Monitor daily
weight, abdominal
weight, abdominal
NSG.
girth and I&O MANAGEMENT
girth and I&O NSG. NSG.
 Restrict Na and fluid  Monitor VS NSG. MANAGEMENT
 Restrict Na and MANAGEMENT MANAGEMENT
intake  Monitor I & O Hyponatremia
fluid intake  Monitor VS  Provide supplemental
 Consult dietitian for  Educate the client  Monitor VS
 Consult dietitian for  Monitor I & O oxygen therapy as
proper diet  Sodium rich food diet
proper diet on high sodium  Check patellar reflex needed
diet regularly  Safety precautions  Educate energy-
 Low potassium  Encourage bed rest  Check weight every day to conservation
PHARMACOLOGIC monitor fluid volume
MANAGEMENT PHARMACOLOGIC diet  Promote safety techniques.
MANAGEMENT measures status  Assist the client in
 Diuretics  Monitor I & O  Monitor for any sign of
 Diuretics  Follow ECG  Administer IV fluids developing
(Furosemide ) seizure
(Furosemide ) closely to look for  Hemodialysis as a schedule for daily
 ACE Inhibitors activity and rest.
 ACE Inhibitors peaked T waves indicated
(Lisonopril )  Blood Transfusion as
(Lisonopril )  Hemodialysis as indicated
indicated
 NSG. NSG. NSG. MANAGEMENT
PHARMACOLOGIC PHARMACOLOGIC PHARMACOLOGIC
CONSIDERATIONS CONSIDERATIONS MANAGEMENT MANAGEMENT Hypernatremia MANAGEMENT
 Potassium Binders  Mineral Supplement  Monitor VS  Erythropoetin
Diuretics Diuretics (Resin Kayexalate) (Calcium Gluconate )  Restrict Na diet stimulating agents
 Follow 14 rights  Follow 14 rights  Diuretics  Monitor I & O (Epoeitin Alfa )
 Rapid-acting insulin  Promote safety
 Monitor VS  Monitor VS (Humulin R) (Furosemide)  Vitamins Supplement
 Monitor I/O  Monitor I/O  Administer IV fluids (Folic Acid)
 Furosemide
 Monitor serum K  Monitor serum K  Salbutamol /neb
 Monitor weight  Monitor weight PHARMACOLOGIC
ACE Inhibitors ACE Inhibitors NSG. MANAGEMENT NSG. CONSIDERATIONS
 Follow 14 rights  Follow 14 rights CONSIDERATIONS Hyponatremia
 Monitor VS  Monitor VS  Administer NaCl 0.9% IV, ESAs
 Monitor serum K  Monitor serum K NSG. Mineral Supplement plasma expander  Follow 14 rights
 Provide safety  Provide safety CONSIDERATIONS  Follow 14 rights Hypernatremia  Monitor VS
 Administer drug  Administer drug  Monitor VS  Diuretics (Furosemide)  Hold the medication if
on empty stomach on empty stomach Potassium Binders  Advised to take the BP is high
 Follow 14 rights the medication  Monitor Hemoglobin
 Monitor VS with food levels
 Provide safety NSG. CONSIDERATIONS  Administer SQ and IV
 Monitor serum K
 Monitor Na Diuretics Vitamin Supplement
 Follow 14 rights Diuretics  Follow 14 rights
Rapid- acting insulin  Follow 14 rights
 Follow 14 rights  Monitor I/O  Monitor VS
 Monitor serum K  Monitor VS  Monitor for signs and
 Monitor VS  Monitor I/O
 Monitor glucose  Monitor weight symptoms of folic acid
 Monitor serum Na deficiency, such as
level  Monitor weight
 Assess for fatigue, weakness, and
hypoglycemia pallor.
Diuretics
 Follow 14 rights
 Monitor VS
 Monitor I/O
 Monitor serum Na
 Monitor weight

 Inability to activate
Failure of the kidney to Elevated levels of urea Vitamin D into active
regenerate bicarbonate and nitrogenous waste form
products

Decreased alkaline in the Decreased calcium

body absorption
Brain tissue damage

Metabolic Acidosis
Renal Encephalopathy

Kussmaul’s Breathing Hypocalcemia/

Hyperphosphatemia Renal Osteodystophy Hyperparathyroidism
Tetany
Confusion Seizure
NSG. DIAGNOSIS
Ineffective breathing
↑ Motor neurons NSG. DIAGNOSIS NSG. DIAGNOSIS NSG. DIAGNOSIS
Risk for injury r/t bone Risk for injury r/t bone Risk for injury r/t
pattern fragility fragility hypercalcemia
NSG. DIAGNOSIS NSG. DIAGNOSIS
Altered mental status r/t Risk for injury r/t cerebral Involuntary muscle
infection of the brain dysfunction contraction
DIAGNOSTIC EXAM DIAGNOSTIC EXAM DIAGNOSTIC
 ABG Test DIAGNOSTIC  Blood Test EXAM
EXAM  PTH testing  Blood Test
DIAGNOSTIC EXAM  Chvostek’s Sign
 Blood Test  Bone mineral  Urinalysis
 Glasgow coma  Trousseau’s Sign
NSG. MANAGEMENT  Urinalysis density testing  PTH level
scale (GCS test)  Laryngospasm
 Monitor VS (BMD)
 Physical
 Maintain good Assessment
respiratory function
 Electroencephalogra
 Protect the client from
m (EEG) NSG. DIAGNOSIS NSG.
injury
 Restore electrolyte
Ineffective breathing NSG. MANAGEMENT
NSG. MANAGEMENT pattern r/t hyperactive MANAGEMENT  Monitor VS,
balance especially K.
 Monitor VS muscles  Monitor VS
 Promote energy NSG. renal stones,
conservation  Establish rapport  Monitor for tetany MANAGEMENT calcium and
 Monitor O2 level  Assess the patients  Assess the patient phosphate levels
 Provide safety
LOC for symptoms of  Monitor I & O
DIAGNOSTIC hyperphosphatemia,  Monitor for
 Promote safety  Low calcium
 Promote orientation EXAM such as nausea, elevation of
Diet
PHARMACOLOGIC  Provide clear  Blood test (serum vomiting, and phosphorus
MANAGEMENT communication calcium) 8.6- muscle weakness.  Assist the client
 Alkalizing agent  Minimize distractions  Restrict foods high while walking
10.3mg/dL in phosphate
(Sodium Bicarbonate )  Provide emotional
 Corticosteroid support  Hemodialysis
(Hydrocotisone)  Hemodialysis as
needed
  Monitor the
PHARMACOLOGIC  Require fluid  Consult to dietitian patient's
NSG. MANAGEMENT
CONSIDERATIONS NSG. restrictions to for proper diet and mobility, strengt
 Benzodiazepines h, and balance to
MANAGEMENT prevent fluid supplemental
(Diazepam) prevent falls or
Alkalizing agent  Diuretics (Mannitol)  Provide safety overload, which needs.
 Follow 14 rights other injuries that
 Corticosteroids  Monitor for can worsen could result from
 Monitor VS (Dexamethasone) elevation of hyperphosphatemia
 Monitor I/O hypercalcemia-
phosphorus . related muscle
 Assess the patient’s  Monitor breathing PHARMACOLOGIC weakness.
electrolyte levels (Laryngospasm may
NSG. CONSIDERATIONS MANAGEMENT
 Monitor the patient's occur)
respiratory status, as  Electrolyte
 Tracheostomy set
alkalinizing agents Benzodiazepines must be at bed site. PHARMACOLOGIC replacement
can cause respiratory  Follow 14 rights  Consult to dietitian MANAGEMENT (Calcium
alkalosis, which can  Monitor VS especially RR for proper diet and  Phosphate binder Gluconate) PHARMACOLOGIC
lead to  Promote safety supplemental needs. (Aluminum  Vtamint D MANAGEMENT
hyperventilation  Assess for risk for hydroxide ) supplement  Diuretics
 Instruct the patient to substance abuse (Furosemide)
avoid taking sodium  The medication should be  Calcitonin
bicarbonate with tapered gradually hormone
acidic foods or Diuretics PHARMACOLOGIC NSG.
MANAGEMENT CONSIDERATIONS (Calcitonin)
beverages, as this  Follow 14 rights NSG.
can reduce its  Monitor VS  Electrolyte CONSIDERATIONS
effectiveness.  Monitor I/O replacement Electrolyte replacement
Corticosteroids (Calcium NSG.
 Monitor serum K Phospahate binder  Follow 14 rights
 Follow 14 rights  Monitor weight Gluconate ) CONSIDERATIONS
 Follow 14 rights  Monitor VS
 Monitor VS Corticosteroids  Vtamint D  Monitor VS  Assess for allergy Diuretics
 Educate the client  Follow 14 rights supplement
about infection  Monitor VS  Monitor serum  Monitor for serum  Follow 14 rights
control  Educate the client about phosphorus level Calcium level  Monitor VS
 The medication infection control NSG.  Monitor serum  Promote rest  Monitor I/O
should be tapered  The medication should be CONSIDERATIONS calcium levels  Promote safety  Monitor serum K
gradually tapered gradually  Provide safety  Monitor weight
 Promote safety  Promote safety Electrolyte replacement Calcitonin Hormone
 Follow 14 rights  Follow 14 rights
 Monitor VS  Monitor VS
 Assess for allergy  Assess for allergy
 Monitor for serum  Promote safety
Calcium level  Monitor calcium
 Promote rest level
 Promote safety  Monitor for tetany

SURGICAL
MANAGEMENT
 Parathyroidectomy

↑ BUN and ↑ serum
creatinine (Azotemia)
NSG. DIAGNOSIS
Altered mental status r/t
infection of the brain
DIAGNOSTIC EXAM
 CBC
 Urinalysis
NSG. MANAGEMENT
 Monitor VS
 Evaluate the patient's
fluid intake and output.
 Monitor for signs of
infection.
 Encourage the patient to
increase fluid intake.
 Modify the patient's diet
as needed to limit
protein
 Monitor the patient's
BUN levels, creatinine
levels, and other lab
values as ordered to
evaluate the
effectiveness of
interventions and detect
any changes in renal
function.
 Hemodialysis as
indicated
PHARMACOLOGIC
MANAGEMENT
 Diuretics
(Furosemide)
NSG. MANAGEMENT
Elevated serum levels of The kidney became highly Pre-Operative care
urochrome permeable  Establish rapport
 Monitor VS prior to OR
 Provide psychological support
Accumulation of sallow  Assess patients level of understanding
Specific protein being
about the procedure
color skin excreted in urine (Albumin)
 Bowel preparation
 Skin preparation
 Monitor lab results prior to surgery
 Advise client for diet modification
Hyperpigmentation
before surgery (NPO)
Proteinuria  Administer medication for pain as
ordered
NSG. DIAGNOSIS
Disturbed body image r/t Post-Operative care
changes in skin color and  Monitor VS especially RR
appearance NSG. DIAGNOSIS  Have tracheostomy set at bed side
Excess fluid volume r/t  Educate patient for wound care
decreased in oncotic pressure  Advise patient to limit physical activity
DIAGNOSTIC EXAM  NPO to DAT
 Physical Examination  Administer post-operative antibiotic for
prophylaxis
 Administer pain reliever (NSAIDS &
DIAGNOSTIC EXAM
Analgesics) as ordered
 Urinalysis
NSG. MANAGEMENT
 Encourage positive self-
talk
 Encourage the patient to NSG. MANAGEMENT
engage in self-care  Monitor VS
activities that promote  Monitor daily weight,
relaxation and stress abdominal girth and
reduction. I&O
 Referral to counseling  Monitor patient’s
may be necessary to protein level
address body image  Restrict Na and fluid
concerns intake
 Discuss available  Assess breath sounds for
treatment options and presence of crackles and
provide information congestion
about skincare routines  Consult dietitian for
that may help reduce the proper diet
appearance of
hyperpigmentation
 Hemodialysis as
indicated
PHARMACOLOGIC
MANAGEMENT
 ACE inhibitors
(Lisinopril)
 Diuretics (Furosemide)
 NSG.
CONSIDERATIONS
ACE Inhibitor
NSG.  Follow 14 rights
CONSIDERATIONS  Monintor VS
Diuretics  Monitor serum K
 Follow 14 rights  Provide safety
 Monitorz VS  Administer drug on
 Monitor I/O empty stomach
 Monitor serum K Diuretics
 Monitor weight  Follow 14 rights
 Monitor I/O
 Monitor VS
 Monitor serum K
 Monitor weight

PHARMACOLOGIC
MANAGEMENT
 ORS
NSG. CONSIDERATIONS
ORS
 Follow 14 rights
 Monintor VS
 Should be based on the
severity of dehydration
and the patient's weight.
 Encouraged to take
frequent sips throughout
the day to maintain
hydration.
 Provide safety
RECOVERY PHASE
DIURETIC PHASE GFR 80%
GFR 30-50% Duration: 3-12 months
Duration: Lasts for 1 week
Normalization of fluids and
electrolyte balance
The kidney became highly
permeable
POLYURIA
Excessive fluid loss Excessive potassium loss PHARMACOLOGIC MANAGEMENT
 Oral potassium supplements
 Electrolyte supplement (Potassium
Chloride)
Dehydration Hypokalemia  Potassium sparing diuretics
(Spironolactone)
NSG. DIAGNOSIS NSG. DIAGNOSIS
NSG. CONSIDERATIONS
Fluid volume deficit r/t Decreased cardiac output r/t excessive
excessive fluid loss potassium loss
Oral k supplement
 Follow 14 rights
 Monintor VS
DIAGNOSTIC EXAM  Monitor K level
DIAGNOSTIC EXAM  Physical exam
 Physical exam  Advised the patient not to crush, chew, or
 Blood test for Trop 1 break the tablets, as this may cause irritation
 Urinalysis  Electrocardiogram (ECG or EKG)
 Blood test to the gastrointestinal tract
 Chest X-ray  Advised the patient to administered with
food to reduce the risk of gastrointestinal
upset.
NSG. MANAGEMENT
NSG. MANAGEMENT  Monitor VS Electrolyte supplement
 Establish rapport  Promote rest  Follow 14 rights
 Monitor Vital Signs  Establish Rapport  Monintor VS
 Assess skin turgor and oral  Monitor respiratory rate, depth, and  Monitor K level
mucous membranes for effort.  The medication should be administered
signs of dehydration.  Monitor rate of IV potassium slowly to avoid the risk of hyperkalemia and
 Assess and Monitor Intake administration cardiac arrest
and output  Assess the injection site
 Encourage deep breathing and
 Assess color and amount coughing exercise.  Monitor for sign of hyperkalemia
of urine  Promote safety
 Encouraged frequent re-positions.
 Weigh patient daily with Potassium sparing diuretics
 Note for signs of metabolic alkalosis
 the same scale, and  Follow 14 rights
such as tachycardia, dysrhythmias,
preferably at the same  Monintor VS
hypoventilation, tetany, and changes
time of day.  Monitor K level
in mentation
 Urge the patient to drink  Monitor I/O
 IV fluids
the prescribed amount of  Monitor weight
fluid  Promote safety
 IV fluids  Blood pressure should also be monitored
regularly to assess the efficacy of the
medication.