Developing Critical Thinking Through Understanding Pathophysiology
Write Worksheet Topic: Acute Kidney Injury
1. Define and describe in your OWN WORDS, the pathophysiology of the primary problem of your patient:
Acute kidney injury is where there is sudden onset of reduced renal function. It can lead to electrolyte imbalances, HTN,
acid-base disorders, and anemia.
2. How would you explain and teach your patient about the pathophysiology of this medical problem using non-medical
terminology?
AKI is an abrupt onset- within 48 hours- where their kidneys are not working well. It can lead to high blood pressure,
electrolyte imbalances, and low blood counts.
3. What body system(s) are directly impacted by this disease and how are those systems affected?
Body System(s):
How Body System(s) is Affected:
Kindeys
ABN renal lab values
Low urine output, changes in urinary composition
Decreased filtration- GFR, increased BUN, Creatinine
Electrolytes
High potassium, high phosphorus, low calcium, acidosis
Blood
Anemia, lack of adequate erythropoiesis
Hemodynamics
HTN
Fluid imbalances
Weight gain
4. PRIORITY nursing assessments with this disease? (refer to body system that is most affected). What assessment findings
may be abnormal as a result of this illness?
Priority Assessments:
Expected Abnormal Assessments:
Urine output
oliguria- less than 500ml/day
Non oliguria- greater than 500m/day
Anuria- less than 50ml/day
Weight and Fluid volume status
Increased weight , edema, Assess for s/s of fluid volume
excess, keep accurate I&O, and daily weights
Lab values
High potassium, high phosphorus, low calcium, acidosis
Low HGB/HCT, high serum osmolality, increased urine
specific gravity, sediment may be present, urine sodium
Blood Pressure
may be elevated
Neuro
Watch for hypertension
Watch for confusion as toxins build up in their
bloodstream
Obtain blood and urine cultures as needed
fever and infections can increase metabolic and catabolic
rate
Skin
may be dry, scaley, susceptible to breakdown due to
edema
Respiratory/Lung sounds
can be short of breath with fluid overload, increased resp
rate
5. What lab tests are altered by this problem? How are those lab tests affected? Does the altered lab test affect any physical
assessment findings?
Abnormal Lab Tests:
How Lab Tests Affected:
Does it Impact Assessment?
Urine tests helpful in diagnosing
etiology
Urine sodium, osmolality, and specific
gravity distinguish AKI from ATN
Patient may need IVFs
Patient may need dialysis
Pre-renal- increased
Post renal- varies
ATN- 250-300
Fractional excretion of Na+ (FENa)
Pre-renal- <1%
Post-renal- >1%
ATN- >1% (often >3%)
Bun/Creat ratio
Fractional excretion of BUN and
Pre-renal- >20:1
creatinine distinguish prerenal AKI and Post-renal- 10:1 to 15:1
ATN or postrenal AKI
ATN- 10:1 to 15:1
Sedimentation
Distinguish AKI from ATN
Helps distinguish pre-renal AKI from
and ATN and or post renal AKI
Patient may need IVFs
Patient may need dialysis
Pre-renal- normal , few casts
Post-renal- normal may be crystals
ATN- granular casts, yubular epithelial
cells
Helps distinguish pre-renal AKI from
and ATN and or post renal AKI
GFR decreased
Patient may need IVFs
Patient may need dialysis
GFR
6. What medications are most commonly used to manage this problem? Consider the medications you might use, how it
works, and why you are using it….
Medications:
Mechanism of Action (Own Words):
administer IV fluid therapy diuretics –
sodium polystyrene –
IV medications (dextrose, insulin, potassium, and calcium) –
sodium bicarbonate –
Rehydrates kidneys and patient
Encourages urine output
This medication is used to treat a high level of potassium in
your blood.
Calcium gluconate for hyperkalemia
Insulin and glucose can shift potassium into the cells
Helpful after contrast medium, cardiac surgery, or liver
transplant can reduce the incidence of AKI. It’s a base
substance that helps kidney not get worse
Manages HTN
CCB along with renin angiotensin aldosterone inhibitors
7. Are there any surgical, procedural, or diagnostic interventions for each topic that are important to note? If there are, list 1
or 2 below and why they are used.
Renal ultrasonography- R/O obstruction
CT and MRI- Evaluate for masses, vascular disorders and filling defects
Renal angiography- Evaluate for renal artery stenosis
Renal biopsy- Diagnosis, prognosis, and therapy evaluation
continuous renal replacement therapy – better for a slower treatment when patient is not HDS enough to tolerate HD. CRRT
differs from hemodialysis and peritoneal dialysis in that it is intended to be utilized for 24 hours or longer, continuous and slower
(removing fluid at a much slower pace than traditional hemodialysis or peritoneal dialysis) which is better for hemodynamically
unstable patients. For this reason, CRRT is usually administered in the critical care units.
hemodialysis- good for HDS patients with long term dialysis needs
peritoneal dialysis- good for home dialysis and less acute/unstable cases
______________________________________________________________________________________________
On Your Own Time:
Consider the Clinical Judgement Measurement Model and try to order your knowledge and understanding of this disease process:
Recognize
Cues
Evaluate
outcomes
Analyze
Cues
Take Action
Generate
Solutions
Prioritize
Hypotheses