Acute Kidney Injury

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Acute Kidney Injury by Mind Map: Acute Kidney Injury

1. Causes

1.1. Post-Streptococcal Glomerulonephritis

1.1.1. pathophysiology inflammation alters glomerular structure kidney function follows infections, either skin or respiratory group A Beta-hemolytic streptococcus antibody-antigen reaction

1.1.2. complications uremia renal failure

1.1.3. signs/symptoms fever lethargy headache decreased urine output abdominal pain vomiting anorexia elevated BP proteinuria

1.1.4. nursing management antihypertensives diuretics monitor BP Sodium/fluid restrictions Weight on same scale with same weight at same time

1.2. Hemolytic Uremia Syndrome

1.2.1. defined by hemolytic anemia thrombocytopenia acute renal failure

1.2.2. Typical diarrheal illness leads to this progressed to hemorrhagic colitis typically caused by a specific strain of E. coli that releases verotoxin labs Increased BUN/creatinine Anemia Increased reticulocyte Increased bilirubin Hyponatremia Hyperkalemia Hyperphosphatemia Metabolic acidosis

1.2.3. nurse management Strict I&Os monitor infusions vs labs diuretic administration blood pressure monitor monitor for bleeding dialysis promote handwashing

1.3. Nephrotic Syndrome

1.3.1. Pathophysiology Increased glomerular permeability Plasma proteins can move through Proteinuria Hypoalbuminemia change in osmotic pressure Increased risk for clotting infection

1.3.2. Management Corticosteroids IV albumin with severe edema Immunosuppressive therapy if unresponsive to steroids experiencing flare ups Diuretics to get rid of excess fluid

1.3.3. signs and symptoms nausea/vomiting weight gain Weakness, fatigue Irritability/fussiness

1.3.4. Risk factors Slowed intrauterine growth Young age Male sex

2. Pathophysiology

2.1. sudden, reversible, renal function

2.1.1. accumulation of metabolic toxins

2.1.2. fluid and electrolyte imbalance fluid overload HTN pulmonary edema congestive heart failure

2.1.3. decreased renal perfusion hypovolemic septic shock

3. Symptoms

3.1. nausea

3.2. vomiting

3.3. diarrhea

3.4. lethargy

3.5. fever

3.6. decreased urine output

4. Complications

4.1. anemia

4.2. hyperkalimia

4.3. hypertension

4.4. pulmonary edema

4.5. cardiac failure

4.6. altered level of consciousness

4.7. seizures

5. Treatment

5.1. Pre-RRT

5.1.1. fluid administration for hypovolemia

5.1.2. Inotropic support following adequate volume repletion

5.1.3. Adjust/substitute nephrotoxic medications based on renal function and drug levels

5.2. RRT

5.2.1. Indications acute/urgent high levels of increasing levels of advanced uremia remove medications/toxins edema that doesn't respond to other treatment hyperkalemia, hypercalcemia, hypertension chronic/maintenance advanced CKD

5.2.2. Complications hypertriglyceridemia is accentuated heart failure angina stroke peripheral vascular disease compounded anemia coronary artery disease vomiting with rapid fluid shift

5.3. K

5.3.1. normal values 3.5-5.0 mEq/L

5.3.2. treatment to hyperkalemia albuterol in moderate cases reduce potassium levels calcium chloride in severe cases exchange resin in mild cases insulin and glucose in moderate cases sodium bicarbonate (though limited effects) diuretics in mild cases

6. Nursing Care

6.1. manage hypertension

6.1.1. monitor BP

6.1.2. antihypertensives

6.2. restore fluid/electrolyte balance

6.2.1. assess vitals

6.2.2. assess urine specific gravity

6.2.3. strict I&Os

6.2.4. monitor for hyperkalemia weak/irregular pulse muscle weakness stomach/abdominal cramps

6.2.5. monitor for hypocalcemia muscle twitching tetany

6.2.6. polystyrene sulfonate to reduce potassium levels

6.2.7. RBC as needed

6.2.8. dialysis if significant fluid overload, severe electrolyte imbalance, depressed CNS

6.3. provide family education

6.3.1. s/s to report

6.3.2. home therapies

6.3.3. dialysis education

6.3.4. prevention