Acute Kidney Injury

Acute Kidney Injury

Start

Background

Brian Brown is a 62-year-old male in the medical surgical unit with a post-surgery abdominal wound infection. His wound is being dressed daily with a wet to dry dressing. He has been receiving intravenous gentamicin to treat the wound infection. Over the last 24 hours, the nursing staff has assessed Mr. Brown as being drowsy. He has complained of a headache and fatigue. During assessment Mr. Brown is noted to have dry mucous membranes and decreased urine output. Vital signs are all within normal limits.

Next

You suspect Mr. Brown may be in acute kidney injury (AKI) although he has no previous renal history. What risk factor does Mr. Brown have that puts him at increased risk for AKI?

Older male patient profile

Headache and fatigue

Decreased urine output

Intravenous gentamicin

Correct

Intravenous Gentamicin is an aminoglycoside antibiotic that has the potential to be nephrotoxic.

Next

Click on the boxes to reveal the answer

The three major categories of Acute Kidney Injury are prerenal, intrarenal, and postrenal.

Next

Next

Next

Next

You communicate your concerns to the primary care provider who orders several laboratory diagnostics to determine the status of Mr. Brown's kidney function. The orders include blood urea nitrogen (BUN), creatinine, and urine specific gravity tests. Knowing that Mr. Brown's acute kidney injury is most likely classified in the intrarenal category, what could you expect from the following lab results:

The BUN would likely be:

Low

Elevated

Low Normal

High Normal

Correct

Next

You communicate your concerns to the primary care provider who orders several laboratory diagnostics to determine the status of Mr. Brown's kidney function. The orders include blood urea nitrogen (BUN), creatinine, and urine specific gravity tests. Knowing that Mr. Brown's acute kidney injury is most likely classified in the intrarenal category, what could you expect from the following lab results:

The creatinine would likely be:

Low

Elevated

Low Normal

High Normal

Correct

Next

You communicate your concerns to the primary care provider who orders several laboratory diagnostics to determine the status of Mr. Brown's kidney function. The orders include blood urea nitrogen (BUN), creatinine, and urine specific gravity tests. Knowing that Mr. Brown's acute kidney injury is most likely classified in the intrarenal category, what could you expect from the following lab results:

The creatinine would likely be:

Low

Elevated

Low Normal

High Normal

Correct

Next

In intrarenal AKI, the BUN and creatinine are elevated, and the urine specific gravity is usually low normal. Urine output varies, but is often decreased. Urine sodium is increased to greater than 40 mEq/L. Sediment has abnormal castes and debris. Urine osmolality is approximately 350 mOsm, similar to serum.

Mr. Brown's lab results are as follows: BUN: 25 mg/dL Creatinine: 2.0 mg/dL Urine specific gravity: 1.005 Sodium: 137 Potassium: 6.0

Next

BUN: 25 mg/dL Creatinine: 2.0 mg/dL Urine specific gravity: 1.005 Sodium: 137 Potassium: 6.0

Based on these results you determine that Mr. Brown has what type of electrolyte imbalance?

Hyperkalemia

Hyponatremia

Hypokalemia

Hypernatremia

Correct

Next

Normal BUN is 7 to 18 mg/dL for an adult, and 8 to 20 mg/dL for adults 60 years of age and older Normal creatinine is 0.6 to 1.2 mg/dL Normal urine specific gravity is 1.003 to 1030 Normal sodium is 135 to 145 mEq/L Normal potassium is 3.5 to 5.0 mEq/L

Next

Next

You receive an order to administer Kayexalate (sodium polystyrene). What should you know about Kayexalate? (Select all that apply)

Click on the boxes to reveal the answer

Kayexalate may be given intravenously Kayexalate induces diarrhea Kayexalate exchanges sodium ions for potayssium ions in the intestinal tract Kayexalate may be given orally Kayexalate may be given by enema

Next

new orders from pcp

New orders for arrive for Mr. Brown from the PCP. Discontinue IV gentamicin Daily weight measurement Renal diet Daily labs: CMP, CBC, BUN, creatinine Bedrest Strict I&O

Next

Click on the boxes to reveal the answer

As you enter Mr. Brown's room at lunch you note the lunch tray consists of spaghetti with marinara sauce, garlic bread, chocolate cake, a banana, ice water, and coffee. Which items should the nurse instruct the patient NOT to eat?

spaghetti marinara sauce garlic bread chocolate cake banana ice water coffee

A renal diet restricts potassium, sodium, and phosphorus. Examples include bananas, tomatoes, citrus fruits, juices, milk products, and coffee.

Next

Mr. Brown should be educated on ways to prevent atelectasis and respiratory infection since he has been placed on bed rest.

What intervention should the nurse instruct the patient to perform every 2 hours?

Get out of bed and stand upright for a few minutes

Administer pain medication through a PCA

Walk to the bathroom to urinate

Turn, cough, and deep breathe

Correct

Next

Turning, coughing, and deep-breathing assist in mobilizing respiratory secretions and therefore reduce the risk of atelectasis or pneumonia. A patient on bedrest should not be instructed to get out of bed on his own; neither should he be instructed to go to the bathroom, as I&O need to be monitored. Pain medication may be needed but does not have to do with preventing atelectasis and respiratory infection.

Next

Next

Mr. Brown should be monitored for possible fluid retention related to acute kidney injury. All of the following are indicators of fluid volume excess, EXCEPT?

All of the following are indicators of fluid volume excess, EXCEPT?

Wheezes in lungs

Distended neck veins

Tachycardia

Weight gain

Correct

Next

Tachycardia, distended neck veins, and weight gain are signs of fluid volume excess/retention.Crackles, not wheezes, would be heard in the lungs with a fluid volume excess.

Next

Here is a recap of AKI: The three major categories of AKI are prerenal, intrarenal, and postrenal.

There are four phases of AKI:

1. *INITIATION: The initiation period, which begins with the initial insult and ends when oliguria develops.
2. *OLIGURIA: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, including urea. creatinine, uric acid, potassium, and magnesium. The minimum amount of urine needed to rid the body of waste is 400 mL.
1. In this stage symptoms of uremia first appear. Symptoms of uremia include nausea, vomiting, headache, dizziness, hypertension, and tachycardia.
2. The patient is a risk for life-threatening conditions related to electrolyte imbalances. He or she may need dialysis to assist with removing toxins from the body.
3. The patient may also need additional nutritional support through parenteral nutrition.
3. *DIURESIS: The next phase is diuresis. This stage is marked by a gradual increase in urine output, which is a sign that glomerular filtration has started to recover. Urinary elimination may be normal or elevated and laboratory values stop increasing and eventually decrease. Renal function may still be abnormal, however, and the patient should still be monitored closely.
4. *RECOVERY: Improvement of renal function marks the recovery period. Laboratory values return to normal. This may take 3 to 12 months.

Please try again

Go Back

The End