NUR 265 Exam 1 (Answered) Complete Solution
Acute Kidney Injury
EXPECTED FINDINGS
● Risks: REDUCED PERFUSION (reduced blood flow to the kidneys)
○ blood/fluid loss
○ Blood pressure drugs resulting in hypotension
○ Heart attack/heart failure (low ejection fraction and low cardiac output)
○ Infection (sepsis/septic shock)
○ Liver failure
○ Use of aspirin, NSAIDs (advil, motrin, naproxen)
○ Severe allergic reactions (anaphylaxis)
○ Severe burns
○ Severe dehydration
○ Renal artery stenosis
○ bleeding/clotting in the kidney blood vessels (coagulopathy)
○ atherosclerosis/cholesterol deposits (block blood flow to the kidney)
■ Get history ^ (surgery, transfusions, meds), recent contrast dye (damaging to kidneys),
coexisting conditions (hypertension, diabetes, pre-existing lower GFR), acute
illnesses
● Signs and Symptoms: oliguria, anuria, increased creatinine and BUN, urine concentrated (specific
gravity greater than 1.030), azotemia (retention of nitrogenous wastes)
● Diagnostics: ultrasound of kidneys (obstruction of stones, patency of ureters), CT scan WITHOUT
contrast, KUB X-ray, nuclear medicine -MAG3 (measures GFR), cystoscopy or retrograde
pyelography (obstruction of lower tract), biopsy (prepare patient for hypotension/hypertension)
● Labs: BUN and creatinine (increased), serum electrolytes (especially
K+→ ECG=bradycardia, peak T wave, wide QRS, ST elevation), serum
osmolarity (low), urine specific gravity (high), GFR (not accurate during
acute)
○ IF ONLY BUN ELEVATED=DEHYDRATION →creatinine=#1 lab for kidney function
● Meds:
○ Diuretics- increase UOP, get rid of retained fluid and electrolytes (used in the beginning, does
not preserve kidney function or stop AKI)
○ Fluid challenge: 500-1000 mL of N.S. bolus (to see how the kidneys are functioning)
MONITOR FOR FLUID OVERLOAD (ESPECIALLY RESPIRATORY DISTRESS)
● Nursing interventions:
○ PRIORITY= PREVENTING AKI (promoting daily hydration)
■ Evaluate fluid status
■ Strict I&O
■ Body weight
■ Characteristics of urine
■ REPORT IF UOP <0.5 mL/kg/hour (especially if persisting over 2 hours)
○ Monitor MAP (maintain 80 mmHG in high-risk or critically ill)
○ Reduce risk factors (nephrotoxic agents, contrast media)
○ Diuretic and fluid challenge, hemodynamic monitoring (if fluid volume overload do not use)
● Diet: catabolism=protein breakdown=breakdown of muscle protein and increased azotemia
○ NO dialysis: 0.6 g/kg of body weight or 40 g/day of protein
○ Dialysis: 1-1.5 g/kg of protein
, ○ Sodium: 60-90 mEq/kg
○ If high K+: restricted to 60-70 mEq/kg
○ Fluid: urine output + 500 mL
UNEXPECTED →INTERVENE
Fluid volume overload
○ Crackles
○ Anasarca (swelling all over body)
○ Decreased O2 sat
○ Increased RR
○ LOC changes (confusion)
○ Restlessness (not normal to be restless for no reason)
■ Treated with: diuretics, dialysis, or paracentesis (removal of excess fluids), fluid
and sodium restrictions
Hypoperfusion/hypoxia →reduced blood volume
○ MAP <65 mmHg
○ Tachycardiac
○ Thready peripheral pulses
○ Decreased cognition
■ Treated with: IV fluids and possible blood transfusion
Acute Kidney Injury
EXPECTED FINDINGS
● Risks: REDUCED PERFUSION (reduced blood flow to the kidneys)
○ blood/fluid loss
○ Blood pressure drugs resulting in hypotension
○ Heart attack/heart failure (low ejection fraction and low cardiac output)
○ Infection (sepsis/septic shock)
○ Liver failure
○ Use of aspirin, NSAIDs (advil, motrin, naproxen)
○ Severe allergic reactions (anaphylaxis)
○ Severe burns
○ Severe dehydration
○ Renal artery stenosis
○ bleeding/clotting in the kidney blood vessels (coagulopathy)
○ atherosclerosis/cholesterol deposits (block blood flow to the kidney)
■ Get history ^ (surgery, transfusions, meds), recent contrast dye (damaging to kidneys),
coexisting conditions (hypertension, diabetes, pre-existing lower GFR), acute
illnesses
● Signs and Symptoms: oliguria, anuria, increased creatinine and BUN, urine concentrated (specific
gravity greater than 1.030), azotemia (retention of nitrogenous wastes)
● Diagnostics: ultrasound of kidneys (obstruction of stones, patency of ureters), CT scan WITHOUT
contrast, KUB X-ray, nuclear medicine -MAG3 (measures GFR), cystoscopy or retrograde
pyelography (obstruction of lower tract), biopsy (prepare patient for hypotension/hypertension)
● Labs: BUN and creatinine (increased), serum electrolytes (especially
K+→ ECG=bradycardia, peak T wave, wide QRS, ST elevation), serum
osmolarity (low), urine specific gravity (high), GFR (not accurate during
acute)
○ IF ONLY BUN ELEVATED=DEHYDRATION →creatinine=#1 lab for kidney function
● Meds:
○ Diuretics- increase UOP, get rid of retained fluid and electrolytes (used in the beginning, does
not preserve kidney function or stop AKI)
○ Fluid challenge: 500-1000 mL of N.S. bolus (to see how the kidneys are functioning)
MONITOR FOR FLUID OVERLOAD (ESPECIALLY RESPIRATORY DISTRESS)
● Nursing interventions:
○ PRIORITY= PREVENTING AKI (promoting daily hydration)
■ Evaluate fluid status
■ Strict I&O
■ Body weight
■ Characteristics of urine
■ REPORT IF UOP <0.5 mL/kg/hour (especially if persisting over 2 hours)
○ Monitor MAP (maintain 80 mmHG in high-risk or critically ill)
○ Reduce risk factors (nephrotoxic agents, contrast media)
○ Diuretic and fluid challenge, hemodynamic monitoring (if fluid volume overload do not use)
● Diet: catabolism=protein breakdown=breakdown of muscle protein and increased azotemia
○ NO dialysis: 0.6 g/kg of body weight or 40 g/day of protein
○ Dialysis: 1-1.5 g/kg of protein
, ○ Sodium: 60-90 mEq/kg
○ If high K+: restricted to 60-70 mEq/kg
○ Fluid: urine output + 500 mL
UNEXPECTED →INTERVENE
Fluid volume overload
○ Crackles
○ Anasarca (swelling all over body)
○ Decreased O2 sat
○ Increased RR
○ LOC changes (confusion)
○ Restlessness (not normal to be restless for no reason)
■ Treated with: diuretics, dialysis, or paracentesis (removal of excess fluids), fluid
and sodium restrictions
Hypoperfusion/hypoxia →reduced blood volume
○ MAP <65 mmHg
○ Tachycardiac
○ Thready peripheral pulses
○ Decreased cognition
■ Treated with: IV fluids and possible blood transfusion
