Acute Kidney injury

Student name :Rana Abdullah Alsubeih

Id number: 439004755
section:3ND
course name: Adult2(NUR333)
Hospital : DR. Sulaiman AL Habib
Assuwaidi
Instructor name : Fida al sararn
Course Coordinator : Naglla Fathy
  objectives
 Pathophysiology
 patient information Out line
Reason for admission,Current history
 health history
 Medications
lab result and radiological investigation
 physical examinations
 nursing diagnosis with interventions
 conclusion
 reference
: Objectives
Describe the pathophysiology, clinical-1
manifestations, and medical management of
.acute kidney injury
Use the nursing process as a framework for-2
. care of patients with acute kidney injury
 .Pathophysiology Acute kidney injury
Definition :We can define the Acute kidney injury (AKI)
as a sudden episode of kidney failure or kidney damage
.that happens within a few hours or a few days

The most serious complications of acute

:kidney injury are
high level of potassium in the blood – in-1
severe cases, this can lead to muscle weakness,
paralysis and heart rhythm problems
fluid in the lungs (pulmonary oedema)-2
which can – )metabolic acidosis ( -3
cause nausea, vomiting, drowsiness and
breathlessness
 Case BOOK Clinical manifestation
Urine output normal rate Decrease urine output and
usually urine remain in
normal rate

no fluid retention Fluid retention, causing

swelling in your legs,
ankles or feet

Nausea , dehydration Nausea , dehydration

NO Shortness of breath Shortness of breath

Fatigue Fatigue

NoConfusion Confusion
: Patient’s information

Date of admission
Name : SA
:15/9/2020
Gender : female Diagnosis : acute
Age : 70 years kidney injury
old Occupation :
National : Saudi house wife
Material status :
Department :
widow
medical ward Level of
Surgery : no education:
current surgery primary
Reason of admission and Current
history
Reason for hospitalization :She felt a fever with shivering and
lost of consciousness
current history :she has a moderate LLQ abdominal pain 5 on
pain scale ,constipation , urinary catheter with hematuria
. ,elevated in blood pressure ,anorexia and fever 37.5
 Health history

: Family history : Past history : Life style I

No previous • Her sleep pattern was
hospitalization or surgery regular
• She has previous blood • Level of activity : Life style II
• No cancer ,liver transfusion B+ blood independent She takes Claritine
,heart ,kidney group, 1 units before 5 • Nutrition she was eat 2 medication for
disease , years because she had meals/day with 2snakes
sever anemia . • -bowel frequency 1/day
allergies
hypertension and • She has allergies from black and hard She is not smoker
asthma dust it's appear as • - Urinary frequency 4- and no alcohol intake
• Her sister has redness and itching on 6 /day yellow color .
diabetes mellitus the neck. if irritated she
takes Claritine
medication
•
Medication
 Lab result
Interpretation Value Name of test
terminology

Hypocalcemia 1.09mmol/L CA ion

Hight level of mg/l 9. 195 CRP(C-reactive

CRP .protein )
Elevated mcmol/L 103 creatinine
creatinine level
Low mean FL 7.29 MPV
platelet volume
Hypokalemia mmol/L 3.3 K
Radiological investigation
Urinalysis -15/9/2020
-Hematuria ,bacteriuria

Ultrasound – 15/9/2020
Slightly fibrosis on the right kidney

CT scan – 20/9/2020 - I don't know

because the test did after my shift
 Head : skull , face ,
scalp
nostril :drainage, blockage
.Eye :vision sclera color
smell mucus membrane
Ears : hearing ,pain,
normal

Physical
comprehension
Throat and mouth : mucus
Normal
,membrane ,tongue ,lips dry
dental caries

examination
Neck : jugular vein
,ROM
Normal
Respiratory : breath
sound , respiration ,
chest expansion , cough Cardiovascular : pulse : Vital signs
, SOB ,apical rate ,apical
Normal rhythm ,cap refill T :37.5 c
(within2 sec)
Normal P:74 bpm ,regular

: Gastrointestinal Rr: 18b/m ,regular , depth normal

Inspection; round , bowel
sound ;hypoactive , BP:131/67mmhg ,bronchial artery
palpation ; hard and tender
,diet ; poor (anorexia) , Skin : color , hair Pain: in LLQ region severity :5 of 10
recent weight loss ; loss 2kg distribution , texture , turgor ,
since admission date , vasculatiry , edema , lesion Increasing factors :when the patient on
toleration of diet ; normal Normal supine position she felt increase on pain
Moisture ,temperature
Dry and warm Decreasing factors : walking and fowler
position
 Neurological : LOC ,

Physical
orientation , mood ,
communication ,motor
function , memory intact

: Musculoskeletal
ROM , strength ,pulse
. Normal
examination
,gait ,posture , ambulates
,history of falls (no) ,
ADLS ,edema , nail color
and shape , capillary refill ,
,joints General appearance
,Normal

: Urinary Level of consciousness :

Urination ; incautious and conscious
. hematuria
Urinary assistive devices ;
urinary catheter Patient posture : normal
. Urine color : bloody
Grooming :tidy

Weight : 59kg Hight :150cm

BMI:25 normal hygiene :clean
.Assess the patient’s pattern of elimination -1

Rationale : Serve as a basis for determining appropriate

.interventions Nursing
Instruct the female client to wipe the area from front to -2
.back and the avoidance of bath tubs
diagnosis ,
Rationale : Proper perineal care helps in minimizing the risk of
interventions
.contamination and re-infection 1
Record urinary output. Investigate sudden reduction or -3
.cessation of urine flow Impaired urinary
elimination related to
Rationale : Sudden decrease in urine flow may indicate
obstruction or dysfunction, such as blockage by edema or infection evidence by
.mucus, or dehydration .hematuria
observe and record color of urine note hematuria -4
) actual(
Rationale : Urine may be slightly pink, which should clear up in
.2 to 3 days
Assess pain reports, noting location, intensity (scale of 0–-11- Nursing
10),frequency, and time of onset. Note nonverbal cues, such as
.restlessness, tachycardia, or grimacing diagnosis ,
Rationale : Indicates need for, and effectiveness of, interventions and interventions
.may signal development or resolution of complications
2
. Encourage the patient to take in fluid 2000 to 3000 mL/day -2

.Rationale : Sufficient fluid is needed to keep the fecal mass soft

Acute pain related to
Suggest use of non-pharmacological techniques as -3
accumulation of
.appropriate abdominal gases
Rationale : Alternative therapies such as relaxation, massage, guided evidence by tenderness
.imagery, or distraction may decrease pain and provide comfort
(actual)

.Instruct to avoid coffee, tea, alcohol, and sodas -4

Rationale : These food items cause irritation to the digestive system

.and should be avoided
Consult with client about likes and dislikes, foods that-
.cause distress, and preferred meal schedule Nursing
Rationale :Involving client in planning enables client to have a
. sense of control and encourages eating low fat diet diagnosis ,
interventions
.Provide frequent, small feedings -2
Rationale : Minimizes anorexia and nausea associated with
3
. uremic state

Weigh daily, preferably in the morning before breakfast-3

Imbalance nutrition
.role in maintaining adequate caloric and protein intake
Rationale : The fasting and catabolic client normally loses 0.2 less than body
to 0.5 kg/day. Changes in excess of 0.5 kg may reflect shifts in requirement related to
fluid balance loss of appetite
Create pleasant dining atmosphere; encourage client to-4
evidence by decrease
.share meals with family and friends
Rationale : Makes mealtime more enjoyable, which may
. body weight 2kg
.enhance intake
)actual(
.
.Reduce environmental distraction such as noise and light -1
Nursing
.Rationale : Provide a quite situation will conducive to sleep
diagnosis ,
Encourage to limit intake of chocolate and caffeinated -2 interventions
.beverages prior to bedtime
4
Rationale : Caffeine increases alertness by blocking sleep-inducing
.chemicals in the brain and increasing adrenaline production

Provide comfortable bedding and some of own possessions, -3 Disturbed sleep pattern
.such as a pillow n related to pain evidence
Rationale : Increases comfort for sleep; provides physiological and .by restlessness
psychological support
)actual(
Avoid or limit interruptions such as awakening for medications -4
.or therapies
Rationale : Uninterrupted sleep is more restful, and client may be
.unable to return to sleep when wakened
educate the patient and family membrane about signs of-1
bleeding that need to be reported to a health care provider Nursing
Rationale : early evaluation and treatment of bleeding by a health
care provider reduce the risk for complications from blood loss
diagnosis ,
Monitor for changes in vital signs and skin color, such as-2 
interventions
.BP,pulse, respirations, and skin pallor or discoloration 5
Rationale : Presence of bleeding or hemorrhage may lead to
.circulatory failure and shock

Review laboratory studies, such as Prothrombin time (PT),-3 

activated partial thromboplastin time (aPTT), clotting time,
Risk for bleeding related
.platelets, and Hgb and Hct
to decrease in mean
Rationale : Detects alterations in clotting capability; identifies
therapy needs
platelet volume(MPV)
.7.29 FL
Hematest body fluids—urine, stool, and vomitus—for occult-4 
.blood
)) potential
Rationale : Prompt detection of bleeding and initiation of therapy
.may prevent critical loss of blood
.Monitor BP and HR-1

Rationale : imbalance electrolyte will affected the heart rate

Nursing
Assess color of skin, mucous membranes, and nail beds. Note-2
diagnosis ,
capillary refill time interventions
Rationale : Pallor may reflect vasoconstriction or anemia. Cyanosis
is a late sign and is related to pulmonary congestion and/or cardiac
6
.failure

Investigate reports of muscle cramps, numbness of fingers,-3

.with muscle twitching, hyperreflexia Risk for decrease cardiac
Rationale : Neuromuscular indicators of hypocalcemia, which can output related to
also affect cardiac contractility and function
electrolyte imbalance . .
.Observe ECG or telemetry for changes in rhythm-4
(potential )
Rationale : Changes in electromechanical function may become
evident in response to progressing renal failure and accumulation
of toxins and electrolyte imbalance
.Encourage fluids intake -1

Rationale : Adequate fluid intake enhances immune system and aids

Nursing
.natural defense mechanisms diagnosis ,
Educate patient and family members about the signs and-2
symptoms of hyperthermia and help in identifying factors
interventions
related to occurrence of fever; discuss importance of increased 7
.fluid intake to avoid dehydration

Rationale : Providing health teachings to the patient and family aids

in coping with disease condition and could help prevent further
.complications of hyperthermia Risk for hyperthermia
Monitor client temperature—degree and pattern. Note shaking-3 related to presence of
.chills or profuse diaphoresis
. infection
Rationale : Fever pattern may aid in diagnosis: sustained or
continuous fever curves lasting more than 24 hours suggest acute
infection
) potential(.
.Provide cooling blanket, or hypothermia therapy, as indicated-4

Rationale : Used to reduce fever, especially when higher than

.(39.5C–40C), and when seizures or brain damage are likely to occur
 Conclusion
At the end, This is my patient was
name SA she came to the hospital
because she felt a fever with
shivering and lost of consciousness .
She has acute kidney injury and also
urinary tract infection her vital signs
stable except the blood pressure
slightly elevated also with fever .but
now after the care plan and
intervention the patient her health
. improved
 Reference
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarths textbook -1
of medical-surgical nursing. Philadelphia: Wolters Kluwer
National Kidney Foundation. 2020. Acute Kidney Injury (AKI). [online] -2
Available at:
<https://www.kidney.org/atoz/content/AcuteKidneyInjury> [Accessed
.24 October 2020]
3Acute kidney injury. (2020). Retrieved 24 October 2020, from
-/https://www.nhs.uk/conditions/acute-kidney-injury