Acute Kidney Injury (AKI), formerly known as acute renal failure, is a sudden decline in kidney function that occurs over hours to days.
Causes of Acute Kidney Injury
AKI can result from various factors, which are typically categorized into three main groups:
Prerenal causes (impaired blood flow to the kidneys):
- Severe dehydration
- Blood loss
- Heart failure
- Sepsis
- Certain medications (e.g., NSAIDs, ACE inhibitors)
Intrinsic causes (direct damage to the kidney tissue):
- Acute tubular necrosis
- Glomerulonephritis
- Interstitial nephritis
- Vasculitis
- Rhabdomyolysis
Postrenal causes (obstruction of urine outflow):
- Kidney stones
- Enlarged prostate
- Bladder or urethral strictures
- Tumors
Risk factors for developing AKI include advanced age, chronic kidney disease, diabetes, hypertension, and recent major surgery.
Symptoms and Diagnosis
AKI often develops without noticeable symptoms, especially in its early stages. When symptoms do occur, they may include:
- Decreased urine output (oliguria)
- Fluid retention and swelling (edema)
- Shortness of breath
- Fatigue
- Confusion
- Nausea and vomiting
- Loss of appetite
Diagnosis of AKI typically involves:
- Blood tests (serum creatinine, blood urea nitrogen)
- Urine tests
- Imaging studies (ultrasound, CT scan)
- In some cases, kidney biopsy
Nursing Process in Acute Kidney Injury
The nursing process for patients with AKI involves comprehensive assessment, planning, implementation, and evaluation of care. Key aspects include:
- Assessment: Monitor vital signs, fluid balance, urine output, and electrolyte levels.
- Diagnosis: Develop nursing diagnoses based on patient assessment and clinical presentation.
- Planning: Set achievable goals and outcomes for patient care.
- Implementation: Execute interventions to manage symptoms and prevent complications.
- Evaluation: Continuously assess the effectiveness of interventions and adjust care plans as needed.
Nursing Care Plans for Acute Kidney Injury
Here are five essential nursing care plans for patients with Acute Kidney Injury:
- Fluid Volume Excess
Nursing Diagnosis: Fluid volume excess is related to impaired kidney function and decreased urine output, as evidenced by edema, weight gain, and increased blood pressure.
Related factors/causes:
- Compromised regulatory mechanism due to kidney dysfunction
- Decreased glomerular filtration rate
- Sodium and water retention
Nursing Interventions and Rationales:
a) Monitor and record accurate intake and output every 2-4 hours.
Rationale: Provides data to assess fluid balance and guide fluid management.
b) Weigh the patient daily at the same time and with the same scale.
Rationale: Sudden weight changes can indicate fluid retention or loss.
c) Assess for peripheral and dependent edema every shift.
Rationale: Edema is a sign of fluid overload and can worsen with AKI.
d) Administer diuretics as prescribed.
Rationale: Helps promote fluid excretion and reduce edema.
e) Educate the patient on fluid and sodium restrictions as ordered.
Rationale: Empower patients to participate in their care and manage fluid balance.
Desired Outcomes:
- The patient will maintain fluid balance as evidenced by stable weight, reduced edema, and normal blood pressure within 48-72 hours.
- The patient will verbalize understanding of fluid and sodium restrictions within 24 hours.
- Risk for Electrolyte Imbalance
Nursing Diagnosis: Risk for Electrolyte Imbalance related to impaired kidney function and alterations in fluid volume.
Related factors/causes:
- Decreased glomerular filtration rate
- Altered hormone regulation
- Medication side effects
Nursing Interventions and Rationales:
a) Monitor serum electrolyte levels, especially potassium, sodium, and calcium.
Rationale: Early detection of imbalances allows for prompt intervention.
b) Assess for signs and symptoms of electrolyte imbalances (e.g., muscle weakness, cardiac arrhythmias).
Rationale: Helps identify potential complications of electrolyte disturbances.
c) Administer electrolyte replacements or binding agents as prescribed.
Rationale: Helps correct electrolyte imbalances and prevent complications.
d) Educate the patient on dietary restrictions and foods high in potassium.
Rationale: Empowers patient to make informed dietary choices to manage electrolyte levels.
e) Monitor ECG for changes indicating electrolyte imbalances.
Rationale: Cardiac changes can signal severe electrolyte disturbances requiring immediate intervention.
Desired Outcomes:
- The patient will maintain electrolyte levels within normal ranges.
- The patient will remain free from signs and symptoms of electrolyte imbalances.
- Acute Pain
Nursing Diagnosis: Acute Pain related to kidney inflammation and edema as evidenced by verbal reports of pain and grimacing.
Related factors/causes:
- Tissue inflammation
- Edema
- Urinary tract obstruction
Nursing Interventions and Rationales:
a) Assess pain characteristics using a standardized pain scale every 4 hours and as needed.
Rationale: Provides a baseline for pain management and evaluates intervention effectiveness.
b) Administer analgesics as prescribed, considering renal function.
Rationale: Promotes comfort while ensuring medication safety for compromised renal function.
c) Apply heat or cold therapy as appropriate and preferred by the patient.
Rationale: Non-pharmacological interventions can help alleviate pain and reduce medication dependence.
d) Assist patients in finding comfortable positions that reduce pain.
Rationale: Proper positioning can alleviate pressure and reduce pain intensity.
e) Provide relaxation techniques such as guided imagery or deep breathing exercises.
Rationale: These techniques can help manage pain and reduce anxiety associated with discomfort.
Desired Outcomes:
- The patient will report pain levels at three or less on a 0-10 scale within 24 hours.
- The patient will demonstrate the use of non-pharmacological pain management techniques.
- Risk for Infection
Nursing Diagnosis: Risk for Infection related to decreased immune function and invasive procedures.
Related factors/causes:
- Uremia
- Malnutrition
- Presence of invasive devices (e.g., urinary catheters, IV lines)
- Altered skin integrity due to edema
Nursing Interventions and Rationales:
a) Practice and enforce strict hand hygiene.
Rationale: Reduces the risk of healthcare-associated infections.
b) Assess for signs and symptoms of infection (e.g., fever, chills, localized redness) every shift.
Rationale: Early detection allows for prompt treatment of infections.
c) Maintain an aseptic technique when handling invasive devices.
Rationale: Prevents introduction of pathogens through invasive lines.
d) Encourage proper nutrition and hydration within prescribed limits.
Rationale: Adequate nutrition supports immune function.
e) Educate patient and family on infection prevention measures.
Rationale: Empower patient and family to participate in infection control.
Desired Outcomes:
- The patient will remain free from signs and symptoms of infection throughout hospitalization.
- The patient will demonstrate an understanding of infection prevention measures.
- Impaired Skin Integrity
Nursing Diagnosis: Impaired Skin Integrity related to edema and decreased mobility as evidenced by skin breakdown and pressure areas.
Related factors/causes:
- Fluid retention causing edema
- Decreased peripheral circulation
- Limited mobility
- Altered nutritional status
Nursing Interventions and Rationales:
a) Assess skin integrity every shift, paying close attention to bony prominences and edematous areas.
Rationale: Early identification of skin breakdown allows for prompt intervention.
b) Implement a regular turning schedule at least every 2 hours.
Rationale: Frequent position changes reduce pressure on vulnerable areas.
c) Use pressure-relieving devices such as specialized mattresses or cushions.
Rationale: These devices help distribute pressure and reduce the risk of pressure injuries.
d) Keep skin clean and dry using pH-balanced skin care products.
Rationale: Proper skin hygiene helps maintain skin integrity and prevent breakdown.
e) Consult a wound care specialist for existing or developing pressure injuries.
Rationale: Specialized care can promote healing and prevent the worsening of skin breakdown.
Desired Outcomes:
- The patient will maintain intact skin throughout hospitalization.
- Any existing pressure injuries will show signs of healing within 1 week.
Conclusion
Effective nursing care for patients with Acute Kidney Injury requires a comprehensive understanding of the condition, its causes, and potential complications. By implementing these nursing care plans, healthcare professionals can provide high-quality, patient-centered care that addresses the complex needs of individuals with AKI. Regular assessment, timely interventions, and patient education are key components in managing AKI and promoting optimal outcomes.
References
- Kellum, J. A., Lameire, N., & KDIGO AKI Guideline Work Group. (2013). Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Critical care, 17(1), 204. https://doi.org/10.1186/cc11454
- Palevsky, P. M., Liu, K. D., Brophy, P. D., Chawla, L. S., Parikh, C. R., Thakar, C. V., … & Weisbord, S. D. (2013). KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. American Journal of Kidney Diseases, 61(5), 649-672. https://doi.org/10.1053/j.ajkd.2013.02.349
- Prowle, J. R., Bellomo, R., & Bagshaw, S. M. (2011). Acute kidney injury: diagnosis and classification of AKI: AKIN or RIFLE?. Nature Reviews Nephrology, 7(12), 738-739. https://doi.org/10.1038/nrneph.2011.153
- Schetz, M., Gunst, J., & Van den Berghe, G. (2014). The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU. Intensive care medicine, 40(11), 1709-1717. https://doi.org/10.1007/s00134-014-3487-1
- Zarbock, A., Koyner, J. L., Hoste, E. A., & Kellum, J. A. (2018). Update on perioperative acute kidney injury. Anesthesia & Analgesia, 127(5), 1236-1245. https://doi.org/10.1213/ANE.0000000000003741