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Year One Undergraduate Nurses AKI Education UPDATED 2020

Year One Undergraduate Nurses AKI Education

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Acute Kidney Injury (AKI)
Undergraduate nurse education
Year One
Developed Summer 2017
Reviewed Autumn 2020
Overview
Basic A & P of:
Urinary system
Kidneys
Followed by:
Introduction to Acute Kidney Injury
Acute Kidney Injury Year One
Urinary System
The urinary system consists of:
2 kidneys (usually!)
Ureters
Bladder
Urethra
Acute Kidney Injury Year One
Urethra – Tube that leads from the bladder and drains urine out of the
body. Features two sphincters – internal sphincter is involuntarily controlled
while the external sphincter is voluntarily controlled.
Positioning of the Kidneys
Kidneys are bean shaped
Located between 12th thoracic and 3rd
lumber vertebrae
Right lies lower than left
Cushioned and held in place by adipose
tissue, renal fascia & abdominal organs
Blood supply originates from the
abdominal aorta and then the renal artery.
Blood travels away from the kidney via
renal vein and then the inferior vena cava
Acute Kidney Injury Year One
Anatomy of the Kidney
Surrounded by a tough fibrous
capsule
Renal Cortex – contains nephrons
Renal medulla – loop of Henle and
collecting ducts of the nephrons
occupy this area
Minor and major calyces collect urine
and empty this into the renal pelvis
Renal pelvis is a continuation of the
ureter
Acute Kidney Injury Year One
Nephrons are the functioning units of the kidneys with
approximately 1 million in each kidney.
Glomerulus and glomerular capsule known collectively as
the renal corpuscle – where filtration occurs.
Proximal convoluted tubule (PCT) – reabsorption and
secretion
Loop of Henle – reabsorption of water (descending limb)
and sodium (ascending limb)
Distal convoluted tubule (DCT) – reabsorption, mainly
facilitated by the presence of hormones and secretion
Collecting duct – transports urine to calyces. Some
reabsorption in presence of hormones
Video on urine formation
Acute Kidney Injury Year One
Nephron
Ad

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Year One Undergraduate Nurses AKI Education UPDATED 2020

  • 1. Acute Kidney Injury (AKI) Undergraduate nurse education Year One Developed Summer 2017 Reviewed Autumn 2020
  • 2. Overview Basic A & P of: Urinary system Kidneys Followed by: Introduction to Acute Kidney Injury Acute Kidney Injury Year One
  • 3. Urinary System The urinary system consists of: 2 kidneys (usually!) Ureters Bladder Urethra Acute Kidney Injury Year One Urethra – Tube that leads from the bladder and drains urine out of the body. Features two sphincters – internal sphincter is involuntarily controlled while the external sphincter is voluntarily controlled.
  • 4. Positioning of the Kidneys Kidneys are bean shaped Located between 12th thoracic and 3rd lumber vertebrae Right lies lower than left Cushioned and held in place by adipose tissue, renal fascia & abdominal organs Blood supply originates from the abdominal aorta and then the renal artery. Blood travels away from the kidney via renal vein and then the inferior vena cava Acute Kidney Injury Year One
  • 5. Anatomy of the Kidney Surrounded by a tough fibrous capsule Renal Cortex – contains nephrons Renal medulla – loop of Henle and collecting ducts of the nephrons occupy this area Minor and major calyces collect urine and empty this into the renal pelvis Renal pelvis is a continuation of the ureter Acute Kidney Injury Year One
  • 6. Nephrons are the functioning units of the kidneys with approximately 1 million in each kidney. Glomerulus and glomerular capsule known collectively as the renal corpuscle – where filtration occurs. Proximal convoluted tubule (PCT) – reabsorption and secretion Loop of Henle – reabsorption of water (descending limb) and sodium (ascending limb) Distal convoluted tubule (DCT) – reabsorption, mainly facilitated by the presence of hormones and secretion Collecting duct – transports urine to calyces. Some reabsorption in presence of hormones Video on urine formation Acute Kidney Injury Year One Nephron
  • 7. The kidneys require 25% cardiac output to be adequately perfused with blood and work effectively. Kidneys filter about 200 litres of fluid from the blood each day Most of this is reabsorbed – if it weren’t, our vascular system would be empty of fluid within about 30 minutes! The kidneys don’t just make urine, they have a number of other vital functions. Generally, people know very little about their kidneys – until something goes wrong. Think Kidneys Infographic – almost everything need know about your kidneys Acute Kidney Injury Year One Key facts about the kidneys
  • 8. Functions of the kidneys The kidneys have numerous functions and don’t just produce urine Play a key role in regulating blood pressure Produce Erythropoietin that is vital in the production of red blood cells Maintains calcium and phosphate balance via the nephrons and through the activation of Vitamin D Maintain acid/base balance Maintain electrolyte balance, such as potassium and sodium Removal of waste products such as urea, creatinine, drugs and toxins Acute Kidney Injury Year One
  • 9. Kidney Dysfunction Kidney dysfunction can be seen as chronic or acute in nature Chronic Kidney Disease (CKD) is the gradual decline in renal function over months or usually years Acute Kidney Injury (AKI), formally known as acute renal failure, is the sudden deterioration of renal function over hours or days. People with CKD can also experience episodes of AKI – known as acute on chronic. People with CKD are most at risk of developing AKI Acute Kidney Injury Year One
  • 10. AKI AKI seen in up to 20% of all people admitted to hospital with older adults being particular affected AKI is increasingly being seen in primary care without any acute illness. About 65% of AKI starts in community. If AKI is highlighted early (community) this may prevent hospital admission or reduced length of stay. Financial burden to the NHS estimated between £420 million and £600 million per year (https://www.thinkkidneys.nhs.uk/aki/) Acute Kidney Injury Year One
  • 11. Risk Factors for AKI NICE guideline NG148 (2019) focuses on the prevention, detection and management of AKI Identifies numerous risk factors – the main ones are summarised below: Chronic Kidney Disease Age (above 65 years) Cardiac Failure Liver Disease Diabetes Nephrotoxic medications History of AKI Sepsis Deteriorating Early Warning Scores Acute Kidney Injury Year One
  • 12. The prevalence of CKD and AKI increases with age. Between one- quarter and one-third of all adults aged over 64 years have CKD. The incidence of severe AKI is more than fifty times higher in people aged over 80 years than in people aged under 50 years. Acute Kidney Injury Year One Who is at risk of developing acute kidney injury? In addition to this, Think Kidneys (2018) suggest some individuals in the following groups can also be at risk of AKI in the primary care setting: Diabetics Dementia Heart failure Psychiatric patients Patients with cancer
  • 13. The causes of AKI can be classified into one of 3 areas: Pre-renal: Failure to receive an adequate blood supply (40-80%) Renal: Intrinsic damage to the kidney tissue (actual damage of renal cells, commonly referred to as ATN) (20-40%) Post-renal: Impaired renal drainage (obstruction of the renal tract) (2-10%) Acute Kidney Injury Year One Causes of AKI Consider: Risk + Insult = increased risk of AKI Example would be: Patient who is 68 years old, diabetic and has had a previous episode of AKI who has c. diff Risk factors: Age, diabetes, previous AKI Insult: vomiting and diarrhea due to c. diff. resulting in dehydration
  • 14. Urinalysis Assessment of urine can provide vital information as to whether the damage is within the kidneys or as a result of pre renal cause. Blood and protein enter the urine if the filtration system within the kidneys is not working effectively. 2+ of blood or 2+ protein is a significant finding and should be reported to the doctor. Acute Kidney Injury Year One
  • 15. Think Kidneys public campaign Acute Kidney Injury Year One
  • 16. Dehydration Mild – no more than 5% of the body's fluid. Moderate is 5-10% Severe dehydration 10-15% is considered life threatening http://medical-dictionary.thefreedictionary.com/Dehydration It’s vital to monitor fluid input/output accurately Dehydration can be further compounded by continuation with diuretics and anti-hypertensives and other nephrotoxic medications. For further information regarding medications optimisation and AKI follow this LINK Acute Kidney Injury Year One
  • 17. How much should I drink?! The Food Standards Agency (FSA) recommends that if you live in the UK (or somewhere with a similar climate), you should drink 1.2 litres (6-8) glasses of fluid every day Acute Kidney Injury Year One
  • 18. Age & Dehydration Adults over the age of 60 who drink only when they are thirsty probably get only about 90% of the fluid they need. Developing a habit of drinking only in response to the body's thirst signals raises an older person's risk of becoming dehydrated. Dehydration in children usually results from losing large amounts of fluid and not drinking enough water to replace the loss. This generally occurs in children who have stomach flu. An infant can become dehydrated only hours after becoming ill. Acute Kidney Injury Year One
  • 19. Signs of dehydration Thirst Dark urine Sunken eyes Irritability Confusion Cool hands or feet Low blood pressure Raised heart rate Headaches If a person has AKI they may pass less urine than usual (oliguria), or pass no urine at all (anuria) Acute Kidney Injury Year One
  • 20. Clinical Signs of Dehydration Other symptoms may include: Dizziness or light-headedness or confusion Headache Tiredness Dry mouth, lips and eyes Passing small amounts of urine infrequently (less than three or four times a day) Loss/ deterioration of strength and stamina Muscle cramps Reduced appetite Pressure area break downs Constipation Acute Kidney Injury Year One
  • 21. Treating Dehydration The best way to treat dehydration is to rehydrate the body by drinking plenty of fluids, such as water, semi-skimmed milk, diluted squash or diluted fruit juice. Acute Kidney Injury Year One
  • 22. Suspect Dehydration? What clinical signs are present? Assess Respiratory rate, BP, Temperature and pulse Feel limb temperature, assess skin turgor, feeling thirsty, any oedema? Look inside the mouth for dry mucous membranes Ask when they last passed urine? Note (if able – volume, colour, smell and clarity) Look for any acute illness Look at the prescription chart / medications Acute Kidney Injury Year One
  • 23. Prevention is better than cure Up to 30% AKI maybe preventable by: volume replacement discontinuing and/or avoiding certain potentially nephrotoxic agents earlier recognition of conditions causing rapid progression of AKI Correctly completing and acting upon Early Warning Scores Acute Kidney Injury Year One
  • 24. Summary The kidneys have numerous functions and when they fail, this has complex and life-threatening consequences AKI is the sudden deterioration of kidney function over hours or days AKI is often preventable Older patients, those with chronic diseases such as CKD, diabetes and heart failure are at high risk of AKI AKI has numerous causes that may be pre, intra or post renal in nature Dehydration is a major cause of AKI Acute Kidney Injury Year One