Acute kidney injury (AKI) is the rapid loss of kidney function that can be caused by physical injury, infection, toxins, or decreased blood flow to the kidneys. AKI leads to cell damage and loss of renal function. Treatment focuses on correcting the underlying cause, controlling complications through fluid management and dialysis, and allowing the kidneys time to recover. Nursing care involves close monitoring for changes in urine output, fluid balance, and laboratory values to guide treatment and detect early signs of complications.
Acute Kidney Failure is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.
Chronic renal failure is a Progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails resulting in Uremia and Azotemia.
Definition, Etiology, Risk Factors, Stages, Clinical Manifestations, Management, Surgical Management, Prevention, Complications. Nursing Management
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...HariSedai
Approach to a patient with AKI or CKD in emergency setup and the relevant analysis of patient who visit emergency setting with the AKI and ckd a retrospective analysis in THTH emergency nepal, a developing country scenario
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
Objective Acute kidney injury
Know about definition of Acute kidney injury
Function of kidney
Sign and symptoms of AKI
Know about Risk factor of AKI
Understand about complication of AKI
Contents:
Introduction Of Acute kidney injury
Physiology Of Acute kidney injury
Pathophysiology Of Acute kidney injury
Clinical feature Of Acute kidney injury
Risk Factor Of Acute kidney injury
Diagnosis Of Acute kidney injury
Differential diagnosis Of Acute kidney injury
Complication Of Acute kidney injury
Management Of Acute kidney injury
Acute Kidney Failure is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.
Chronic renal failure is a Progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails resulting in Uremia and Azotemia.
Definition, Etiology, Risk Factors, Stages, Clinical Manifestations, Management, Surgical Management, Prevention, Complications. Nursing Management
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...HariSedai
Approach to a patient with AKI or CKD in emergency setup and the relevant analysis of patient who visit emergency setting with the AKI and ckd a retrospective analysis in THTH emergency nepal, a developing country scenario
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
Objective Acute kidney injury
Know about definition of Acute kidney injury
Function of kidney
Sign and symptoms of AKI
Know about Risk factor of AKI
Understand about complication of AKI
Contents:
Introduction Of Acute kidney injury
Physiology Of Acute kidney injury
Pathophysiology Of Acute kidney injury
Clinical feature Of Acute kidney injury
Risk Factor Of Acute kidney injury
Diagnosis Of Acute kidney injury
Differential diagnosis Of Acute kidney injury
Complication Of Acute kidney injury
Management Of Acute kidney injury
MEANING
Sudden and often temporary loss of kidney function.
DEFINITION
Acute renal failure (ARF) is an abrupt and sudden reduction in renal function resulting in the inability to excrete metabolic wastes and maintain proper fluid & electrolyte balance.
• It usually associated with oliguria (less than 500ml/day), no oliguria (greater than 800ml/day) or anuria (less than 50ml/day).
• BUN &creatinine values are elevated.
Etiology
ARF can be further divided into pre-renal, intra renal and post renal etiologies.
1) Pre- Renal causes
Are those that decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function.
Volume depletion resulting from:
• Hemorrhage
• Renal losses (diuretics, osmotic diuresis)
• Gastrointestinal losses (vomiting, diarrhea, nasogastric suction)
Impaired cardiac efficiency resulting from:
• Myocardia infraction
• Heart failure
• Dysrhythmias
• Cardiogenic shock
Vasodilation resulting from:
• Sepsis
• Anaphylaxis
• Antihypertensive medications or other medications that cause vasodilation.
2) Intrarenal causes
Refers to disease processes which directly damage the kidney itself. It can be due to one or more of the kidney’s structures including the glomeruli, kidney tubules or the interstitium.
Prolonged renal ischemia resulting from:
• Pigment nephropathy (associated with the breakdown of blood cells containing pigments that in turn occlude kidney structures)
• Myoglobinuria (trauma, crush injuries, burns)
• Hemoglobinreuria (transfusion reaction, hemolytic anemia)
Nephrotoxic agents such as:
• Aminoglycoside antibiotics (gentamycin, tobramycin)
• Radiopaque contrast agents
• Heavy metals (lead, mercury)
• Solvents and chemicals (ethylene glycol, carbon tetrachloride, arsenic)
• NSAIDS
• ACE inhibitors
Infections processes such as:
• Acute pyelonephritis
• Acute glomerulonephritis
3) Post renal causes
Refers to mechanical obstruction of urinary outflow, between the kidney and the urethral meatus, which includes urethral and bladder neck obstruction due to:
Calculi formation
Benign prostatic hyperplasia
Tumors
Strictures
Trauma (to back, pelvis or perineum)
Blood clots
Pathophysiology
The kidneys receive approximately one fourth of cardiac output; therefore, they are very sensitive to alteration in perfusion. Most cases of ARF are caused by ischemia episode. The pathophysiology of ARF is not completely understood.
PrerenalARF, is the result of impaired blood flow that leads to hypo perfusion of the kidney which causes decreased oxygen delivery that leads to hypoxemia and ischemia due to damage the kidney and glomerular filtration rate (GFR) decreases that leads to electrolyte imbalance and increased tubular reabsorption of sodium and water.
Intrarenal ARF is the result of actual parenchymal damage to the glomeruli or kidney
Acute renal failure nursing care plan & managementNursing Path
Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.
Brief Information regarding the disorders of the genitourinary system. This presentation involves the disorders of the urinary system including Chronic Kidney Disease, Congenital problems related to the urinary system, and renal cancers.
Acute renal failure or acute kidney injury is characterized by determination of renal functions over a period of hours to few days, resulting in failure of the kidney to excrete nitrogenous waste product and to maintain fluid, electrolytes and acid-base homeostasis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Acute Kidney Injury
Description
• Acute kidney injury (AKI) is the rapid loss of kidney function from
renal cell damage.
• Occurs abruptly and can be reversible
• AKI leads to cell hypoperfusion, cell death, and decompensation of
renal function.
• The prognosis depends on the cause and the condition of the client.
Near-normal or normal kidney function may resume gradually.
3. • Acute renal failure (ARF) occurs suddenly as a result of physical injury,
infection, inflammation, or damage from toxic chemicals.
• Nephrotoxic agents are those that are poisonous to kidney cells and
include many drugs, iodine substances used as radiographic contrast
media, heavy metals, snake venom, or exposure to industrial chemicals.
• These toxins may inflict damage on the renal tubules, causing acute
tubular necrosis (ATN) and loss of function.
• They can also indirectly harm the tubules by causing severe constriction of
blood vessels that serve the kidney, producing renal ischemia. ATN is
responsible for 90% of acute renal failure.
• Other causes of renal ischemia include circulatory collapse, severe
dehydration, and prolonged hypotension in compromised surgical or
trauma patients.
4. Causes
1. Prerenal:
Outside the kidney; caused by intravascular volume depletion such as
with blood loss associated with trauma or surgery
• Dehydration,
• Decreased cardiac output (as with cardiogenic shock),
• Decreased peripheral vascular resistance,
• Decreased renovascular blood flow,
• Prerenal infection or obstruction.
5. 2. Intrarenal
Within the parenchyma of the kidney (occurs from glomerular damage)
• Tubular necrosis,
• Prolonged prerenal ischemia,
• Intrarenal infection or obstruction,
• Nephrotoxicity.
6. 3. Postrenal:
Between the kidney and urethral meatus,
• Bladder neck obstruction,
• Bladder cancer,
• Calculi, and postrenal infection
ARF is potentially reversible, especially if identified early; patients often
regain kidney function.
8. Phases of AKI
1. Onset: Begins with precipitating event
2. Oliguric phase
a. For some clients, oliguria does not occur and the urine output is normal;
otherwise, the duration of oliguria is 8 to 15 days; the longer the duration, the
less chance of recovery.
b. Sudden decrease in urine output; urine output is less than 400 mL/day.
c. Signs of excess fluid volume: Hypertension, edema, pleural and pericardial
effusions, dysrhythmias, heart failure, and pulmonary edema
d. Signs of uremia: Anorexia, nausea, vomiting, and pruritus
e. Signs of metabolic acidosis: Kussmaul’s respirations
9. Phases of AKI
f. Signs of neurological changes: Tingling of extremities, drowsiness
progressing to disorientation, and then coma
g. Signs of pericarditis: Friction rub, chest pain with inspiration, and
low-grade fever
In this phase uremic symptoms first appear and life threatening
conditions such as hyperkalemia develop.
10. Intervention
With early recognition or potential for AKI, client may be treated with
fluid challenges (IV boluses of 500 to 1000 mL over 1 hour).
Restrict fluid intake; if hypertension is present, daily fluid allowances
may be 400 to 1000 mL plus the measured urinary output.
Administer medications, such as diuretics, as prescribed to increase
renal blood flow and diuresis of retained fluid and electrolytes.
11. 3. Diuretic phase
a. Urine output rises slowly, followed by diuresis (4 to 5 L/day).
b. Excessive urine output indicates that damaged nephrons are
recovering their ability to excrete wastes.
c. Dehydration, hypovolemia, hypotension, and tachycardia can occur.
d. Level of consciousness improves.
13. 4. Recovery phase (convalescent)
a. Recovery is a slow process; complete recovery may take 1 to 2 years.
b. Urine volume returns to normal.
c. Memory improves.
d. The older adult is less likely than a younger adult to regain full kidney
function.
15. DIAGNOSIS
• BUN (increases depends on the degree of catabolism(protein
breakdown), renal perfusion, and protein intake.
• Serum creatinine levels
• radiologic studies (such as ultrasound,CT, or MRI)(show evidence for
anatomical changes)
• A renal biopsy may be obtained to assist in determining the cause or
to evaluate the extent of kidney damage.
• CBC (anemia can occur as a results of reduced erythropoietin
production, reduced RBC lifespan)
16. Prevention
• Continually assess renal function( urine output, laboratory
values)when appropriate
• Monitor central venous and arterial pressure and hourly urine output
of critically ill patient
• Prevent and treat infections promptly. Infection can produce
progressive kidney damage.
• Prevent and treat shock promptly with blood and fluid replacement.
• Provide adequate hydration to patients at risk for dehydration,
17. Prevention
• Avoid severe transfusion reaction
• Prevent ascending urinary tract infection
• To prevent toxic drug effect, dosage, duration and blood levelsof all
medications metabolized or excreted by the kidneys
• Treat hypotension promptly
18. Medical management
Treatment of ARF is aimed toward correcting the underlying cause and preventing
or controlling complications and maintaining a tolerable internal environment until
the kidneys are able to recover and resume their normal functions
Symptomatic treatment includes
• correction of fluid and electrolyte balances,
• management of anemia and hypertension, and
• cleansing the blood and tissues of waste products with hemodialysis (filtration of
blood across a semipermeable membrane) or peritoneal dialysis (filtration of
blood across the peritoneal membrane).
• Pharmacologic therapy.
IV dextrose 50%, insulin, and calcium replacement may be administered
to shift potassium back into cells;
• diuretic agents are often administered to control fluid volume.
19. Medical management contd
• Volume overload is treated with diuretics and sometimes low-dose
dopamine to promote better kidney perfusion.
• Dialysis is also used to reduce volume overload if it cannot be reduced
with drugs. Electrolyte imbalances (hyperkalemia, hypocalcemia,
hyperphosphatemia, and mild hypermagnesemia) are monitored and
treated.
• Metabolic acidosis, if severe, is treated with IV sodium bicarbonate
• Replacement of dietary proteins is individualized to provide the
maximum benefit and minimize uremic symptoms; likewise, caloric
requirements are met with high-carbohydrate meals, because
carbohydrates have a protein-sparing effect; foods and fluids
containing potassium or phosphorus are restricted; and after diuretic
phase, the patient is placed on a high-protein, high-calorie diet.
20. Assessment
Patient's history, include questions that relate to
• fluid imbalance (e.g., changes in voiding patterns, weight gain,
muscle cramps, cardiac arrhythmia or palpitations, vomiting, or
edema) and
• potential risk factors (e.g., patient or family history of renal disease
or hypertension; recent surgery, trauma, or anesthesia; and exposure
to nephrotoxic substances or any medications).
• Complete head-to-toe assessment
• Laboratory investigation
21. Diagnosis
• Fluid volume excess due to decreased kidney function.
• Altered nutrition due to nausea and loss of appetite.
• Altered activity tolerance due to metabolic changes.
• Potential for infection due to indwelling urinary catheter.
22. Nursing Interventions
1. Monitor vital signs, especially for signs of hypertension, tachycardia,
tachypnea, and an irregular heart rate.
2. Monitor urine and intake and output hourly and urine color and
characteristics.
3. Monitor daily weight (same scale, same clothes, same time of day), noting
that an increase of 0.5 to 1 lb/day (0.25 to 0.5 kg/day) indicates fluid
retention.
4. Monitor for changes in the BUN, serum creatinine, and serum electrolyte
levels.
5. Monitor for acidosis (may need to be treated with sodium bicarbonate).
23. 6. Monitor urinalysis for protein level, hematuria, casts, and specific gravity.
7. Monitor for altered level of consciousness caused by uremia.
8. Monitor for signs of infection because the client may not exhibit an
elevated temperature or an increased WBC count.
9. Monitor the lungs for wheezes and rhonchi and monitor for edema, which
can indicate fluid overload.
10. Administer the prescribed diet, which is usually a low to moderate-
protein (to decrease the workload on the kidneys) and high-carbohydrate
diet; ill clients may require nutritional support with supplements, enteral
feedings, or parenteral nutrition.
24. 11. Restrict potassium and sodium intake as prescribed based on the
electrolyte level.
12. Administer medications as prescribed; be alert to the mechanism
for metabolism and excretion of all prescribed medications.
13. Be alert to nephrotoxic medications, which may be prescribed
25. 15. Prepare the client for dialysis if prescribed; continuous renal
replacement therapy may be used in AKI to treat fluid volume overload
or metabolic acidosis.
16. Provide emotional support by allowing opportunities for the client
to express concerns and fears and by encouraging family interactions.