Acute Kidney Injury [AKI] Nursing Diagnosis, Care Plan & Interventions

Acute kidney injury is a serious medical condition that can lead to long-term health complications. Without prompt treatment, acute kidney injury can cause permanent damage to the kidneys and other organs in the body. It can also result in high blood pressure, anemia, and electrolyte imbalances.

Early diagnosis of acute kidney injury is critical for successful treatment. That’s why it’s essential to recognize the signs and symptoms of this condition as soon as possible so you can seek medical attention immediately. By getting timely care from your doctor or healthcare provider, you may be able to prevent further damage and reduce your risk of long-term complications.

In this Nursingtroop post, we will provide you with an acute kidney injury care plan for this disease. Read on.

What is Acute Kidney Injury (AKI)?

Acute kidney injury, commonly called AKI, is when the kidneys suddenly stop working correctly. This condition can be severe and can happen to anyone, regardless of age or health status.

Various factors, including dehydration, infections, and certain medications, can cause AKI. When left untreated, AKI can lead to complications such as kidney failure, so it is essential to seek medical attention immediately if you suspect you may be experiencing symptoms of the condition, such as reduced urine output, swelling in the legs, feet, or ankles, and confusion or lethargy. With proper treatment and care, however, most cases of AKI can be successfully treated and managed.

Pathophysiology

Acute kidney injury is caused by a sudden decrease in renal function due to direct or indirect kidney damage. Several factors, including infection, dehydration, medication toxicity, and blockages in the urinary tract, can cause this. When this occurs, toxins and other waste products accumulate in the blood and body tissues, leading to changes in electrolyte balance and organ dysfunction.

What happens when kidney failure starts?

The stages of kidney disease are determined by your estimated glomerular filtration rate (eGFR). This calculation measures how efficiently the kidneys filter out elements. A normal eGFR is usually around 100, while an eGFR of 0 indicates no remaining kidney function.

Kidney disease stages include:

• Stage I. Your GFR is greater than 90 but below 100. This indicates your kidneys have mild damage but are still functioning normally.
• Stage II. With a GFR of between 60 and 89, your kidneys have more damage but still operate effectively.
• Stage III. When your GFR falls between 30 and 59, you may experience mild or severe loss of kidney function.
• Stage IV. You will significantly reduce kidney function if your GFR is between 15 and 29.
• Stage V. When your GFR drops below 15, it indicates that your kidneys are near or at complete failure.

Symptoms

The main Signs and symptoms of acute kidney failure may include:

• Shortness of breath
• Fatigue
• Decreased urine output
• Confusion
• Fluid retention, leading to swelling in the legs, ankles, or feet
• Nausea and vomiting
• Seizures or coma in severe cases

Changes in urine output

It’s difficult to determine if prerenal, renal, or postrenal causes are behind acute kidney injury (AKI) solely by looking at the amount of urine output.

Generally, there are three phases of urine output in an acute tubular injury: prodromal, oliguric, and post-oliguric.

• The prodromal phase may last a few minutes to hours and has average urine production. It can be affected by the amount of toxin ingested or the duration and severity of hypotension.
• The oliguric phase is typically characterized by a urine output between 50 and 500 mL/day, but the duration can vary significantly. Nonoliguric patients have been shown to have lower mortality and morbidity, as well as less need for dialysis.
• In the post-oliguric stage, urine output gradually returns to normal even though creatinine and urea levels may not fall for several days. During this time, tubular dysfunction can take the form of sodium wasting, polyuria (possibly massive) that isn’t responsive to vasopressin, or hyperchloremic metabolic acidosis.

Causes

Acute kidney failure can occur when:

• You have a state that slows the blood flow rate to your kidneys.
• You experience direct harm to your kidneys.
• Urine drainage tubes (ureters) become blocked, and wastes can’t leave your body through your urine.

Impaired blood flow to the kidneys:

It can lead to kidney damage if the decreased blood flow lasts long enough. Reduced blood flow may be caused by various conditions, including:

• Low blood pressure
• Serious injury or surgery
• Heart attack or heart failure
• Dehydration
• Severe allergic reaction (anaphylaxis)
• Burns

Damage to the kidneys:

• Medications, like some antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Certain poisons or toxins
• Infections like sepsis and urinary tract infections (UTIs)

Urine blockage in the kidneys

Blockage of the urine outflow from both kidneys can cause AKI. Causes for such blockage may include:

• Kidney stones
• Blood clots in the urinary tract
• An enlarged prostate gland (in men)
• Tumors or an abnormal connection between two organs near the kidneys (in children)

Diagnosis

Diagnosing acute kidney injury may involve several tests, including:

• Urine and blood tests measure the level of creatinine, a waste product normally excreted through urine. A high creatinine level can indicate kidney damage.
• A renal scan to measure how well your kidneys are functioning.
• Imaging tests like an ultrasound or CT scan to look for any blockages in the urinary tract.
• A kidney biopsy if a cause other than decreased blood flow is suspected, such as an infection or drug reaction.

Who is at Risk?

Anyone can develop AKI, but certain conditions and lifestyle decisions make some people more vulnerable. Risk factors for acute kidney injury include:

• Advanced age
• Chronic illnesses such as diabetes or hypertension
• Certain medications, including NSAIDs, antibiotics, and diuretics
• Use of recreational drugs or alcohol
• Dehydration or prolonged fasting
• Surgery or other medical procedures, such as a kidney biopsy
• Heart attack or severe trauma

Complications

Possible problems that may arise due to acute kidney failure are:

• Fluid buildup. This may cause breathlessness.
• Chest pain. Inflammation of the pericardium, which covers the heart, can cause chest pains.
• Weakness of muscles. Imbalanced body fluids and electrolytes may result in muscle weakness.
• Permanent kidney damage. In some cases, acute kidney failure results in permanent loss of renal function or end-stage renal disease. People suffering from this condition necessitate lasting dialysis or a kidney transplant for survival.
• Death. Severe cases of acute kidney failure can lead to death.

Treatment for Acute Kidney Injury

The treatment and care plan for acute kidney injury focuses on restoring kidney function and treating underlying causes. Treatment may include:

• Intravenous fluids help restore normal blood pressure and hydrate the body
• Dialysis, which is a process that filters waste from the bloodstream using a machine
• Medication to treat any infections or conditions causing the kidney failure
• Surgery to remove an obstruction in the urinary tract
• Dietary changes to help reduce strain on the kidneys, including reducing salt and protein intake
• Monitoring of electrolyte levels and kidney function tests

Acute Kidney Injury Nursing Care Plan [NCP]:

Assessment

• Oliguric-anuric phase: urine output of less than 400 ml in 24 hours, along with increased creatinine and urea, uric acid, organic acids, potassium, and magnesium; this typically lasts three to five days for infants and children, ten to fourteen days in adolescents and adults.
• Diuretic phase: commences when the urine output surpasses 500 ml within 24 hours and ceases when the BUN and creatinine levels have stabilized; the length of this phase is variable.
• Recovery phase: generally symptom-free, persisting for several months to a year; sometimes, scar tissue may remain.
• In prerenal disease: decreases in tissue turgor, dryness of mucous membranes, weight loss, flat neck veins, hypotension, and tachycardia.
• In postrenal disease: difficulty in voiding and alterations in urine flow are observed.
• In intrarenal disease: the presentation tends to vary from case to case; usually showing signs of edema, possibly accompanied by fever or a skin rash. Furthermore, nausea, vomiting, diarrhea, and lethargy may occur.

Subjective Data:

• The patient expresses fatigue and severe pain in the lower back

Objective Data:

• Decreased urine output
• Swelling of legs, feet, and ankles
• Breathlessness and chest pains

Nursing diagnoses for acute kidney injury 

• Acute pain: inflammation and pressure buildup in the renal capsule can lead to acute pain.
• Excess fluid volume: monitor weight/output for signs of fluid overload, such as edema; diuretics and restriction on fluids may be ordered.
• Impaired urinary elimination: keep an eye on intake/output and electrolytes.
• Risk for electrolyte imbalance: check serum electrolyte levels and watch out for signs of imbalance.
• Knowledge deficit: educate patients on their condition, management, medications, and dietary limitations.

Nursing Interventions and Rationales

Monitor vital signs: Heart rate and blood pressure.

Tachycardia and hypertension may occur due to the kidney’s inability to excrete urine, so this must be monitored.

Also, perform 12 lead EKG to assess for arrhythmias: Listen for adventitious breath sounds or extra heart sounds, as fluid overload may lead to pulmonary edema and heart failure.

Check for changes in consciousness level: these may indicate fluid shifts or electrolyte imbalance.

Assess dependent and periorbital edema: noting any degree of swelling (+1 – +4). Up to 10 lbs of fluid can accumulate before pitting is noticed.

Monitor diagnostic studies

• such as chest X-rays
• ultrasound or CT of kidneys,
• urinalysis and serum tests, including BUN,
• creatinine ratio and sodium.

Also, insert an indwelling urinary catheter to measure urine output unless contraindicated for infection accurately.

Monitor I & O for fluid retention: a decrease in output (<400 mL/24 hr period) may be evident by dependent edema. Daily weigh-ins at the same time and scale each day can indicate fluid retention if >0.5kg/day is gained.

Note changes in characteristics of urine: such as odor, blood, mucus, or sediment present.

Administer medications as ordered: e.g., IV fluids, diuretics, calcium channel blockers, antihypertensive, and cation-exchange resins to treat hyperkalemia.

Provide nutrition management and education: limiting excess fluids and sodium intake and increasing fresh fruits & vegetables.

Limit foods high in potassium, such as beans, rice, bananas, etc. Refer for further dietitian counseling if necessary.

Prepare patient for dialysis if indicated: peritoneal, hemodialysis, or Continuous Renal Replacement Therapy.

Ensure the head of the bed is elevated to reduce pressure on the diaphragm and monitor any signs of clot or infection at the shunt site.

Assess for thrill/bruit of shunt for patency.

Documentation Guidelines

Record the patient’s vital signs and any changes in level of consciousness.

• Monitor I&Os, urine output/characteristics, and weight daily.
• Document medications administered and response to treatments.
• Note the patient’s emotional response during interventions.
• Monitor labs for electrolyte levels, BUN/Creatinine ratio, and other pertinent blood work.
• Document the patient’s response to nutrition management and education.
• Record any complications related to dialysis or other treatments.
• Document the patient’s knowledge of the condition/treatment plan.
• Note any interventions that were ineffective or need further teaching/re-evaluation.
• Record discharge education and follow-up plan.
• Refer the patient to a dietitian/social worker/other resources as needed.

Final Words

acute kidney injury nursing diagnosis and care plan can be complex; long-term dialysis or a kidney transplant may be necessary for some patients. It is essential that the nurse assesses the patient’s individual needs and utilizes evidence-based practices to develop an optimal plan of care. Nurses play an integral role in helping patients improve their quality of life during this challenging time through monitoring, interventions, teaching, and follow-up.

References

• https://en.wikipedia.org/wiki/Acute_kidney_injury
• https://medlineplus.gov/ency/article/000501.htm
• https://www.ncbi.nlm.nih.gov/books/NBK441896/
• https://www.kidney.org/atoz/content/AcuteKidneyInjury
• https://my.clevelandclinic.org/health/diseases/17689-kidney-failure