Chapter 49

Nursing Management:
Acute Kidney Injury
and Chronic Kidney Disease
 Acute Kidney Injury
 Etiology and pathophysiology
 Prerenal
 Intrarenal
 Postrenal

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Acute Kidney Injury (Cont.)

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 Acute Kidney Injury (Cont.)
 Etiology and pathophysiology (Cont.)
 Postrenal

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Acute Kidney Injury (Cont.)

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 Acute Kidney Injury (Cont.)
 Clinical manifestations
 Initiation phase
 Maintenance phase
• Urinary changes
• Fluid volume excess
• Metabolic acidosis
• Sodium balance
• Potassium excess
• Hematological disorders
• Calcium deficit and phosphate excess
• Waste product accumulation
• Neurological disorders

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 Acute Kidney Injury (Cont.)
 Clinical manifestations (Cont.)
 Recovery phase
 Diagnostic studies
 Interprofessional care
 Nutritional therapy

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 Nursing Management:
Acute Kidney Injury
 Nursing assessment
 Nursing diagnoses
 Planning
 Nursing implementation
 Health promotion
 Acute intervention
 Ambulatory and home care
 Evaluation

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 Age-Related Considerations:
Acute Kidney Injury
 Older persons are more susceptible than
younger adults to acute kidney injury because
the number of functioning nephrons decreases
with age.
 Impaired function of other organ systems (e.g.,
cardiovascular disease, impaired pancreas
function) can increase the risk of developing
acute kidney injury.

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 Age-Related Considerations:
Acute Kidney Injury (Cont.)
 The aging kidney is less able to compensate for
changes in fluid volume, solute load, and cardiac
output.
 Common causes of acute kidney injury in the
older person include dehydration, hypotension,
diuretic therapy, aminoglycoside therapy,
obstructive disorders (e.g., prostatic
hyperplasia), surgery, infection, and
radiocontrast agents.

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 Chronic Kidney Disease
 Involves progressive, irreversible loss of kidney
function
 Clinical manifestations

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Chronic Kidney Disease (Cont.)

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 Chronic Kidney Disease (Cont.)
 Clinical manifestations
 Urinary system
 Metabolic disturbances
• Waste product accumulation
• Altered carbohydrate metabolism
• Elevated triglycerides

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 Chronic Kidney Disease (Cont.)
 Clinical manifestations (Cont.)
 Electrolyte and acid–base imbalances
• Potassium
• Sodium
• Calcium and phosphate
• Magnesium
• Metabolic acidosis

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 Chronic Kidney Disease (Cont.)
 Clinical manifestations (Cont.)
 Hematological system
• Anemia
• Bleeding tendencies
• Infection
 Cardiovascular system
 Respiratory system
 Gastrointestinal system
 Neurological system

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 Chronic Kidney Disease (Cont.)
 Clinical manifestations (Cont.)
 Musculoskeletal system
 Integumentary system
 Reproductive system
 Psychological changes
 Diagnostic studies

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Chronic Kidney Disease:
Pathophysiology

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 Chronic Kidney Disease (Cont.)
 Interprofessional management of chronic kidney
disease
 Medication therapy
• Hyperkalemia
• Hypertension
• Chronic kidney disease—mineral and bone disorder
• Anemia
• Dyslipidemia
• Complications of medication therapy

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 Chronic Kidney Disease (Cont.)
 Interprofessional management of chronic kidney
disease (Cont.)
 Nutritional therapy
• Protein restriction
• Sodium and fluid restriction
• Potassium restriction
• Phosphate restriction

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 Nursing Management:
Chronic Kidney Disease
 Nursing assessment
 Nursing diagnoses
 Planning
 Nursing implementation
 Health promotion
 Care considerations for chronic kidney disease in
stages 4 to 5
 Ambulatory and home care
 Evaluation

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 Dialysis
 General principles of dialysis
 Diffusion
 Osmosis
 Ultrafiltration

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Dialysis (Cont.)

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 Peritoneal Dialysis
 Catheter placement
 Nonsurgical approach
 Surgical approach

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Peritoneal Dialysis (Cont.)

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Peritoneal Dialysis (Cont.)

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 Peritoneal Dialysis (Cont.)
 Dialysis solutions and cycles
 Peritoneal dialysis systems
 Automated peritoneal dialysis

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Peritoneal Dialysis (Cont.)

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 Peritoneal Dialysis (Cont.)
 Peritoneal dialysis systems
 Continuous ambulatory peritoneal dialysis

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 Peritoneal Dialysis (Cont.)
 Complications of peritoneal dialysis
 Exit-site infection
 Peritonitis
 Abdominal pain
 Outflow problems
 Hernias
 Lower back problems
 Bleeding
 Pulmonary complications
 Protein loss
 Carbohydrate and lipid abnormalities

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 Peritoneal Dialysis (Cont.)
 Effectiveness of and adaptation to chronic
peritoneal dialysis

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 Hemodialysis
 Vascular access sites for hemodialysis
 Arteriovenous fistulas and grafts
 Central venous catheters

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Hemodialysis (Cont.)

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Hemodialysis (Cont.)

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 Hemodialysis (Cont.)
 Vascular access sites (cont.)
 Temporary vascular access

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Hemodialysis (Cont.)

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Hemodialysis (Cont.)

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 Hemodialysis (Cont.)
 Dialyzers
 Procedure for hemodialysis

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Hemodialysis (Cont.)

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 Hemodialysis (Cont.)
 Procedure for hemodialysis (Cont.)
 Settings for hemodialysis

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Hemodialysis (Cont.)

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 Hemodialysis (Cont.)
 Complications of hemodialysis
 Hypotension
 Muscle cramps
 Loss of blood
 Hepatitis
 Sepsis
 Disequilibrium syndrome
 Effectiveness of and adaptation to hemodialysis

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 Continuous Renal
Replacement Therapy

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 Kidney Transplantation
 Ethical issues
 Recipient selection
 Histocompatibility studies
 Donor sources
 Living donors
 Deceased donors
 Surgical procedure
 Live donor
 Kidney transplant recipient

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Kidney Transplantation (Cont.)

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 Nursing Management:
Kidney Transplant Recipient
 Preoperative care
 Postoperative care
 Living donor
 Kidney transplant recipient
 Immunosuppressive therapy

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 Nursing Management:
Kidney Transplant Recipient (Cont.)
 Complications of transplantation
 Rejection
 Infection
 Cardiovascular disease
 Malignancies
 Recurrence of original renal disease
 Corticosteroid-related complications

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 Age-Related Considerations:
Chronic Kidney Disease
 The incidence of stage 5 chronic kidney disease
in Canada is increasing most rapidly in older
patients.
 The most common diseases leading to renal
failure in older persons are diabetes and
hypertension.

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 Age-Related Considerations:
Chronic Kidney Disease (Cont.)
 Physiological changes of clinical importance in
the older person with chronic kidney disease
include diminished cardiopulmonary function,
bone loss, immunodeficiency, altered protein
synthesis, impaired cognition, and altered drug
metabolism.
 Malnutrition is common in the older patient with
chronic kidney disease.

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