Editing Medical-Surgical Nursing (section)

=== Acute Kidney Injury ===

Acute kidney injury is a sudden decline in kidney function classified as prerenal (hypoperfusion from hypovolemia, heart failure, or shock), intrarenal (direct damage from nephrotoxins, contrast media, aminoglycosides, or acute tubular necrosis), or postrenal (obstruction from stones, tumors, or prostatic enlargement).

The classic course has an oliguric phase with rising blood urea nitrogen and creatinine, hyperkalemia, metabolic acidosis, and fluid overload, followed by a diuretic phase in which large volumes of dilute urine are produced and the risks shift to hypovolemia and hypokalemia, and finally a recovery phase.

Nursing application: hyperkalemia is the most immediately lethal complication. Monitor the electrocardiogram, restrict potassium, and anticipate calcium gluconate to stabilize the myocardium, insulin with dextrose or a beta agonist to shift potassium into cells, and a potassium binder or dialysis to remove it. Calcium gluconate protects the heart but does not lower the serum potassium level.