Acute Kidney Injury (Nursing)

00:01 Hi! Welcome to our video series on renal injury.

00:05 Now we're going to look at the difference between acute kidney injury versus chronic disease.

00:10 Now why you care about this is because as nurses we're the ones at the bedside that are alert and with our patients and we can recognize the signs and symptoms of acute kidney injury.

00:21 So we don't let it progress to chronic disease.

00:23 Ready? We're going to look at the definition of what acute kidney injury is, and the people who are most likely to experience it.

00:31 Now we're going to start with a picture anytime you're looking at a system you always want to start with normal.

00:37 That's the best way to understand when an organ is struggling.

00:41 So right in the middle there, you see a pretty nice picture of the kidneys, right? It's full. It's got good color.

00:47 It's got a nice ureter coming out of it.

00:49 Everything looks well.

00:51 This is a kidney that can filter waste and toxins out of the body can also help us get rid of excess water.

00:58 That's when a kidneys able to do what it was designed to do.

01:02 Now let's go from little perfect to a little bit worse.

01:06 If you move to the left, it's called acute K kidney injury.

01:10 Now the old term used to be acute renal failure.

01:13 I've actually experienced this.

01:14 So I'm going to tell you a little bit about what it's about, but see the kidney tissue, it looks pretty okay, but see he likes almost has like a bruise there.

01:23 That's to help you kind of think about this kidneys taken a hit.

01:26 It has an issue and we'll talk about what causes that a little bit later, but for right now what I want you to see is this is what normal would look like.

01:35 This is what acute kidney injury would look like and then all the way over on the right.

01:41 That is the saddest part of the slide that's chronic renal failure or chronic kidney disease.

01:48 So he's saying that it's all shrivel up and over like that.

01:51 That's a tip a kidney that is tough and fibrous, it doesn't filter well, it can't get rid of waste and you end up with excess fluid in your patient's body.

02:02 So normal, look how healthy and robust that looks, then acute kidney injury.

02:07 It's taken a hit, but we can probably recover from that chronic renal failure or chronic kidney disease.

02:14 That's pretty much the end of the line where to do some pretty severe things for that patient must support like dialysis either hemodialysis or peritoneal dialysis.

02:24 So on a happier note, let's look at where you and I can intervene as nurses.

02:29 So acute kidney injury is a sudden episode.

02:32 So underline that word acute right that will remind you of this is something that it's an event, It happens and we can intervene with we recognize it and help take the next best step to keep them healthy.

02:44 So we've got the event causes some kidney failure or damage and it can happen within a few hours or a few days.

02:52 So look at our friend the kidney there.

02:53 We've got few more bumps and bruises on that kidney and when we say a few hours to a few days keep in mind you work 12 hour shifts usually in healthcare.

03:03 So your patient may experience acute kidney injury after your shift starts and it can progress throughout your shift.

03:10 So you want to keep a sharp eye out for the key signs and symptoms.

03:14 So when it happens when the kidney suffers an acute injury you end up with a buildup of waste products in the blood and that makes it harder for the kidneys to keep a right balance of fluid in your body.

03:25 So when your kidneys are kind of limping as I like to call it, they've been injured now they have this buildup of waste that they normally can get rid of it staying in the bloodstream and building up in the body.

03:38 The great news is it's usually reversible.

03:42 If we recognize it and intervene quickly.

03:45 Now, let's talk about the criteria for acute kidney injury.

03:48 This just means these are things that you can look for as a nurse to keep an eye on your patient's kidney function.

03:54 Now, there's two main criteria.

03:56 You're going to see an increase in the patient's serum creatinine and you're also going to see a decrease in the amount of urine their kidneys putting out.

04:05 Alright, so the two things I want you to have solid before we move forward, if I have an acute kidney injury, I'll have either an increase in serum creatinine or a decrease in urine output the patient may even have both but they only need to have one or the other for us to be concerned about acute kidney injury.

04:25 Now, let's look at serum creatinine.

04:27 We Define that increase in serum creatinine is either greater than zero point three milligrams or greater than 50 percent increase.

04:35 So that's the that's a range for you.

04:37 That's a definition of what we mean.

04:39 When we say rise in serum meaning blood, creatinine.

04:42 Now, here's the normal levels.

04:44 We always like to give these to you to remind you kind of what we use these for.

04:48 Remember males have a little bit higher level than females Males, 0.6 to 1.2, and Females, 0.5 to 1.1.

04:59 Now I want to remind you that special note about serum creatinine because serum creatinine it's a really cool test it kind of gives us a two for one.

05:06 We can see what the level of creatinine is, and if it's going up we know that's a waste product the kidneys are meant to get rid of but if it's going up it's a sign of poor kidney function.

05:18 Now serum creatinine can also help us calculate the glomerular filtration rate.

05:23 Sometimes my tongue gets wrapped around that, but we're looking at the glomerular filtration rate and see the little "e" there in front of GFR.

05:32 That means estimate.

05:33 It takes some pretty fancy stuff to actually measure the GFR.

05:38 So we use a calculation and one of the things we use to calculate an estimate of the glomerular filtration rate Wooh! Got it that time, is we use the serum creatinine.

05:48 So this is a really important lab value.

05:51 We're talking about kidney function.

05:53 We know that creatinine is a waste product that should be removed from the body.

05:57 If the kidney is struggling we're going to watch that levels going to start to rise and this level will also give us the estimated glomerular filtration rate.

06:06 Remember, the glomerulus is one of three parts of the Nephron the working unit of the kidney.

06:12 So if that isn't flowing well if that GFR the glomerular filtration rate is going down that means another sign of kidney damage.

06:22 Now back to our criteria a reduction in urine output.

06:26 Now, we've got a range there for you to kind of give you an idea of what you should be looking for.

06:30 Notice the formula says less than 0.5 milliliters per kilogram per hour for more than six hours.

06:39 So let's pick an easy kilogram weight for our patient.

06:42 Let's say they weigh 100 kilograms.

06:45 So that means I'm going to watch a hundred kilogram patient times 0.5 that would equal 50, right? So that means a hundred kilogram patient, I'm going to watch if they have a urine output that's less than 50 milliliters per hour for more than six hours that meets our criteria to be really suspect about acute kidney injury.

07:08 Okay, so watching the serum creatinine that's a lab work, watching the urine output that just involves basic nursing care.

07:16 If you have a fully in your patient to watch it in a bag or you're going to be very careful about measuring their urine when they use the restroom.