Acute kidney injury (AKI): Nursing Process (ADPIE)

00:00 / 00:00



You are assigned to take care for Maurice Jones, a 58-year-old Black male, who sustained a back injury several weeks ago while cleaning out his garage, and since then he’s been taking ibuprofen three to four times each day for pain. Mr. Jones has a history of hypertension for which he takes the angiotensin II receptor blocker, or ARB, losartan, though he says sometimes he forgets to take it. He also takes the proton pump inhibitor, or PPI, omeprazole, for gastrointestinal reflux disease, or GERD. He presented to his primary care provider, or PCP, with fatigue, headache, lower extremity edema, and decreased urine output.

His vital signs were oral temperature 99.0 F or 37 C, heart rate 98 beats per minute, respiratory rate 20 breaths per minute and blood pressure 148/96mmHg. Labs were ordered which showed BUN 28 mg/dL, creatinine 2.4 mg/dL, sodium 124 mEq/L, and potassium 5.3 mEq/L. Arterial blood gas analysis revealed pH 7.25, PCO2 32, PO2 85, HCO3 30. Urine specific gravity is 1.010. Mr. Jones was admitted to the medical unit with a diagnosis of acute kidney injury, or AKI.

Acute kidney injury, or AKI for short, refers to a sudden decrease in kidney function over hours or days. As a result, the kidney’s ability to manage fluid, electrolyte, and acid-base balance is impaired, and there’s decreased excretion of waste products, such as urea and creatinine, which build up in the blood.

There are some factors that can put an individual at risk for AKI. Unfortunately, many of them are non-modifiable factors that decrease kidney function over time, such as advanced age, diabetes mellitus, autoimmune diseases, certain cancers, uncontrolled hypertension, and heart, liver, or kidney disease. Some modifiable risk factors include exposure to nephrotoxic agents, such as certain antibiotics, heavy metals, or chemotherapy or being exposed to iodinated IV contrast dye during radiology procedures.


Acute kidney injury (AKI) is a sudden, potentially reversible decline in renal function. AKI results in the accumulation of water, nitrogenous wastes, sodium, and other metabolic wastes in the body, and can also lead to electrolyte imbalances. Common causes include dehydration, sepsis, and some drug therapy.

AKI often presents with reduced urine output, but there can be other signs such as edema, and those associated with the accumulation of metabolic wastes such as anorexia, seizures, and altered mental status. The nursing process for AKI begins with the assessment and identification of patients at risk for developing the condition. Once AKI is diagnosed, nurses work with other health care providers to implement therapies aimed at preventing progression and maximizing patient outcomes. If AKI is left untreated, it can lead to chronic kidney disease (CKD).


  1. "Diagnosing the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition" Routledge (2019)
  2. "Saunders Comprehensive Review for the NCLEX-RN Examination" Elsevier (2022)
  3. "Critical care nursing: Diagnosis and management (9th ed)" Elsevier (2022)
  4. "Harrison’s principles of internal medicine" Mcgraw Hill (2022)
  5. "Sepsis associated acute kidney injury" BMJ (2019)
  6. "Acute kidney injury in the critically ill: an updated review on pathophysiology and management" Intensive Care Medicine (2021)
  7. "Robbins Basic Pathology" Elsevier (2017)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.