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

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.