NURS2102 Chapter Notes - Chapter 1: Tachycardia, Dietitian, Hypotension

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20 Jun 2018
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Acute Kidney Illness Fact Sheet
It is recommended that Acute Kidney Injury (AKI) which is predictable and avoidable should
never occur. The following risk factors increase a patients predisposition to AKI during admission
to hospital:
oMedications
oPeri-operative factors
oAge related changes to the kidney
oType II diabetes
oHypovalaemia
The elderly are at great risk of AKI, even though they may not have Chronic Kidney Disease.
This is due to age related structural and functional changes to the kidney that are independent of
co-morbid conditions. After the age of 30, glomerular filtration rate actually decreases by
10ml/min/1.73m2 every decade and kidney mass decreases also.
Consequently, the elderly have a greater disposition to developing AKI. Both diabetes and
hypertension are known risk factors for AKI. Surgery can potentially expose patients to the risks
of hypovolaemia and sepsis due to the impacts that surgery places on the body.
If a patient is already dehydrated pre-operatively this will impact on overall fluid status
Blood loss is not always recorded on the fluid balance chart during surgery. Extra fluid is lost to
the atmosphere from the exposed internal organs
Patients loose approximately 500ml to 1L of fluid for an adult through insensible loss (mainly
evaporation from the lungs and skin). This is not included in figures on most fluid balance charts
Staff will need to refer back to the anaesthetic record to ensure that all fluids given
intraoperatively have been recorded on the fluid balance chart
Staff do no always complete fluid balance charts accurately
Significant amounts of fluid can be lost into the tissues of the surgical wound as part of the initial
inflammatory stage of wound healing. This is termed ‘third spacing’. This fluid will return to the
general circulation as healing progresses
One of the major factors impacting renal perfusion and GFR is the patient’s circulating fluid
volume. Which observations, for example, primarily indicate that a patient may be hypovolaemic?
oPulse of 116, reduced circulating fluid volume causes tachycardia
oBP 90/60, reduced circulating volume causes hypotension
oDry oral mucosa are indicative of dehydration
oUrine output, > 0.5ml-1ml/kg/hr needed as indicative of adequate renal perfusion
Total body water may accumulate via excess fluid administration or as a result of the body’s
inability to regulate body water volume. In normal circumstances, you would therefore expect to
see an increase in heart rate as a sign of excess fluid in the circulation. Excess body water may
increase pressure in the pulmonary circulation, causing fluid to accumulate in the pulmonary
interstitial tissues and alveoli, impeding oxygen transfer across the alveolar-capillary membrane,
and causing breathlessness
Acute tubular necrosis is a potential outcome if the cause of hypo perfusion in pre-renal AKI is
not adequately treated
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Document Summary

It is recommended that acute kidney injury (aki) which is predictable and avoidable should never occur. The following risk factors increase a patients predisposition to aki during admission to hospital: medications, peri-operative factors, age related changes to the kidney, type ii diabetes, hypovalaemia. The elderly are at great risk of aki, even though they may not have chronic kidney disease. This is due to age related structural and functional changes to the kidney that are independent of co-morbid conditions. After the age of 30, glomerular filtration rate actually decreases by. 10ml/min/1. 73m2 every decade and kidney mass decreases also. Consequently, the elderly have a greater disposition to developing aki. Both diabetes and hypertension are known risk factors for aki. Surgery can potentially expose patients to the risks of hypovolaemia and sepsis due to the impacts that surgery places on the body. If a patient is already dehydrated pre-operatively this will impact on overall fluid status.

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