Acute kidney injury: Challenges and opportunities.

Acute kidney injury (AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses AKI and its implications for nurses.

Acute kidney injury: Challenges and opportunities.

Community-acquired acute kidney injury (CA-AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses CA-AKI and its implications for APRNs.

Nursing Care of Patients With Cirrhosis: The LiverHope Nursing Project.

Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers.

Intervenções de enfermagem à pessoa com lesão renal aguda em Unidades de Cuidados Intensivos / Nursing interventions for people with acute kidney injury in Intensive Care Units

A lesão renal aguda é considerada uma complicação de uma doença de base. Tem incidência de 60% nos doentes internados numa unidade de cuidados intensivos e a taxa de mortalidade varia entre 10-80%. O enfermeiro é um elemento crucial na prevenção e na coordenação de cuidados ao doente renal. Uma pessoa com lesão renal aguda, internada numa unidade de cuidados intensivos, exige da equipa de enfermagem intervenções específicas. O presente relatório de estágio pretende demonstrar o desenvolvimento das competências comuns do enfermeiro especialista, segundo o Regulamento nº 140/2019, e o desenvolvimento das competências do quadro de competências específicas do enfermeiro de nefrologia, de acordo com Chamney (2007). Promoveuse este desenvolvimento das competências de enfermeiro especialista e mestre através da realização de quatro estágios, em contextos direcionados para a área da nefrologia. Realizou-se uma revisão scoping para mapear e analisar as intervenções de enfermagem à pessoa com lesão renal aguda em unidade de cuidados intensivos, orientada pela metodologia proposta pelo Joanna Briggs Institute (Peter set al., 2015). A elaboração da revisão scoping é fundamental pois promove uma uniformização da atuação do enfermeiro, potenciando a mudança na prática e contribuindo para uma atuação precoce e eficaz. Este relatório teve como modelo conceptual de enfermagem orientador a teórica Virgínia Henderson, que permite ver a pessoa doente como um indivíduo que precisa de assistência para obter a sua saúde e independência, tendo por base as necessidades humanas básicas do doente e as intervenções de enfermagem inerentes. O relatório de estágio irá permitir a disseminação da evidência disponível acerca da temática desenvolvida, mas futuros estudos de análise do impacto das intervenções de enfermagem são importantes para determinarem a melhor atuação do enfermeiro e orientar a prática clínica.

Acute kidney injury is considered to be a complication of a underlying disease. It has an incidence in 60% of patients admitted to an intensive care unit and the mortality rate varies between 10% to 80%. The nurse is a crucial element in the prevention and coordination of care for renal patients. A person with acute kidney injury admitted to an intensive care unit requires specific interventions from the nursing team. This internship report aims to demonstrate the development of the common skills of the specialist nurse, according to Regulation No. 140/2019, and the development of the skills considered on the specific skills framework of the nephrology nurse, according to Chamney (2007). This development of specialist and master nurse skills was promoted through four internships, in contexts directed to the area of nephrology. A scoping review was carried out to map and analyze nursing interventions to people with acute kidney injury in an intensive care unit, guided by the methodology proposed by the Joanna Briggs Institute (Peter set al., 2015). Making a scoping review is essential because it promotes uniformity of the nurse's performance, enhancing the change in practice and contributing to an early and effective action. This report had as conceptual model of nursing guiding the theoretical Virginia Henderson, which allows seeing the sick person as an individual who needs assistance to obtain their health and independence, based on the basic needs of the patient and the necessary nursing interventions. The internship report will allow the dissemination of available evidence about the theme developed, but future studies to analyze the impact of nursing interventions are important to determine the best performance of nurses and guide clinical practice.

Pharmacologic Renal Therapy.

This article discusses some of the recommended pharmacologic treatments for patients with renal drug toxicity, acute kidney injury (AKI), and chronic kidney injury (CKI). The treatment of AKI often consists of treating patients in emergency departments. Renal pharmacologic management in an acute care setting consists of identifying the cause of AKI, reviewing serum creatinine levels, administration of crystalloids, and the elimination of nephrotoxic agents.

Acute Kidney Injury.

Acute kidney injury (AKI) most commonly occurs in the hospital setting, and hospital-acquired AKI accounts for 22% of all AKI cases worldwide. AKI causes 2 million deaths per year, and 50% of critically ill patients develop AKI. AKIs include prerenal, intrarenal, and postrenal causes. Treatments include renal replacement therapies and correcting reversible causes. Management of these patients includes medical and social history, laboratory studies, tests such as renal biopsy and ultrasonography, vital signs, volume status, and identifying risk factors. Thus, it is essential to identify high-risk patients, correct any reversible causes, prevent further kidney injury, and perform supportive therapy.

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals.

OBJECTIVE: to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. METHOD: quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. RESULTS: the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the "installation and removal of hemodialysis fistula access" caused a significantly lower economic impact compared to "installation and removal of hemodialysis catheter access". CONCLUSION: with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

Validation of the nursing interventions and activities for patients on hemodialytic therapy. / Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica.

OBJECTIVE: To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. METHODS: Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. RESULTS: The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. CONCLUSION: The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

A narrative review of the impact of interventions in acute kidney injury.

Acute kidney injury (AKI) is independently associated with significant morbidity and mortality, and is thus an important challenge facing physicians in modern healthcare. This narrative review assesses the impact of strategies employed to tackle AKI following the 2009 NCEPOD report on acute kidney injury (Sterwart et al. Acute kidney injury: adding insult to injury, pp 1-22, 2009). There is scarce and heterogeneous research into hard end points such as mortality and AKI progression for AKI interventions. This review found that e-alerts have varying effects on mortality and AKI progression, but decrease the incidence of contrast-induced AKI. The use of AKI bundles delivers statistically significant improvements in mortality and AKI progression. Similarly, AKI nurses generate statistically significant improvements on hospital acquired AKI and mortality. As yet there is no evidence base for the effects of education, sick day rules and smart phone apps. Overall, a combination of e-alerts and AKI bundles supported by education yielded the most effective and statistically significant results. Current practice revolves around reactive rather than preventative behaviour. This narrative review discusses reactive interventions and their impact on the progression and severity of AKI, and on mortality from it. Preventative behaviour, such as risk stratification and early intervention in the deteriorating patient, may be influential in decreasing AKI incidence.

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety.

BACKGROUND: Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE: To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS: Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS: Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m2. Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS: Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material.

Diagnosis, results, and nursing interventions for patients with acute renal injury / Diagnósticos, resultados e intervenções de enfermagem em pacientes com lesão renal aguda

Objective: To identify prevalence and correlate diagnosis, results, and nursing interventions in patients with acute renal injury (ARI) who were hospitalized in an intensive care unit (ICU). Methods: This was a cross-sectional study including 98 patients older than 18 years old with ARI who were undergoing hemodialysis treatment in the ICU . The study was carried out in an ICU a large public hospital located in the city of São Paulo, Brazil. For statistics analysis we used the SPSS v21.0 to estimate prevalence, the 95% of confidence interval and sample error of 0.05. Data were collected from March to July 2016 using structured interviews, anamnesis and physical exam of patients using an instrument designed by this study researchers. The main instrument was completed by the principal researcher. Nursing consultation lasted for approximately 30 minutes. Of the total sample, 10% was selected and checked randomly in order to evaluate data quality and atypical values. Two patients previously did a pilot test to verify whether information in the instrument achieved the objective of the study. Results: The 98 participatns were aged ≥60 years (33%), men (60%), and classified as pre-renal injury (54%). Prevalent diagnosis was (100%) risk of infection, risk of inefficient gastrointestinal perfusion, risk of ineffective renal perfusion, risk of electrolyte imbalance, excessive fluid volume, and risk of imbalanced fluid volume. Results (100%) were: severity of infection, access for hemodialysis, tissue perfusion - abdominal organs, hydric balance, mobility, removal of toxins and renal function. Prevalent nursing interventions (100%) were: promotion against infection, control of infection, maintenance of access for dialysis, hydroeletrolitic control, urinary elimination control, acid-base control, electrolytic control, hypervolemia control, hydric control, hydric monitoring, respiratory physiotherapy, respiratory and positioning monitoring. Correlations were significant (p< 0.001) between diagnosis and nursing interventions and between nursing interventions and results. Conclusion: Main diagnosis, results and nursing interventions related with loss of renal function originated from changes of renal perfusion, volemia, hydroelectrolytic dysfunctions, and risk of infection. The number of diagnosis showed to be correlated with number of nursing interventions and nursing interventions was correlated with results.

Objetivo: Identificar prevalência de diagnósticos (DE), resultados (RE) e intervenções de enfermagem (IE) em pacientes com lesão renal aguda (LRA) internados em unidade de terapia intensiva (UTI). Correlacionar DE, RE e IE identificados. Métodos: Estudo transversal, conduzido em Unidades de Terapia Intensiva de um hospital público de grande porte da cidade de São Paulo. Foram incluídos, numa amostra intencional, 98 pacientes com LRA em tratamento hemodialítico internados em UTI, maiores de 18 anos. Foi utilizado software SPSS v21.0 para estimação da prevalência, fixando a estimativa no intervalo de confiança (IC) de 95% e erro amostral de 0,05. A coleta de dados foi realizada por meio da consulta de enfermagem, composta de entrevista estruturada, anamnese e exame físico dos pacientes, utilizando instrumento elaborado pelos pesquisadores. A coleta de dados foi realizada no período de março a julho de 2016, e o instrumento de coleta de dados foi preenchido pela pesquisadora principal. A consulta de enfermagem teve duração de aproximadamente 30 minutos. Do total da amostra, 10% foi selecionada aleatoriamente e checada, com o propósito de avaliar a qualidade dos dados e valores atípicos. Foi também realizado teste piloto em dois pacientes, previamente, para verificar se as informações contidas no instrumento atingiriam os objetivos da pesquisa. Resultados: Participaram 98 pacientes, predominantemente com idade ≥60 anos (33%), sexo masculino (60%) e classificados com lesão pré-renal (54%). DE prevalentes (100%): risco de infecção, risco de perfusão gastrointestinal ineficaz, risco de perfusão renal ineficaz, risco de desequilíbrio eletrolítico, volume de líquidos excessivos e risco de volume de líquidos desequilibrados. RE prevalentes (100%): gravidade da infecção, acesso para hemodiálise, perfusão tissular: órgãos abdominais, equilíbrio hídrico, mobilidade, remoção de toxinas e função renal. IE prevalentes (100%): promoção contra infecção, controle de infecção, manutenção de acesso para diálise, controle hidroeletrolítico, controle de eliminação urinária, controle ácido-básico, controle de eletrólitos, controle de hipervolemia, controle hídrico, monitorização hídrica, fisioterapia respiratória, monitorização respiratória e posicionamento. Correlações foram significativas (p< 0,001) entre DE e IE e entre IE e RE. Conclusão: Os principais DE, RE e IE foram relacionados à perda da função renal, origem das alterações na perfusão renal, volemia, distúrbios hidroletroliticos e risco para infecção. O número de DE atribuídos mostrou-se relacionado ao número de IE, assim como, das IE aos RE.

Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica / Validación de intervenciones y actividades de enfermería para pacientes en terapia hemodialítica / Validation of the nursing interventions and activities for patients on hemodialytic therapy

RESUMO Objetivo Validar intervenções e atividades de enfermagem propostas pela Nursing Interventions Classification, para pacientes com insuficiência renal aguda ou doença renal crônica agudizada, em terapia hemodialítica com os diagnósticos de enfermagem Volume de Líquidos Excessivo e Risco de Volume de Líquidos Desequilibrado. Métodos Validação de conteúdo com 19 enfermeiros peritos de um hospital universitário. A coleta de dados ocorreu de setembro a novembro de 2011, por meio de instrumentos que continham as intervenções e atividades de enfermagem em estudo. A análise considerou a média dos escores obtidos na validação. Resultados O Controle Hídrico foi validado como intervenção prioritária (média ≥ 0.8), com oito atividades principais para o diagnóstico Volume de Líquidos Excessivo e oito para o diagnóstico Risco de Volume de Líquidos Desequilibrado. Conclusão A intervenção validada de Controle Hídrico possibilita o monitoramento do equilíbrio hídrico e facilita a prevenção de complicações, consideradas importantes atividades do cuidado ao paciente em terapia hemodialítica.

RESUMEN Objectivo Validar intervenciones y actividades de enfermería propuestas por la Nursing Interventions Classification, para pacientes con insuficiencia renal aguda o enfermedad renal crónica agudizada, en terapia hemodialítica con los diagnósticos de enfermería Volumen de Líquidos Excesivo y Riesgo de Desequilibrio de Volumen de Líquidos. Métodos Validación de contenido con 19 enfermeros expertos de un hospital universitario. La recolección de datos fue realizada de septiembre a noviembre de 2011 con instrumentos que contenían las intervenciones y actividades de enfermería en estudio. El análisis consideró el promedio de los puntajes obtenidos en la validación. Resultados El Manejo de Líquidos fue validado como intervención prioritaria (media >0.8), con ocho actividades principales para el diagnóstico Volumen de Líquidos Excesivo y ocho para el diagnóstico Riesgo de Desequilibrio de Volumen de Líquidos. Conclusión La intervención validada de Manejo de Líquidos posibilita el monitoreo del balance hídrico y facilita la prevención de complicaciones, consideradas importantes actividades del cuidado al paciente en terapia hemodialítica.

ABSTRACT Objective To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. Methods Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. Results The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. Conclusion The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

A nurse-led intervention improves detection and management of AKI in Malawi.

BACKGROUND: Acute kidney injury is common and has significant impact on mortality and morbidity. There is a global drive to improve the lack of knowledge and understanding surrounding the recognition, diagnosis and management of patients with AKI in resource poor healthcare systems. OBJECTIVES: We propose a nurse-led education programme to medical and nursing staff of the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, will improve the overall care and understanding of patients with AKI that will still be effective 3 months later. METHODS: This was a three phase, prospective interventional pilot study which evaluated base line knowledge and clinical practice amongst healthcare workers, provided a comprehensive combination nurse-led class room and ward based teaching programme and evaluated the change in knowledge and clinical management of patients in the high dependency areas of the hospital immediately, and 3 months, after the teaching intervention. RESULTS: The nurse-led intervention significantly improved the healthcare workers attitudes towards detecting or managing patients with suspected AKI (p < 0.0001). There were also significant improvements in the completion of fluid charts and recording of urine output (p < 0.0001), corner stones of AKI management. Knowledge and clinical intervention was still present three months later. There was however little change in the understanding that AKI could be a significant clinical problem in QECH and that it may have a major impact on mortality and working practice and this needs to be addressed in future teaching programmes. CONCLUSIONS: A low cost, nurse-led AKI educational intervention improved the knowledge and management of AKI at QECH, which was still evident 3 months later.

Citrate anticoagulation in the ICU: the Leeds experience.

Continuous renal replacement therapy (CRRT) is widely used in the management of critically ill patients with acute kidney injury. It requires effective anticoagulation of the extracorporeal blood circuit. Although heparin is the most commonly prescribed anticoagulant, there are issues associated with heparin, and there has been increasing interest in regional citrate anticoagulation as an alternative. In 2013, The Leeds Teaching Hospitals NHS Trust switched from heparin to citrate anticoagulant for CRRT in intensive care units (ICUs) across the Trust. This article examines the reasons for the switch, the implementation of citrate and the impact of this quality-improvement project in terms of patient outcome data and feedback from the ICU nursing team.

Continuous Renal Replacement Therapy (CRRT) practices in Canadian hospitals: Where are we now?

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices. PURPOSE: A national survey was conducted to gain insight into CRRT nursing practices. METHODS: T he design for this study was descriptive using a survey The target population for this survey was ICU nurse educators at Canadian teaching and community hospitals. Topics in the survey included staff education, CRRT ordering and initiation practices, vascular access, filters and filter life, fluids used, anticoagulation methods, adverse events, and greatest concerns. FINDINGS: One hundred and twenty-nine surveys were sent out and 73 were returned for a response rate of 57%. Thirty-six hospitals used CRRT and of these, 73% had used CR RT for more than eight years. The findings revealed that educators identified achieving and maintaining competence as their greatest concern related to CRRT practices. CONCLUSION: The fndings of this research revealed that consistent training programs were not the norm. The complexity of caring for patients on CRRT requires consideration of when to introduce to staff the technology and care of patients on CRRT and how to sustain their competence.

Acute kidney injury after cardiovascular surgery.

Acute kidney injury (AKI) is a complication experienced by many patients undergoing cardiovascular surgery. Postoperative deterioration in renal function is associated with an increased risk of in-hospital mortality and affects long-term survival. Developing strategies to identify and treat AKI is important to reduce incidence and optimize outcomes.