Northern Devon Healthcare NHS Trust. Acute Kidney Injury. Presenter

Transcription

1 Acute Kidney Injury Presenter

2 Housekeeping Northern Devon Healthcare NHS Trust

3 To respect confidentiality within the group unless it is necessary to address a current concern about the safety of an adult at risk.

4 Learning Objectives Understand what Acute Kidney Injury (AKI) is Identify possible common causes of AKI Identify clients most at risk of AKI How you can help prevent AKI in your clients

5 What is AKI? Acute is a term used to describe something that has occurred over hours or days (as opposed to chronic which means months or years) Kidney Injury describes evidence of damage to the kidneys usually with a change in kidney function tests and passing only small amounts of urine

6 100,000 UK deaths each year in hospital are associated with AKI. 30% could be prevented with the right care and treatment (1) One in five people admitted to hospital in the UK each year as an emergency has AKI (2) Half of the people in the UK don t know that their kidneys make urine (3) Approx 65% of AKI starts in the community (3)

7 (Almost) everything you need to know about your kidneys Most people have 2 kidneys They filter your blood every minute of the day They sit in your lower back under the bottom ribs They are the hardest working organs in your body (3)

8 What do your kidneys do for you? (5) Remove waste products and toxins Northern Devon Healthcare NHS Trust Make hormone that stimulates production of RBC Help control fluid balance Produce Vitamin D Help control Blood Pressure (3)

9 Underlying risk factors for AKI Aged 75 or over Heart failure Diabetes Vascular disease Chronic Kidney Disease Dementia Liver disease (3) Some Antibiotics, BP medications, Cancer treatment and Non steroidal anti inflammatory drugs can trigger AKI

10 Causes of AKI Pre Renal (before the kidneys) Intrinsic (inside the kidneys) Post Renal (after the kidneys) (3)

11 Pre Renal (before the kidneys) Most common cause of AKI Disruption of blood flow to the kidney Low blood pressure Heart failure Low blood volume (Diarrhoea, vomiting, bleeding, dehydration)

12 Intrinsic (inside the kidneys) Damage to the kidney itself Damage to the tiny filters inside the kidneys (Glomerulonephritis) Damage to the kidney cells (Acute tubular Necrosis)

13 Post Renal (after the kidneys) Caused by a blockage in the urinary tract Blocked catheter Kidney stones (renal calculi) Bladder tumours Enlarged prostate

14 Symptoms Reduced urine output In the early stages there may be no real symptoms or signs. A blood test is needed to detect it. However, someone with AKI can deteriorate quickly and suddenly experience these symptoms Thirst Abdominal pains AKI Changes to colour / smell of urine Nausea / Vomiting Confusion or Drowsiness Consider urine dipstick to test for presence of blood/protein to inform GP (4)

15 Hydration Dehydration is the underlying cause of many common conditions: Constipation Falls UTI s Pressure damage Malnutrition Confusion Pre renal AKI Why are your clients more prone to dehydration? Reduced ability to detect thirst Reduced dexterity Impaired swallow Reduced mobility Reduced cognition

16 Prevention You play a vital role in the early detection, treatment and management of people who may be at risk of AKI

17 Signs of Dehydration Thirst Dark Urine Sunken eyes Reduced or no urine output Irritability Headaches Confusion Low BP or Heart rate Cool hands or feet

18 Tips to you help promote hydration in your clients Some clients need more support to stay hydrated than others Choose a cup suitable for your client Dexterity / Pain / Strength Know clients preferences Give choice Make it sociable Support and encouragement to maintain fluid intake throughout the day Don t rely on thirst Include food rich in fluid in addition to drinks Encourage fluids with every intervention, not just at meal times Think about outside and indoor temperature Review Fluid balance charts through out the day Ensure that hydration is discussed at each handover

19 Assessing Fluid Balance Northern Devon Healthcare NHS Trust

20 Problem Your client goes to the toilet independently and doesn t tell you so it isn t recorded on their chart Can the client record their own output? Explain the importance of recording it and give them a chart to complete

21 Problem Relatives give drinks to the client so it is difficult to record how much fluid is being taken Give the relatives a sheet with the amounts on. Get them to document the amounts of fluid input. This works for some clients too

22 Problem Quantities To help understand the quantities, how much fluid do you think is in these? 1000mls 200mls 150mls Standard Jug Standard glass Standard cup

23 Problem Assessing urine output How much urine do you think there is here?

24 Problem Assessing urine output How much urine do you think there is here?

25 Problem Assessing urine output Do the pads in your care setting have level indicators? What do they tell you?

26 Product Absorbency Product TENA Comfort Normal TENA Comfort Plus TENA Comfort Extra TENA Comfort Super TENA Comfort Maxi Working Absorbency 450mls 650mls 800mls 950mls 1300mls Product TENA Slip Plus S TENA Slip Plus M TENA Slip Plus L Working Absorbency 700mls 900mls 1000mls TENA Slip Super S 750mls TENA Slip Super M TENA Slip Super L TENA Slip Maxi S 1000mls 1150mls 900mls TENA Slip Maxi M 1350mls TENA Slip Maxi L TENA Slip Ultima M TENA Slip Ultima L 1650mls 1500mls 1800mls

27 What can you do to prevent AKI? Encourage hydration Accurately measure fluid balance Monitor for signs of dehydration Identify risk factors for AKI If you are concerned, gather information and request a visit from GP

28 Case study: Marjory Northern Devon Healthcare NHS Trust

29 Time is of the essence It s very important that AKI is detected early and treated promptly as in some cases it can be very serious. In the large majority of cases early detection and treatment will result in resolution of the AKI.

30 How to keep your kidneys healthy

31 Northern Devon Healthcare NHS Trust

32 Learning Objectives Understand what Acute Kidney Injury (AKI) is Identify possible common causes of AKI Identify clients most at risk of AKI How you can help prevent AKI in your clients

33 Questions? Northern Devon Healthcare NHS Trust

34 Quiz Northern Devon Healthcare NHS Trust

35 References (1) National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Acute Kidney Injury: Adding Insult to Injury. (2) Selby NM, Crowley L, Fluck RJ, McIntyre CW, Monaghan J, Lawson N, Kolhe NV. Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc nephrol Apr;7(4): doi: /CJN Epub 2012 Feb 23 (3) (4)