NCLEX Notes:

Understanding acute kidney injury (AKI) and chronic kidney disease (CKD) is essential for nursing students preparing for the NCLEX exam as well as practicing nurses. AKI refers to the sudden loss of kidney function and is often reversible if addressed promptly. The causes of AKI fall into three categories: prerenal (decreased blood flow to the kidneys), intrarenal (direct damage to kidney tissue), and postrenal (obstruction of urine flow). Key clinical indicators include changes in urine output (oliguria or anuria), elevated blood urea nitrogen (BUN), and creatinine levels. Nurses must closely monitor these values and watch for complications such as hyperkalemia, which can cause dangerous cardiac arrhythmias. Treatment for hyperkalemia may include administration of calcium gluconate, insulin with glucose, and potassium binders like kayexalate. In chronic kidney disease, kidney damage progresses slowly over months or years leading to permanent loss of function. CKD is often classified by stages based on glomerular filtration rate (GFR), with later stages showing more severe loss of kidney function. Common causes include poorly controlled diabetes and hypertension. Nursing care focuses on managing cardiovascular risk factors, controlling blood pressure, monitoring electrolytes, managing anemia with erythropoietin and iron supplements, and addressing bone disease through phosphate binders and vitamin D supplementation. Dietary modifications like low-protein, low-potassium, and low-phosphorus diets are critical to slow progression. Nurses must teach patients the importance of medication adherence and lifestyle changes to prevent complications. Renal replacement therapies, such as hemodialysis and peritoneal dialysis, become necessary when CKD progresses to end-stage renal disease and medical management no longer suffices. Hemodialysis involves filtering blood through a machine and requires vascular access via fistula or graft, while peritoneal dialysis uses the abdominal cavity lining to filter waste. Close monitoring for complications like hypotension, infection, and electrolyte imbalances during and after dialysis is essential. Patient education about dialysis care and recognizing signs of complications is a key nursing responsibility. Overall, effective nursing care in both AKI and CKD requires continuous assessment of fluid balance, electrolytes, and cardiac status alongside patient education and multidisciplinary collaboration to optimize outcomes. These NCLEX notes highlight crucial knowledge areas and clinical skills for nurses to safely manage patients with kidney-related conditions.