NLE Renal & Urinary Nursing — Acute & Chronic Kidney DiseaseConcept Map

Concept

Acute Kidney Injury (AKI)

Sub Concepts

• Prerenal causes (perfusion deficit)
• Intrarenal causes (direct tissue damage)
• Postrenal causes (obstruction)
• Four phases: onset, oliguric, diuretic, recovery
• HYPERKALEMIA management (life threat)
• Fluid and electrolyte monitoring

Relationship To Central

Sudden reversible renal dysfunction requiring immediate intervention

Concept

Chronic Kidney Disease (CKD) & ESRD

Sub Concepts

• GFR-based staging (1-5)
• Diabetes and hypertension as leading causes
• Uremia and multisystem manifestations
• Anemia management (erythropoietin)
• Bone disease (renal osteodystrophy)
• Dietary and pharmacologic management
• Long-term complications

Relationship To Central

Progressive irreversible renal failure with multisystem complications

Concept

Renal Replacement Therapy (RRT)

Sub Concepts

• Hemodialysis (HD)
• Peritoneal dialysis (PD)
• Vascular access management
• Complications and monitoring
• Patient selection and adherence

Relationship To Central

Therapeutic modalities for managing ESRD

Concept

Kidney Transplantation

Sub Concepts

• Surgical placement and post-operative monitoring
• Immunosuppressive therapy
• Rejection types and signs
• Infection prevention
• Graft function monitoring

Relationship To Central

Definitive treatment for ESRD with long-term outcomes

Concept

Benign Prostatic Hyperplasia (BPH)

Sub Concepts

• Pathophysiology and symptoms (LUTS)
• Diagnostic evaluation
• Alpha-blockers and 5-alpha reductase inhibitors
• TURP procedure and complications
• Post-operative nursing care

Relationship To Central

Common postrenal cause of obstructive uropathy in older men

Concept

Critical Nursing Priorities in Renal Failure

Sub Concepts

• HYPERKALEMIA (ECG monitoring, emergency management)
• Fluid overload (I&O, weight monitoring)
• Metabolic acidosis
• Medication management and renal dosing
• Infection prevention

Relationship To Central

Life-threatening emergencies requiring immediate action

To

HYPERKALEMIA Management

From

Acute Kidney Injury

Strength

strong

Relationship

AKI's most life-threatening complication; oliguric phase causes potassium accumulation requiring emergency intervention

To

Fluid Overload

From

Acute Kidney Injury

Strength

strong

Relationship

Oliguria leads to fluid retention; strict I&O and weight monitoring are priorities; diuretic phase reverses risk

To

Renal Replacement Therapy

From

Chronic Kidney Disease

Strength

strong

Relationship

CKD progression to ESRD (GFR <15) necessitates initiation of RRT (hemodialysis, PD, or transplant)

To

Anemia Management

From

Chronic Kidney Disease

Strength

strong

Relationship

Failing kidneys cannot produce erythropoietin; anemia develops; managed with epoetin alfa and iron replacement

To

Renal Osteodystrophy

From

Chronic Kidney Disease

Strength

strong

Relationship

Hyperphosphatemia + hypocalcemia + low active vitamin D cause secondary hyperparathyroidism and bone loss

To

Dietary Restrictions

From

Chronic Kidney Disease

Strength

strong

Relationship

Failing kidneys cannot regulate potassium, sodium, phosphate; dietary control is essential to prevent complications

To

Vascular Access

From

Hemodialysis

Strength

strong

Relationship

AV fistula is the lifeline for hemodialysis; thrill and bruit assessment are daily priorities to prevent clotting

To

Hyperkalemia Management

From

Hemodialysis

Strength

strong

Relationship

Dialysis removes potassium most effectively; best treatment for refractory hyperkalemia in renal failure

To

Infection Prevention

From

Peritoneal Dialysis

Strength

strong

Relationship

Peritonitis is the most common complication of PD; cloudy outflow indicates infection; strict asepsis at each connection required

To

Fluid Balance

From

Peritoneal Dialysis

Strength

strong

Relationship

PD fill-dwell-drain cycle manages fluid overload; outflow assessment guides dialysis effectiveness and infection status

To

Immunosuppression

From

Kidney Transplant

Strength

strong

Relationship

Lifelong immunosuppressive therapy prevents rejection; non-adherence is the leading cause of late graft failure

To

Rejection Recognition

From

Kidney Transplant

Strength

strong

Relationship

Acute rejection (decreased output, fever, graft pain) requires immediate intervention; hourly urine monitoring detects early changes

To

Infection Prevention

From

Kidney Transplant

Strength

strong

Relationship

Immunosuppressed transplant recipients have high infection risk; fever and infection signs must be reported immediately

To

Postrenal Obstruction

From

Benign Prostatic Hyperplasia

Strength

strong

Relationship

BPH causes urethral compression and outlet obstruction; can lead to acute retention, UTI, and hydronephrosis

To

Post-TURP Management

From

Benign Prostatic Hyperplasia

Strength

strong

Relationship

TURP relieves obstruction surgically; post-op care requires CBI, hemorrhage monitoring, and TUR syndrome prevention

To

Orthostatic Hypotension

From

Alpha-Blockers

Strength

moderate

Relationship

Alpha-blockers dilate arteries and relax smooth muscle; side effect causes dizziness and falls; patient must rise slowly

To

Dietary Phosphate Control

From

Phosphate Binders

Strength

strong

Relationship

Given with meals to bind dietary phosphate; reduces hyperphosphatemia and risk of renal osteodystrophy

To

Anemia in CKD

From

Erythropoietin

Strength

strong

Relationship

Failing kidneys produce less erythropoietin; exogenous epoetin alfa (given SC or IV) stimulates RBC production

To

CKD Progression

From

ACE Inhibitors/ARBs

Strength

strong

Relationship

Reduce proteinuria and slow GFR decline; first-line antihypertensives in CKD, but require potassium monitoring

To

Treatment Response

From

Prerenal AKI

Strength

strong

Relationship

Prerenal AKI is reversible if perfusion is restored (IV fluids, vasopressors); kidney tissue is intact

To

Acute Tubular Necrosis

From

Intrarenal AKI

Strength

strong

Relationship

ATN from nephrotoxins or ischemia damages tubular epithelium; recovery depends on stopping the insult and time

To

Obstruction Relief

From

Postrenal AKI

Strength

strong

Relationship

Obstruction (stones, tumors, BPH) prevents urine flow; relieving the obstruction can reverse AKI

To

Diuretic Phase AKI

From

Oliguric Phase AKI

Strength

strong

Relationship

As kidney tubules recover, urine output rises dramatically; monitoring shifts from fluid overload to preventing dehydration/electrolyte loss

To

Post-TURP Hemorrhage Prevention

From

Continuous Bladder Irrigation

Strength

strong

Relationship

CBI keeps drainage pink/clear by continuously removing blood clots; prevents obstruction and maintains hemostasis

To

Hyponatremia

From

TUR Syndrome

Strength

strong

Relationship

Absorption of hypotonic irrigation fluid dilutes serum sodium; causes neurologic symptoms (confusion, seizure) and hypertension