Canada Nursing OSCE Renal Alterations, Acute Kidney Injury & Hemodialysis Care (Unfolding Clinical Judgment Blueprint)

Prerenal vs Intrarenal vs Postrenal AKI & Dialysis Disequilibrium: ACUTE KIDNEY INJURY CLASSIFICATION: • PRERENAL: Decreased perfusion (Hypovolemia, shock, heart failure, sepsis). BUN:Cr ratio > 20:1. • INTRARENAL: Direct parenchymal damage (Acute Tubular Necrosis, aminoglycosides, IV contrast dye, myoglobinuria). BUN:Cr ratio ~ 10:1 to 15:1. • POSTRENAL: Obstruction downstream (BPH, calculi, tumors, neurogenic bladder). DIALYSIS DISEQUILIBRIUM SYNDROME: Occurs when BUN is cleared too rapidly from blood while brain remains hyperosmolar, drawing fluid into cerebral cells causing cerebral edema. Signs: Headache, nausea, vomiting, agitation, seizures. Action: Slow blood flow rate immediately! ---------------------------------------- PRACTICE BOARD QUESTION & RATIONALE: Q: A client receiving hemodialysis for the first time develops a sudden throbbing headache, nausea, restlessness, and twitching. What is the nurse's priority action? A. Increase the ultrafiltration rate to remove excess fluid B. Slow or stop the hemodialysis run and alert the nephrologist C. Administer an oral antiemetic and encourage sleep D. Place the patient in high Fowler's position Correct Answer: B. The client is showing textbook signs of Dialysis Disequilibrium Syndrome caused by cerebral edema. Slowing the blood flow rate prevents further osmotic gradient shifts.