hey everyone is stares Westerners are n.com and in this video I want to be going over a weekly NCLEX question and don't forget to check out our other free resources to help you study for in clicks so let's get started a 36 year old male patient is diagnosed with acute kidney injury the patient's 24 hour urine output is four and a half liters faithfulness stage at Aki what complications and assessment findings may present in this patient select all that apply a water intoxication be hypotension C low urine specific gravity D hypokalemia e GS are greater than 90 milliliters per minute f normal B you in and creatinine levels or G profound confusion due to a 30 Nia so from our scenario we know that our patient has acute kidney injury Aki also known as acute renal failure and one thing that should be jumping out at you in the scenario is that patients 24-hour urinary output which is four and a half liters so now you should be thinking to questions like what is the normal urinary output and what are their stages of acute kidney injury okay so a normal urinary output is one to two liters per day that's what a normal adult should be putting out now those stages let's go over that because if we can determine what stage this patient is in whenever we're going over these signs and symptoms and findings we'll know if this is the correct answer okay so for stages you have the first stage which is the initiation stage and this is where there have been a cause of injury to the kidney remem remember from a renal series we talked about pre renal causes intra renal causes and post renal causes to win signs and symptoms appear so when the signs and symptoms appear there in another stage and they can either go through the awkward or the diaeresis stage not all patients go from an issue Alaric they may skip all glory can go straight to diuresis so you really always want to be watching that urinary output so we know they're not in the initiation stage okay the auger is what is that well one of the best ways to determine if they're in there in this stage or diuresis for recovery is to ask yourself what is their urinary output well it's for enough leaders and what does the urinary output be in the augering stage it should be less than four hundred milliliters per day so less than 400 milliliters per day now our patient is having four and a half so we can write them out of being in this stage but let's review this page because if we see signs and symptoms that should be going in the augur aquino we can eliminate those from over here so we'll put a little bit about dollar on blurred stage okay their urinary output is very minimal and why is that well that Blom aerialist that part of the nephron that filters the blood is damaged and it's not filtering the way it should so the familiar filtration rate that GFR is going to be severely decreased and a normal GFR if greater than ninety milliliters per minute so that is the amount of blood that wall Meireles is filtering so it's not filtering the blood like it should so all the wastes all the water all those electrolytes are staying and accumulating in the blood and not being excreted through the kidneys to be voided out so GFR is going to be decreased what's going to happen to our waist level specifically that'd be you and in creatinine they're just going to stay in the blood because our goal memory list isn't filtering it so they're going to dramatically increase and when we get that what's going to happen patients want to have acidotic conditions they're going to get confused and they're going to have issues like that so we're gonna have a confuse patient who's not filtering a lot of blood because they're not filtering a lot of blood what's going to happen to that water in the blood it's just going to stay there it's not going to be filtered through the kidneys so you're going to get fluid volume overload which can lead to hypertension edema swelling which can lead to pulmonary problems like pulmonary edema and heart failure things like that so fluid volume is going to be increased and we're going to have high / tension okay electrolytes electrolytes going to be all out of whack and specifically we're looking at the potassium levels what's going to happen to this we're going to have high firk Alenia because glomerulus isn't filtering that potassium out we're also going to have hyper false potamia which is going to decrease our calcium level hypokalemia and we're going to have high magnesium levels called hypermagnesemia so we're going to be dealing with a lot of high electrolyte except for the calcium now how is our urine specific gravity going to be is already I'm going to be really concentrated or is it going to be diluted well it's going to be very concentrated so the urine specific gravity is going to be high and whenever you do see the urine put out by these patients that they put any out very dark colored and very concentrated looking okay now let's go to the diaeresis stage what is the urine area out there going to be in the diaeresis stage okay to help me remember this always think of giving patients diuretics whenever you get patients i redick's what do they do they your na a lot so this is what happens in this stage they're putting out a lot of urine and remember one a few liters is the normal amount and these patients who are in this stage can fit out anywhere from three to six liters per day so I think it's confident to say our patient is probably in the diaeresis stage because they're putting out a lot of urine now let's talk about the diaeresis stage okay what is going on well this is where Al Gore mare Ulis is starting to function again so where GFR is going to start improving it's going to start increasing but it's going to be I'm normal still so remember a normal one was greater than 90 milliliters per minute so it's increasing but it's still not there so our kidneys have got that ability to filter the blood again so it's going to start removing a lot of waste from the blood specifically urea and creatinine but it doesn't have the ability yet to concentrate the urine so we're not going to get electrolyte balances yet so what's going to start happening two or bú in in creatinine they're going to start coming down but they're still going to be on normal but they're going to come down now because I go Mary Liz is starting to filter again it's removing specifically a lot of your reality that blood into that filtrate now this is going to cause osmotic diuresis because that high amount of urea is going to cause water to pull from the blood into the kidneys and that is where you're going to see this high amount of urine being lost so they're peeing a lot what's going to happen to their fluid volume they're urinating it up it's going to decrease so they're going to get hypose tension now what's going to happen to our electrolyte levels well we can concentrate our urine yes and we're putting out a lot of fluids well one thing that's going to happen is our potassium levels going to drop so they're at risk for hypokalemia and what's not happening to their urine specific gravity so you're going to be really concentrated or is going to be diluted let me really diluted so it's going to be low because of all that water being pulled from the body into the nephron okay so we're getting somewhere we have a lot of our combinations and our signs and symptoms now why are they not in recovery cuz some people may think they're into the recovery stage well the recovery stage is when the urinary output is normal they have recovered and everything's back to normal so the GFR is going to be normal which is going to allow us to maintain or be you in and creatinine level which will be normal our fluid volume status should be normal and our electrolytes will be normal and you'll be able to maintain itself here this patient isn't maintaining because they're at four and a half liters or voiding Matt within a 24-hour period so they're in the diaeresis age now let's start eliminating our option okay a water intoxication are they going to have this no if anything they're going to be fluid volume depleted they're not going to be water intoxicated so this is not one of our answers so they're going to have hypotension yes because remember their depleted fluid volume they're urinating all their fluid in their blood out so they can have hypotension so B is an answer C low urinary specific gravity yes it's going to be low because that urine is really diluted it's not concentrated like how it was here inaugural stage hypokalemia yes because they are urinating all that fluid out in one of those main electrolytes that can be in trouble whenever a patient is urinating a lot is potassium that's why whenever we give like loop diuretics like lasix we're always watching those potassium levels because it's getting wasted so yes hypokalemia are they going to have a GFR greater than ninety milliliters per minute no member of their GFR is increasing but it's still going to be on normal they've got the ability to filter the blood but it's not going to be normal yet that would be in the recovery stage if they make it they're depending on the degree of damage that was done to the kidney so that's not one of our answers are they going to have a normal B you in and creatinine no they won't that's in the recovery stage but the bu and creatinine will start decreasing but it won't be and it won't be normal yet and G profound confusion due to a co a vo t Mia that is that buildup of those waste products in the blood and actually in the diaeresis stage because I'd be you in sorry because the glomerulus is starting to filter again they're actually you're going to see them become more alert and oriented compared to the alert stage where they're really going to have that confusion so no that is not an answer so our answer is B C and D okay so that wraps up this weekly inquest practice question and don't forget to check out the other questions in this series thank you so much for watching and don't forget to subscribe to our channel for more videos