A nurse is reviewing the lab results of a patient with oliguria and slight dehydration. Which lab finding is most consistent with potential kidney dysfunction?

B) Serum potassium level of 4.2 mEq/L

C) Serum creatinine level of 0.8 mg/dL

D) Blood glucose level of 90 mg/dL

What is the most appropriate initial nursing intervention for a patient exhibiting signs of mild dehydration and oliguria?

B) Encourage oral fluid intake to improve hydration status

A) Administer a diuretic to increase urine output

B) Encourage oral fluid intake to improve hydration status

C) Restrict fluid intake to prevent fluid overload

D) Position the patient in Trendelenburg position to improve circulation

What is the primary reason for encouraging increased oral fluid intake in a patient with acute kidney injury?

B) To prevent dehydration and support kidney function

A) To dilute serum electrolytes

B) To prevent dehydration and support kidney function

Which intervention is most important for the nurse to implement to support kidney function in a patient with acute kidney injury?

A) Encouraging oral fluid intake

B) Providing a high-protein diet

A patient recovering from acute kidney injury reports mild muscle weakness and occasional cramps. The nurse notes a slight decrease in serum sodium levels. What is the most appropriate nursing intervention to address this issue?

B) Educate the patient on increasing dietary sodium intake.

A) Encourage the patient to increase their fluid intake significantly.

B) Educate the patient on increasing dietary sodium intake.

C) Administer a diuretic as prescribed by the physician.

D) Restrict the patient's sodium intake to prevent further complications.

What is the most likely reason for the nurse to continue monitoring the patient's urine output closely after dietary adjustments for sodium intake?

C) To evaluate the recovery of kidney function.

A) To ensure the patient is consuming enough fluids.

B) To assess the patient's compliance with dietary recommendations.

C) To evaluate the recovery of kidney function.

D) To determine if the patient is at risk of dehydration.

A patient recovering from acute kidney injury is experiencing increased blood pressure and mild weight gain. Which nursing intervention is most appropriate to address these changes?

B) Educate the patient on adhering to fluid restrictions.

A) Encourage the patient to increase fluid intake.

B) Educate the patient on adhering to fluid restrictions.

C) Advise the patient to reduce physical activity.

D) Suggest the patient increase dietary sodium intake.

A patient recovering from acute kidney injury is experiencing an increase in blood pressure, mild headaches, and weight gain. Which nursing intervention is most appropriate to address potential fluid overload?

C) Collaborate with the healthcare provider to adjust fluid intake and diuretic therapy

A) Increase the patient's fluid intake to promote kidney function

B) Encourage the patient to perform light exercise to reduce fluid retention

C) Collaborate with the healthcare provider to adjust fluid intake and diuretic therapy

D) Monitor the patient's heart rate continuously for signs of arrhythmia

acute kidney injury - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced blood flow to the kidneys (prerenal injury) leads to decreased oxygen and nutrients, causing cells in the kidneys to become stressed and potentially die, impairing their ability to filter waste.

• Secondary mechanism: Direct damage to kidney tissues (intrarenal injury), often from toxins or prolonged low blood flow, results in inflammation and cell injury, further reducing the kidney’s filtering capacity.

• Key complication: If untreated, these mechanisms can lead to fluid overload, electrolyte imbalances, and waste accumulation in the body, potentially causing symptoms like swelling, confusion, and high blood pressure.

Patient Profile

Demographics:

45-year-old male, office manager

History:

• Key past medical history: Hypertension, managed with lifestyle changes

• Current medications: Occasional use of ibuprofen for headaches

• Allergies: None known

Current Presentation:

• Chief complaint: Decreased urine output over the past 24 hours

• Key symptoms: Mild fatigue, slight swelling in ankles, no pain

• Vital signs: Blood pressure 130/85 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon further assessment, the nurse notes that the patient's urine output has decreased to less than 400 milliliters in the past 24 hours, indicating oliguria. The patient's skin turgor is slightly decreased, suggesting mild dehydration, and there is trace pitting edema present in both ankles. Lung auscultation reveals clear breath sounds bilaterally, and there are no signs of respiratory distress. The patient denies any nausea or vomiting but reports feeling slightly more fatigued than usual. His blood pressure remains stable at 130/85 mmHg, and his heart rate is regular at 78 bpm.

The nurse conducts a basic metabolic panel to assess the patient’s renal function and electrolyte levels. The results show a blood urea nitrogen (BUN) level of 28 mg/dL and a serum creatinine level of 1.8 mg/dL, both elevated, indicating potential kidney dysfunction. Serum electrolytes reveal a potassium level of 5.1 mEq/L, slightly elevated, which necessitates monitoring but is not yet critical. The nurse documents these findings and prepares to discuss the results with the attending physician to determine the next steps in managing the patient's condition. The focus is on maintaining adequate hydration and monitoring for any signs of worsening renal function or electrolyte imbalances. This assessment underscores the importance of early intervention to prevent further kidney damage and complications.

Section 2

Response to Interventions:

Following the initial assessment, the nursing team implements a care plan to manage the patient's acute kidney injury with a focus on hydration and electrolyte balance. The patient is encouraged to increase oral fluid intake, aiming for at least 1500 milliliters per day, if not contraindicated. The nurse provides education on the importance of hydration in supporting kidney function and carefully monitors the patient's fluid intake and output. In addition, the patient is placed on a low-potassium diet to prevent further elevation of serum potassium levels, given the slight increase noted in the lab results.

Over the next 24 hours, the patient shows signs of improvement. Urine output increases to 600 milliliters, indicating a positive response to the increased oral fluids. The patient's skin turgor is now normal, suggesting improved hydration status. Although trace pitting edema persists, it has not worsened, and the patient continues to deny any respiratory distress, with lung sounds remaining clear. The patient's blood pressure remains stable at 128/82 mmHg, and the heart rate is steady at 76 bpm. The patient's fatigue has slightly improved, and he reports feeling more alert and less tired.

The nurse conducts a follow-up basic metabolic panel to reassess renal function and electrolyte status. The new results show a BUN level of 25 mg/dL and a serum creatinine level of 1.6 mg/dL, both showing slight improvement. The potassium level has decreased to 4.8 mEq/L, indicating a positive response to dietary modifications. These findings are discussed with the attending physician, who expresses satisfaction with the patient's progress. The care plan is adjusted to continue monitoring fluid balance and electrolytes, with the aim of achieving further improvement and preventing any potential complications as the patient continues to recover from the early stage of acute kidney injury.

Section 3

Change in Patient Status:

Over the next 48 hours, the patient continues to show signs of recovery from acute kidney injury, but some new subtle changes in status warrant close attention. The nurse notes that the patient's urine output has increased further to 800 milliliters in the past 24 hours, which is a positive sign of kidney function improvement. However, the patient mentions experiencing mild muscle weakness and occasional cramps, prompting the nurse to conduct a focused assessment on these symptoms. Vital signs remain stable, with blood pressure at 126/80 mmHg, heart rate at 78 bpm, and respiratory rate at 16 breaths per minute. The patient's oxygen saturation is a healthy 98% on room air, and lung sounds remain clear, indicating no respiratory complications.

A repeat basic metabolic panel is ordered to investigate the cause of the muscle symptoms. The results show that while the potassium level has decreased to 4.5 mEq/L, the sodium level is slightly lower at 134 mEq/L, at the low end of the normal range and potentially contributing to the muscle issues. The nurse reviews these findings with the physician, who decides to adjust the patient's care plan by recommending a slight increase in sodium intake through diet, while continuing to monitor electrolyte levels closely.

The nursing team collaborates to educate the patient about the importance of balanced electrolyte consumption and ensures that dietary adjustments are feasible and safe. The patient is encouraged to report any further muscle symptoms or changes in how they feel. Meanwhile, the nurse remains vigilant in monitoring the patient's fluid and electrolyte status, understanding that these subtle changes could be pivotal in the patient's recovery trajectory. The focus remains on maintaining stable kidney function and preventing any new complications as the patient moves towards complete recovery.

Section 4

Response to Interventions:

Over the next 24 hours, the patient's response to the dietary adjustments is closely monitored. The nursing team observes that the patient is adhering well to the increased sodium intake recommendations, incorporating foods like soups and broths into their meals. The patient reports feeling slightly more energized and experiences fewer muscle cramps, suggesting a positive response to the intervention. Despite these improvements, the nurse remains attentive to any subtle signs that might indicate an imbalance, as the recovery from acute kidney injury can be fragile.

A follow-up basic metabolic panel is conducted to assess the efficacy of the intervention. The results reveal that the sodium level has risen slightly to 136 mEq/L, now comfortably within the normal range, while the potassium level remains stable at 4.4 mEq/L. These results are encouraging and indicate that the patient's electrolyte balance is improving without causing any adverse effects. The patient's urine output continues to be stable at approximately 900 milliliters over the past 24 hours, further affirming the recovery of kidney function.

The nurse discusses these findings with the patient, emphasizing the importance of continuing the dietary adjustments and monitoring for any new symptoms. The patient is receptive to this guidance and expresses a desire to maintain these healthy habits. The nursing team plans to continue regular assessments and lab monitoring, understanding that vigilance is crucial in preventing any setbacks. As the patient progresses, the focus remains on supporting recovery and ensuring the stability of kidney function, paving the way for eventual discharge planning.

Section 5

New Complications:

On the second day of monitoring, the patient begins to experience a mild increase in blood pressure, with readings now averaging around 140/88 mmHg, up from the previous 120/80 mmHg. This change prompts the nursing team to investigate potential causes, as hypertension can be a common complication in patients recovering from acute kidney injury. The patient also reports experiencing mild headaches, which could be related to the elevated blood pressure. The nursing team prioritizes managing this new development to prevent any further complications.

The nurse performs a thorough assessment, noting that the patient's heart rate remains stable at 78 beats per minute, and respiratory rate is unchanged at 16 breaths per minute. However, the patient's weight has increased by 1.5 kilograms since admission, suggesting possible fluid retention. A review of the recent basic metabolic panel shows that while sodium and potassium levels remain within the normal range, the blood urea nitrogen (BUN) has risen slightly to 25 mg/dL, and creatinine is stable at 1.4 mg/dL. These findings, coupled with the weight gain and elevated blood pressure, suggest that the patient may be experiencing early signs of fluid overload.

In response, the nursing team collaborates with the healthcare provider to adjust the patient's fluid intake and diuretic therapy. The patient is educated about monitoring fluid intake and recognizing symptoms of fluid overload, such as swelling in the extremities or sudden weight gain. The nurse emphasizes the importance of adhering to the adjusted fluid restrictions and reports any changes in symptoms. Close monitoring of vital signs, daily weights, and laboratory results will continue to ensure that the patient remains on the path to recovery while addressing this new complication. The team remains optimistic, as early intervention is key to managing these challenges effectively and supporting the patient's overall recovery and eventual discharge.