What is the primary reason for conducting baseline laboratory tests in a patient with suspected prerenal acute renal failure?

B) To evaluate the extent of renal impairment

A) To assess the patient's blood glucose levels

B) To evaluate the extent of renal impairment

C) To determine the patient's heart function

D) To assess the risk of infection

A patient has been diagnosed with mild hyponatremia and impaired renal function. Which nursing intervention is a priority to address the patient's electrolyte imbalance?

D) Monitor daily weights and urine output

A) Encourage increased fluid intake

B) Administer prescribed diuretics

C) Initiate a low-potassium diet

D) Monitor daily weights and urine output

Which of the following interventions is most appropriate for a patient with mild hyponatremia and impaired renal function?

D) Start intravenous fluids to improve renal perfusion

A) Encourage a high-sodium diet

B) Administer diuretics to increase urine output

C) Promote fluid restriction to concentrate sodium levels

D) Start intravenous fluids to improve renal perfusion

Which of the following findings indicates a positive response to the implemented care plan for the patient in the case section provided?

C) Stable daily weights with urine output averaging 50 mL/hour

A) Decreased urine output to 20 mL/hour

B) Increased blood pressure to 150/90 mmHg

C) Stable daily weights with urine output averaging 50 mL/hour

D) Sodium level decreasing to 128 mEq/L

Which of the following vital signs indicates that the patient's condition is stable following the response to interventions for fluid management?

A) Blood pressure of 118/76 mmHg

C) Respiratory rate of 24 breaths per minute

What is the primary reason for implementing a fluid restriction in this patient with a history of acute renal failure?

C) To enhance medication absorption

A patient with a history of acute renal failure presents with mild pitting edema in the lower extremities and reports shortness of breath when lying flat. What is the most appropriate initial nursing intervention?

B) Elevate the patient's legs when resting

A) Encourage increased fluid intake

B) Elevate the patient's legs when resting

C) Administer prescribed diuretics immediately

D) Place the patient in a supine position

Which nursing intervention is most appropriate for managing the patient's mild pitting edema?

B) Recommend elevating the legs while resting

A) Encourage increased fluid intake

B) Recommend elevating the legs while resting

C) Apply warm compresses to the affected areas

D) Advise the patient to reduce physical activity

Acute Renal Failure - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced blood flow to the kidneys (prerenal cause) - This occurs when there is a significant drop in blood flow to the kidneys, often due to dehydration, heart failure, or shock, impairing their ability to filter waste effectively.

• Secondary mechanism: Direct kidney damage (intrinsic cause) - Conditions like infections, toxins, or severe inflammation can directly harm the kidney tissues, leading to impaired function.

• Key complication: Accumulation of waste products in the blood - As a result of decreased kidney function, waste products like urea and creatinine build up, causing symptoms like fatigue, confusion, and swelling.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Hypertension

• Current medications: Lisinopril 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Decreased urine output

• Key symptoms: Mild fatigue, slight swelling in ankles

• Vital signs: Blood pressure 130/85 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the patient presents with a slightly altered mental status, exhibiting mild confusion and difficulty concentrating, which aligns with the accumulation of waste products in her bloodstream due to impaired kidney function. The physical examination reveals mild pitting edema around the ankles and mild pallor, suggesting possible fluid retention and decreased hemoglobin levels. Her skin is warm and dry, and she reports feeling thirsty, which could indicate dehydration as a contributing factor to her reduced urine output.

The nursing team conducts a focused renal assessment, noting that the patient's urine output over the past 24 hours is significantly decreased at approximately 400 mL, which is suggestive of oliguria. Her abdomen is soft and non-tender, with no signs of ascites. A review of systems indicates no recent episodes of nausea or vomiting, further emphasizing the need to explore other causes for her prerenal acute renal failure. Vital signs remain stable, with a blood pressure of 130/85 mmHg, heart rate of 78 bpm, respiratory rate of 16 breaths per minute, and an oxygen saturation of 98% on room air.

This assessment highlights the importance of addressing potential dehydration and monitoring the patient's renal function closely. The nursing staff prioritizes obtaining baseline laboratory tests, including serum electrolytes, blood urea nitrogen (BUN), and creatinine levels, to evaluate the extent of renal impairment and guide further treatment decisions. The findings underscore the need for early intervention to prevent progression of acute renal failure and to restore kidney function.

Section 2

New Diagnostic Results:

Following the initial assessment, the nursing team receives the results of the laboratory tests. The patient's serum electrolytes reveal a sodium level of 132 mEq/L, indicating mild hyponatremia, and a potassium level of 5.2 mEq/L, which is slightly elevated. The blood urea nitrogen (BUN) is measured at 28 mg/dL, and the creatinine level is 1.8 mg/dL, both of which are above normal ranges, confirming the presence of impaired renal function. These results suggest that the patient's kidneys are struggling to excrete waste products effectively, and there is a need to address the electrolyte imbalances to prevent further complications.

The nursing team collaborates with the healthcare provider to develop a care plan focused on correcting fluid and electrolyte imbalances. Intravenous fluids are initiated to address potential dehydration and help improve renal perfusion. The team also considers dietary modifications to manage the patient's electrolyte levels, specifically advising on reducing potassium-rich foods. The patient's fluid status is monitored closely, with regular assessments of urine output and daily weights to evaluate the effectiveness of the interventions.

These diagnostic results and subsequent interventions provide a clearer understanding of the patient's condition and guide the next steps in her care. The nursing staff remains vigilant in monitoring for any changes in the patient's status, aware that early detection of any deterioration is crucial in preventing the progression to more severe renal impairment. As the patient's journey continues, the focus remains on stabilizing her condition and supporting kidney function, with the goal of achieving a return to her baseline health.

Section 3

Response to Interventions

After the implementation of the care plan, the nursing team closely monitors the patient's response to the interventions. Over the next 48 hours, the patient shows signs of gradual improvement. Her urine output increases to an average of 50 mL/hour, indicating better kidney function, and her daily weights are stable, suggesting effective fluid management. The repeat laboratory tests reveal a slight improvement in her electrolyte levels, with sodium increasing to 134 mEq/L and potassium decreasing to 5.0 mEq/L. Although these values are still outside normal ranges, they demonstrate a positive response to the fluid therapy and dietary adjustments.

The patient's vital signs remain stable, with blood pressure at 118/76 mmHg, heart rate at 78 bpm, and respiratory rate at 18 breaths per minute. She reports feeling less fatigued and more alert, which the nursing team attributes to the correction of mild hyponatremia and improved renal function. Encouraged by these developments, the healthcare team continues to emphasize the importance of dietary compliance and adequate fluid intake to the patient and her family. The patient is educated on recognizing signs of fluid overload or electrolyte disturbances, empowering her to participate actively in her care.

As the patient progresses, the nursing team prepares to transition her to a less intensive monitoring plan. They remain vigilant for any signs of potential complications, such as fluid overload or worsening renal function. With the current interventions showing efficacy, the focus shifts to maintaining stability and preventing any setbacks. The ultimate goal is to achieve sustained improvement and facilitate the patient's return to her baseline level of health, with ongoing support from the healthcare team to ensure a smooth recovery.

Section 4

As the nursing team continues to monitor the patient, they note a slight change in her status. On the morning of the third day, the patient reports mild swelling in her ankles and a slight increase in fatigue, raising concern for potential fluid retention. Her vital signs remain stable, but her blood pressure shows a minor increase to 122/80 mmHg. The nursing team promptly assesses her for signs of fluid overload, considering her recent history of acute renal failure.

A physical examination reveals mild pitting edema in both lower extremities, and the patient mentions feeling a bit short of breath when lying flat. Concerned about these symptoms, the healthcare team orders additional laboratory tests, including a repeat serum creatinine and BUN, to evaluate her renal function more thoroughly. The results show a slight increase in creatinine to 2.1 mg/dL from the previous 1.9 mg/dL, suggesting a potential setback in her recovery.

In response to these findings, the team adjusts the patient's care plan. They implement a more stringent fluid restriction to prevent further fluid accumulation and consult with the dietitian to review her dietary intake, ensuring it remains appropriate for her current renal status. The nursing team also educates the patient and her family on the importance of adhering to these new guidelines and monitors her closely for any further changes in her condition. The goal is to stabilize her renal function and prevent any complications, supporting her continued progress towards recovery.

Section 5

In response to the recent changes in the patient's condition, the nursing team continues their vigilant monitoring and introduces new interventions to manage her symptoms effectively. Over the next 24 hours, the patient follows the adjusted care plan, adhering to the stricter fluid restriction and modified diet. During this period, the nursing team performs regular assessments to evaluate the effectiveness of these interventions. The patient's vital signs remain stable, with her blood pressure slightly elevated at 124/82 mmHg, but her heart rate and respiratory rate remain within normal limits. The team notes that the mild pitting edema in her ankles has not worsened, and the patient reports feeling somewhat more comfortable when resting in an elevated position.

On the fourth day, repeat laboratory tests are conducted to assess the patient's renal function and overall response to the care plan. The results indicate a slight improvement in her serum creatinine, which has decreased to 2.0 mg/dL, and her BUN levels have stabilized. These findings suggest that the interventions are beginning to take effect, and the patient is showing signs of recovery. Encouraged by these results, the healthcare team decides to maintain the current management plan, while also continuing to educate the patient and her family about the importance of compliance with dietary and fluid restrictions.

As part of the ongoing care, the nursing team emphasizes the importance of monitoring for any new symptoms or changes in the patient's condition. They continue to provide support and encouragement, reinforcing the positive progress made thus far. The patient expresses understanding and appreciation for the care provided, feeling hopeful about her recovery journey. The team plans to reassess her condition regularly and remain vigilant for any potential complications, ensuring that she remains on the path to stable renal function and overall improvement.