A patient with dehydration and oliguria is being assessed. Which intervention is the nurse most likely to initiate to address the patient's condition?

A) Encourage increased oral fluid intake

B) Restrict the patient's fluid intake

Based on the initial assessment findings, what is the most appropriate initial intervention to address the patient's dehydration and prevent further kidney injury?

A) Encourage increased oral fluid intake

B) Administer diuretics to reduce edema

C) Restrict fluid intake to prevent overload

D) Schedule dialysis treatment immediately

What is the primary reason for initiating isotonic saline IV fluid therapy in a patient with dehydration?

C) To increase potassium levels

Which laboratory result indicates an improvement in kidney function for the patient with acute kidney injury?

A) Serum creatinine decreased from 1.8 mg/dL to 1.5 mg/dL

B) Blood urea nitrogen increased to 30 mg/dL

C) Potassium level increased to 6.0 mmol/L

D) Hemoglobin level decreased to 9.0 g/dL

Which of the following indicates an improvement in the patient's renal function, based on the provided diagnostic results?

B) Decrease in blood urea nitrogen (BUN) level

A) Increase in serum creatinine level

B) Decrease in blood urea nitrogen (BUN) level

C) Presence of hydronephrosis on ultrasound

Which of the following vital sign findings is most indicative of the patient's improved cardiovascular function and fluid management as he recovers from acute kidney injury?

A) Blood pressure of 118/76 mmHg

B) Heart rate of 100 beats per minute

C) Respiratory rate of 24 breaths per minute

D) Oxygen saturation of 90% on room air

Which of the following vital signs indicates an improvement in the patient's cardiovascular function during recovery from acute kidney injury?

A) Blood pressure of 118/76 mmHg

B) Heart rate of 100 beats per minute

C) Respiratory rate of 24 breaths per minute

D) Oxygen saturation of 92% on room air

A patient recovering from acute kidney injury has a normalized serum creatinine level of 1.2 mg/dL and a blood urea nitrogen (BUN) level of 15 mg/dL. What does this indicate about the patient's kidney function?

A) The patient's kidney function is improving.

B) The patient is likely experiencing chronic kidney disease.

C) The patient requires immediate dialysis.

D) The patient's kidney function is deteriorating.

acute kidney injury - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced blood flow to the kidneys (prerenal causes) - This can occur due to dehydration, heart failure, or blood loss, leading to insufficient blood supply and oxygen, which impairs kidney function.

• Secondary mechanism: Direct kidney damage (intrinsic causes) - Conditions like acute tubular necrosis, which can result from toxins or prolonged low blood flow, cause injury to the kidney tissues, affecting their ability to filter waste.

• Key complication: Fluid and electrolyte imbalances - With impaired kidney function, the body struggles to maintain proper fluid and electrolyte levels, potentially leading to issues like high blood potassium or fluid overload, which can affect the heart and other organs.

Patient Profile

Demographics:

58-year-old male, construction worker

History:

• Key past medical history: Hypertension, mild osteoarthritis

• Current medications: Lisinopril 10 mg daily, acetaminophen as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Decreased urine output

• Key symptoms: Mild fatigue, slight swelling in ankles

• Vital signs: Blood pressure 135/85 mmHg, heart rate 78 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the patient's physical examination reveals dry mucous membranes and decreased skin turgor, indicative of dehydration. His mild ankle swelling, known as peripheral edema, is non-pitting and extends slightly up the lower legs. The construction worker's urine output has decreased to around 400 mL over the past 24 hours, which is lower than the normal range, confirming oliguria. The patient reports feeling more tired than usual, a symptom that aligns with his decreased urine output and fluid retention.

The nurse conducts a thorough review of the patient's recent fluid intake, which has been inadequate given his active job in construction, potentially contributing to his prerenal acute kidney injury. The patient's recent work has been outdoors in high temperatures, further exacerbating his dehydration risk. A focused cardiac and respiratory assessment shows normal heart sounds and clear lung fields, indicating that fluid overload has not yet affected his cardiovascular or respiratory systems.

The initial lab results return, showing elevated blood urea nitrogen (BUN) and creatinine levels, consistent with acute kidney injury. His potassium level is slightly elevated at 5.2 mmol/L, which remains within a mild range but requires monitoring to prevent complications. The patient is advised to increase oral fluid intake, and the healthcare team considers initiating intravenous (IV) fluids to correct dehydration and improve renal perfusion. These findings underscore the importance of addressing both the prerenal and intrinsic factors contributing to the patient's condition to prevent progression and stabilize kidney function.

Section 2

Response to Interventions:

Following the initial assessment, the healthcare team initiates intravenous (IV) fluid therapy with isotonic saline to address the patient’s dehydration and improve renal perfusion. The patient is closely monitored for any signs of fluid overload, given his mild peripheral edema. Over the next 24 hours, the patient’s urine output is carefully tracked, and it begins to increase steadily, reaching 800 mL, a positive sign indicating a response to the treatment. The patient also reports feeling slightly more energetic, although he still experiences some fatigue, suggesting that hydration status is gradually improving.

Vital signs are routinely checked to assess the patient's response to the IV fluids. Blood pressure remains stable at 122/78 mmHg, and heart rate is regular at 78 beats per minute. Respiratory rate is 18 breaths per minute with clear lung sounds, confirming that the fluid therapy has not compromised the patient's respiratory status. Repeat laboratory tests show a slight decrease in blood urea nitrogen (BUN) and creatinine levels, indicating that renal function is beginning to stabilize. Potassium levels remain at 5.2 mmol/L, necessitating continued monitoring but not yet requiring specific interventions.

The healthcare team emphasizes the importance of maintaining adequate oral fluid intake once the IV fluids are tapered. Education is provided on recognizing signs of dehydration and the importance of hydration, especially given the patient’s outdoor work environment. The patient expresses understanding and is encouraged to take frequent breaks and increase fluid intake during work to prevent future episodes. With these improvements, the patient’s condition is closely observed to ensure continued recovery and to prevent any potential complications that could arise from the acute kidney injury.

Section 3

New Diagnostic Results:

As the patient's treatment progresses, the healthcare team conducts further diagnostic tests to gain a more comprehensive understanding of the kidney function and overall health status. A repeat renal ultrasound is performed to assess for any structural abnormalities and to confirm that the kidney size and shape are within normal limits, ruling out obstructions or other anatomical issues. The ultrasound results are clear and consistent with early stage acute kidney injury, reassuring the team that there are no complicating factors such as hydronephrosis or kidney stones.

Additionally, a new set of laboratory tests reveals more improvements. The patient's serum creatinine level has decreased to 1.5 mg/dL from the previous 1.8 mg/dL, and the blood urea nitrogen (BUN) has further reduced to 22 mg/dL. These improvements indicate that the kidneys are regaining their ability to filter waste products effectively. Electrolyte levels, including sodium and potassium, remain stable, with potassium now at a more comfortable 4.8 mmol/L, reducing the risk of hyperkalemia. The patient's hemoglobin and hematocrit levels are checked to ensure no signs of anemia, and they are found to be within normal ranges, supporting the patient's report of increased energy levels.

Based on these encouraging results, the healthcare team decides to gradually taper the IV fluid therapy while continuing to monitor the patient's oral intake and urine output. The patient is instructed to keep a fluid diary to track his daily intake and output, which will help in ensuring adequate hydration. With the patient showing signs of recovery, the team plans to discuss a discharge plan focused on lifestyle modifications, dietary recommendations, and follow-up appointments to monitor renal function and prevent recurrence of acute kidney injury.

Section 4

Change in Patient Status:

As the patient continues to recover from the early stages of acute kidney injury, the healthcare team observes a positive change in his overall status. During the morning assessment, the patient reports feeling more energetic and has resumed light physical activities, such as walking around the unit with minimal assistance. His vital signs reflect this improvement, with a stable blood pressure of 118/76 mmHg, heart rate of 76 beats per minute, respiratory rate of 18 breaths per minute, and an oxygen saturation of 98% on room air. These stable vital signs are indicative of improved cardiovascular function and effective fluid management.

The patient's urine output has steadily increased to an average of 1,800 mL per day, and he reports no difficulty or discomfort during urination. The nursing staff notes that the patient's urine is clear and of normal volume, consistent with effective renal recovery. The patient is adhering to the fluid diary, which shows a balanced intake and output, suggesting that he is maintaining adequate hydration without overloading his system. This balance is crucial for preventing further stress on the kidneys.

In preparation for discharge, the healthcare team initiates discussions about lifestyle modifications and dietary changes aimed at supporting kidney health. The patient expresses a keen interest in learning more about a renal-friendly diet and commits to attending a nutrition consultation. The team also schedules follow-up appointments to monitor his renal function closely, ensuring early detection of any potential setbacks. With a comprehensive plan in place, the patient feels optimistic about his recovery and is motivated to follow the recommendations to prevent future episodes of acute kidney injury.

Section 5

As the patient transitions toward discharge, the healthcare team receives the latest set of diagnostic results, providing further insight into his kidney recovery. The laboratory tests reveal a serum creatinine level of 1.2 mg/dL, which is within the normal range, indicating significant improvement in renal function since admission. Blood urea nitrogen (BUN) levels have also normalized at 15 mg/dL. These findings confirm the effectiveness of the interventions and suggest that the kidneys are recovering well from the acute injury. The patient's electrolytes are stable, with sodium at 140 mEq/L and potassium at 4.2 mEq/L, reflecting proper balance and no signs of electrolyte imbalances that could complicate his recovery.

The patient's urinalysis shows no presence of protein or blood, which further supports renal recovery and hints at a decreased likelihood of underlying chronic kidney issues. The absence of these elements in the urine is a positive sign, suggesting that the glomerular filtration barrier is intact and functioning properly. These results are shared with the patient, who is encouraged by the clear evidence of progress and motivated to continue adhering to the prescribed lifestyle modifications.

The healthcare team uses these results to reinforce the importance of maintaining a renal-friendly lifestyle post-discharge, emphasizing dietary adjustments such as reducing sodium and protein intake and staying hydrated without excessive fluid consumption. Plans for continued monitoring through regular follow-up appointments and lab work are discussed to ensure that any new complications are detected early. The patient expresses gratitude for the care received and remains committed to his recovery plan, feeling empowered to take an active role in his health management.