Nursing Care Plan for Acute Kidney Injury

Pathophysiology

Acute kidney injury, also known as acute renal failure,  is when the kidneys stop working over the period of a few hours or a few days. People at risk for AKI are those who have high blood pressure, a chronic illness such as heart or liver disease or diabetes, or those who have peripheral artery disease. AKI requires immediate treatment but is usually reversible if treated quickly.

Etiology

Acute kidney injury is a result of direct kidney damage, decreased blood flow or blockage of the urinary tract. Direct damage may be a result of sudden trauma to the kidneys, sepsis, scleroderma or allergic reaction. Other, more common, causes include a blockage in the ureters such as kidney stones, blood clots, enlarged prostate or multiple myeloma. Hypotension, severe diarrhea, infection, overuse of NSAIDs, dehydration or severe burns may cause decreased blood flow.

Desired Outcome

Restore kidney function to optimal state, patient will maintain hydration and be free from infection or chronic kidney damage.

Acute Kidney Injury Nursing Care Plan

Subjective Data:

  • Feeling tired
  • Feeling confused
  • Nausea
  • Pain or pressure in the chest
  • Shortness of breath

Objective Data:

  • Dependent edema
  • Periorbital edema
  • Seizures
  • Tachycardia with hypertension
  • Decreased urine output
  • Electrolyte abnormalities
    • ↑ Potassium
    • ↓ Sodium
    • ↑ Phosphate
    • ↓ Calcium
  • ↑ BUN/Creatinine
  • ↓ GFR

Nursing Interventions and Rationales

  • Monitor vitals
    • Heart rate
    • Blood pressure

 

Tachycardia and hypertension may occur because of the kidneys’ inability to excrete urine

 

  • Perform 12 lead EKG

 

To assess for arrhythmias

 

  • Asses heart and lung sounds for adventitious breath sounds or extra heart sounds

 

Fluid overload may lead to pulmonary edema and heart failure and may be manifested by shortness of breath and chest pain

 

  • Monitor mentation and changes in level of consciousness

 

Changes in LOC may indicate fluid shifts and electrolyte imbalance

 

  • Assess dependent and periorbital edema

 

Evaluate and report degree of edema (+1 – +4)

There may be a gain of up to 10lbs of fluid before pitting is noticed

 

  • Monitor diagnostic studies
    • Radiology: Chest x-ray, ultrasound or CT of kidneys
    • Lab: urine, blood

 

  • Chest x-ray may show increase in cardiac size, pleural effusion or pericardial congestion due to fluid overload
  • Urinalysis- urine creatinine usually decreases as serum creatinine increases
  • Serum- BUN, creatinine – monitor ratio, if >10:1, dialysis may be indicated
  • Sodium– may indicate hyponatremia (fluid overload) or hypernatremia (total body fluid deficit)
  • Potassium– elevation indicates kidney disease from lack of excretion or selective retention and leads to hyperkalemia

 

  • Insert indwelling urinary catheter unless contraindicated for infection

 

Indwelling catheter will provide for more accurate measurement of urine output

 

  • Monitor I & O for fluid retention

 

  • Measure for decreased output <400 mL/24 hr period may be evident by dependent edema
  • Daily weights at the same time on the same scale each day, >0.5kg/day is indicative of fluid retention
  • Note changes in characteristics of urine to include odor, blood, mucus or sediment present

 

  • Administer medications as ordered

 

  • IV Fluids- may be given for lack of fluid volume, but may be withheld in cases of fluid overload
  • Diuretics- furosemide, mannitol may be given to flush kidneys of debris and reduce fluid overload, reducing hyperkalemia
  • Calcium channel blockers-given early can help reduce influx of calcium in kidney cells to maintain cell integrity – if calcium level is too low, calcium may be infused
  • Antihypertensives- clonidine, methyldopa may be given to counteract the effects of decreased renal blood flow
  • Cation-exchange resins- sodium polystyrene sulfonate (Kayexalate) help reduce levels of potassium and treat hyperkalemia

 

  • Nutrition management and education

 

  • Limit intake of excess fluids
  • Limit sodium intake – avoid adding salt to foods and limit processed or canned foods that contain hidden sodium
  • Increase fresh fruits and vegetables
  • Limit foods high in potassium such as beans, rice, bananas, oranges, potatoes and tomatoes
  • Limit intake of whole grain breads, bran cereals, nuts and sunflower seeds due to their high phosphorus content
  • Refer patient to dietitian if further counseling is required

 

  • Prepare patient for dialysis if indicated
    • Peritoneal
    • Hemodialysis
    • Continuous Renal Replacement Therapy

 

  • Elevate the head of the bed to reduce pressure on the diaphragm and aid in respiration
  • Monitor for signs and symptoms of clot or infection at shunt site
  • Assess for thrill/bruit of shunt for patency

 


References

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