Acute Kidney Injury : Nursing Management

Nursing Management

• Nursing Assessment
  • Measure vital signs
  • Measure fluid intake and output
  • Examine urine
  • Assess general appearance
  • Observe dialysis access site
  • Mental status/level of consciousness
  • Oral mucosa
  • Lung sounds
  • Heart rhythm
  • Laboratory values
  • Diagnostic test results
• Nursing Diagnoses
  • Risk for infection related to invasive lines, uremic toxins, and altered immune responses secondary to kidney injury
  • Excess fluid volume related to kidney injury and fluid retention
  • Fatigue related to anemia, metabolic acidosis, and uremic toxins
  • Anxiety related to disease processes, therapeutic interventions, and uncertainty of prognosis
  • Potential complication: dysrhythmias related to electrolyte imbalances
• Nursing Planning
  • The patient with AKI will
    • Completely recover without any loss of kidney function
    • Maintain normal fluid and electrolyte balance
    • Have decreased anxiety
    • Adhere to and understand need for careful follow-up care
• Nursing Implementation
  • Health Promotion
    • Identify and monitor populations at high risk
    • Control exposure to nephrotoxic drugs and industrial chemicals
    • Prevent prolonged episodes of hypotension and hypovolemia
    • Measure daily weight
    • Monitor intake and output
    • Monitor electrolyte balance
    • Replace significant fluid losses
    • Provide aggressive diuretic therapy for fluid overload
    • Use nephrotoxic drugs sparingly
  • Acute Care
    • Accurate intake and output
    • Daily weights
    • Assess for signs of hypervolemia or hypovolemia
    • Assess for potassium and sodium disturbances
    • Meticulous aseptic technique
    • Careful use of nephrotoxic drugs
    • Skin care measures/mouth care
  • Ambulatory Care
    • Regulate protein and potassium intake
    • Follow-up care
    • Teaching the patient the signs and symptoms of recurrent kidney disease
    • Appropriate referrals for counseling
      • If the kidneys do not recover, the patient will need to transition to life on chronic dialysis or possible future transplantation
  • Evaluation
    • The expected outcomes are that the patient with AKI will
      • Regain and maintain normal fluid and electrolyte balance
      • Adhere to the treatment regimen
      • Experience no complications
      • Have complete recovery