Nursing care of patients with AKI

1. Nursing Care of patients with Acute Kidney Injury
Maj Bomneichong Leivon

2. Nursing goals for patient with AKI
• Restore fluid balance.
• Reduce metabolic rate.
• Promote pulmonary function.
• Prevent infection.
• Improve nutritional intake.
• Skin care
• Safety Measures

3. Excess Fluid Volume
• Accurately record intake and output (I&O) Monitor urine specific gravity
• Weigh daily at same time of day, on same scale, with same equipment and clothing.
• Assess for edema.
• Monitor heart rate (HR), BP, and JVD/CVP
• Auscultate lung and heart sounds
• Assess level of consciousness.
• Use appropriate safety measures (raising side rails and restraints).
• Monitor diagnostic studies: BUN,Creatinine, Urine Sodium.
• Administer and/or restrict fluids as indicated.
• Administer medication as advised by concern physician
• ..Downloads6 Acute Renal Failure Nursing Care Plans - Nurseslabs - Page 2.html

4. Risk for Deficient Fluid Volume
• Measure I&O accurately.
• Weigh daily.
• Calculate insensible fluid losses.
• Provide allowed fluids throughout 24-hr period.
• Monitor BP (noting postural changes) and HR.
• Note signs and symptoms of dehydration: Control environmental
temperature; limit bed linens as indicated.
• Monitor laboratory studies
• ..DownloadsDeficient fluid volume.html

5. Risk for Decreased Cardiac Output
• Monitor BP and HR.
• Observe ECG for changes in rhythm
• Auscultate heart sounds.
• Assess color of skin, mucous membranes, and nail beds. Note capillary refill time.
• Note occurrence of slow pulse, hypotension, flushing, nausea and vomiting, and depressed level of
consciousness
• Monitor for GI bleeding by testing all stools for blood.
• Investigate reports of muscle cramps, numbness of fingers, with muscle twitching, hyperreflexia.
• Maintain bed rest or encourage adequate rest and provide assistance with care and desired activities
• Monitor laboratory studies
• Administer and/or restrict fluids as indicated
• Provide supplemental oxygen if indicated.
• Administer medications as prescribed by physician
• ..Downloadsdecreasecardiac output.html

6. Risk for Imbalanced Nutrition: Less Than Body
Requirements
• Assess and document dietary intake.
• Provide frequent, small feedings.
• Give patient list of permitted foods or fluids and encourage involvement in menu choices.
• Offer frequent mouth care or rinse.
• Weigh daily.
• Monitor laboratory studies: BUN, albumin, transferrin, sodium, and potassium.
• Consult with dietitian support team.
• Provide high-calorie, low to moderate protein dietMaintain proper electrolyte balance by strictly
monitoring levels.
• Restrict potassium, sodium, and phosphorus intake as indicated.
• Administer medications
• ..Downloadsimbalance nutrition.html

7. Deficient Knowledge
• Explain level of renal function after acute episode is over.
• Review dietary plan and restrictions. Include fact sheet listing food restrictions.
• Encourage patient to observe characteristics of urine and amount, frequency of output.
• Establish regular schedule for weighing.
• Provide emotional support to the patient and family.
• Review fluid restriction.
• Discuss activity restriction and gradual resumption of desired activity.
• Encourage use of energy-saving, relaxation, and diversional techniques.
• Review use of medication
• Stress necessity of follow-up care, laboratory studies.
• Identify symptoms requiring medical intervention
• ..DownloadsDeficient knowledge.html

8. Risk for Electrolyte Imbalance
• Monitor serum electrolyte levels.
• Identify any clinical conditions or situations that may be a factor for an imbalance
in serum electrolytes.
• Supply balanced electrolyte IV solutions as directed.
• Administer electrolyte replacements as prescribed.
• Drug therapy
• Gastrointestinal fluid losses
• Educate the patient about dietary sources of electrolytes
• Sodium and the use of salt substitutes.
• Salt restriction
• ..DownloadsRisk for Electrolyte Imbalance - Nursing Diagnosis - Nurseslabs.html

9. • Monitor BP and HR.
• Observe ECG or telemetry for changes in rhythm
• Auscultate heart sounds.
• Assess color of skin, mucous membranes, and nail beds. Note capillary refill time.
• Note occurrence of slow pulse, hypotension, flushing, nausea and vomiting, and depressed level of
consciousness
• Monitor for GI bleeding by guaiac testing all stools for blood.
• Investigate reports of muscle cramps, numbness of fingers, with muscle twitching, hyperreflexia.
• Maintain bed rest or encourage adequate rest and provide assistance with care and desired activities
• Monitor laboratory studies:
• Administer and/or restrict fluids as indicated
• Provide supplemental oxygen if indicated.
• Administer medications as indicated:

10. Discharge and Home Care Guidelines
• Nutrition. A referral to the nutritionist is made because of the dietary
changes required.
• Problems to report. The patient and family must know what
problems to report to the healthcare provider.
• Follow-up examinations. The importance of follow-up examinations
and treatment is stressed to the patient and family because of
changing physical status and renal functions.

11. Documentation Guidelines
• The focus of documentation in a patient with AKI includes:
• Vital signs.
• Muscle strength and reflexes.
• Results of laboratory tests and diagnostic studies.
• Degree of deficit and current sources of fluid intake.
• I&O and fluid balance.
• Client’s responses to treatment, teaching, and actions performed.