Acute Kidney Injury VI: Nursing Management

Nurses should review the patient's history for recent infections, nephrotoxic drug use, hypertension, and diabetes. During physical examination, assess for oliguria, peripheral edema, jugular vein distension, lung crackles, muscle weakness, and ECG changes like peaked T waves. These findings help identify the underlying cause and severity of acute kidney injury.

Key nursing diagnoses include excess fluid volume related to impaired kidney function, evidenced by peripheral edema and weight gain; impaired gas exchange related to fluid buildup in the lungs, evidenced by dyspnea and crackles; and risk for electrolyte imbalance due to compromised renal clearance, particularly hyperkalemia. These diagnoses guide targeted interventions.

Nurses monitor accurate intake and output and measure daily weight to track fluid status. Diuretics are administered cautiously as prescribed to reduce fluid overload. Positioning patients in semi-Fowler's position facilitates lung expansion and alleviates dyspnea, while frequent repositioning prevents atelectasis and promotes better oxygenation.

Patients should follow a low-sodium and potassium-restricted diet to control fluid retention and prevent electrolyte imbalances. Educate on medication adherence, including diuretics and electrolyte-stabilizing drugs, while avoiding nephrotoxic medications like NSAIDs. This education reduces fluid retention and minimizes further kidney damage.

Nurses monitor electrolyte levels closely, particularly potassium, to detect rising levels early. Educate patients on potassium-restricted diets and ensure medications are appropriately dosed based on renal function. Regular assessment of ECG changes and muscle weakness helps identify hyperkalemia symptoms before serious cardiac complications develop.

Position patients in semi-Fowler's position to facilitate lung expansion and reduce dyspnea. Encourage deep breathing exercises and frequent repositioning to prevent atelectasis. Monitor lung sounds for crackles and assess oxygen saturation regularly. These interventions address impaired gas exchange caused by pulmonary fluid buildup.

Regularly assess patient responses to interventions by monitoring vital signs, oxygen saturation, weight changes, and peripheral edema. Educate patients on follow-up care and lifestyle modifications including physical activity and smoking cessation. Adjust the care plan based on these evaluations to achieve therapeutic goals of improved fluid balance and oxygenation.