Last updated on January 26th, 2024 at 05:13 pm
Acute Kidney Injury Nursing Care Plans Diagnosis and Interventions
Acute Kidney Injury NCLEX Review and Nursing Care Plans
The kidneys have a wide range of functions. Their primary role is to remove waste from the bloodstream. They also manage blood pressure by removing excess fluid from the blood.
Also, kidneys aid in the production of red blood cells, the regulation of electrolytes, and the activation of vitamin D.
Knowing that our kidneys serve a variety of roles in maintaining our bodies’ health, one can only imagine what would happen if they were damaged. One of the common kidney diseases that occur most of the time in conjunction with another medical condition or event is acute kidney injury (AKI).
Acute kidney injury is a sudden loss of kidney function in which the kidneys are unable to filter waste products from the blood. When the kidneys lose their ability to filter waste, the chemical makeup of the blood may go out of balance, and dangerous levels of waste may accumulate.
Acute renal failure is another name for acute kidney injury. It can damage other organs, including the brain, heart, and lungs, and develops fast, generally in a few hours or days.
Acute kidney injury is more likely to occur among individuals who have already been admitted to a hospital, particularly those who are severely ill and require intensive care.
Acute kidney injury affects one in every million persons in the United States each year, and it is identified in 1% among all hospital admissions.
If left untreated, acute kidney injury can lead to chronic renal failure, which is fatal and requires a lot of treatment. Acute kidney injury may also be reversible in patients who do not have other serious health problems. These patients may regain normal or near-normal kidney function if managed earlier.
The goal of nursing care for individuals with acute kidney injury is to address or eliminate any causes that can be reversed. Prompt diagnosis of AKI’s underlying causes, correcting fluid and electrolyte imbalances, acid-base balance stabilization, proper nutrition, and preventing complications are all part of patient care.
Signs and Symptoms of Acute Kidney Injury
Acute kidney injury can have diverse signs and symptoms, depending on the etiology, which includes the following:
- Scanty or insufficient urine output, but may also be normal to some patients on occasion
- Swelling of the legs, ankles, and around the eyes as a result of fluid retention
- Tiredness or fatigue
- Breathing difficulty
- Confusion
- Nausea
- Pressure or pain in the chest
- abnormal heart rhythm
- In severe cases, seizures or comas
In some circumstances, acute kidney injury has no signs and symptoms and is only discovered by coincidence when a healthcare provider orders various tests.
Causes of Acute Kidney Injury
Acute kidney injury can be caused by a variety of causes, including the following:
- Decreased blood flow to the kidneys. Acute kidney injury can be caused by a variety of diseases and conditions that impede or reduce blood flow to the kidneys, such as:
- Hypotension (low blood pressure) or shock
- Loss of blood or fluids (such as bleeding, severe diarrhea)
- Decreased heart function caused by cardiovascular disorders.
- Organ failure
- Over usage of non-steroidal anti-inflammatory drugs (NSAIDs), used to treat headaches, colds, flu, and other common illnesses.
- Anaphylaxis
- Severe burns
- Major operations
2. Direct Kidney Damage. Diseases, conditions, and substances that damage the kidneys and cause acute kidney injury include:
- Sepsis or severe response to an infection
- Inflammation of the small filters in the kidneys – known as glomerulonephritis
- Hemolytic uremic syndrome – a disorder in which red blood cells are destroyed prematurely
- Lupus, an autoimmune disease that can also cause glomerulonephritis
- Scleroderma, a rare skin and connective tissue disorders
- A rare blood condition known as thrombocytopenic purpura
- Toxins from muscle tissue disintegration (rhabdomyolysis) induce acute kidney injury
- Tumor lysis syndrome – occurs when tumor cells are broken down, resulting in the release of toxins that can damage the kidneys
- Infection from viruses
- Certain medications such as dyes used during imaging examinations, chemotherapy drugs, and some antibiotics
- Toxic substances similar as alcohol, heavy metals, and illegal drugs
3. Urine Obstruction. Conditions or disorders that obstruct the flow of urine out of the body can cause acute kidney injury in some individuals. The following circumstances can result in a blockage:
- Cancer of the prostate, cervix, or bladder
- Enlargement of the prostate or Benign prostatic hyperplasia (BPH) in men
- Nerve damage affecting bladder control and urination
- Stones such as renal calculi, nephrolithiasis or urolithiasis
- Bleeding from the urinary tract causing blood clots
Risk Factors of Acute Kidney Injury
Acute kidney injury typically often develops as a result of another medical illness or occurrence. The following are among the conditions that can increase the risks of getting acute kidney injury:
- Hospital confinement, especially for a serious medical condition that necessitates critical care
- Old age
- Peripheral artery disease
- Diabetes Mellitus
- Elevated blood pressure
- Heart failure
- Other kidney problems
- Liver failure or other liver diseases
- Cancers and chemotherapies
Treatment for Acute Kidney Injury
Acute kidney injury frequently necessitates hospitalization for treatment, though the majority of individuals who have them have already been admitted to a hospital for various reasons. The length of stay in the hospital is determined by the cause of the acute kidney injury and the rate at which the kidneys recover.
The primary goal of the healthcare practitioner is to find out what is causing the acute kidney injury so that it can be treated. Until the kidneys recover, the healthcare provider will attempt to address all the symptoms and complications.
Dialysis may also be required in more critical situations to assist in the replacement of renal function until the kidneys are fully recovered.
After an acute kidney injury, there is an increased risk of developing additional health problems such as other kidney disease, stroke, or heart disease in the future. Recurrence of acute kidney injury is also possible. Every time an acute kidney injury occurs, the chances of developing kidney disease and kidney failure also increase.
It is vital to regularly get in touch with the physician to keep track of kidney function. Preventing acute kidney injury or finding and treating it as soon as feasible is the best method to reduce the risk of kidney damage and preserve renal function.
Prevention of Acute Kidney Injury
It can be difficult to anticipate or avoid acute kidney injury, there are a few ways to help kidneys stay in good condition:
- Read the labels carefully when taking over-the-counter (OTC) painkillers. To avoid acute kidney injury, strictly follow the directions for OTC painkillers, as taking too much can cause kidney damage. If an individual has a history of kidney disease, diabetes, or high blood pressure, this is even more essential.
- Manage kidney and other chronic illnesses with the support of a healthcare provider. Stay on track with the treatment plans and follow the physician’s instructions to manage health for kidney disease or another condition, such as diabetes or high blood pressure, that raises the risk of acute kidney injury.
- Take the action to live a healthy life. Be active, eat a well-balanced and healthy diet, and only drink alcohol in moderation as much as possible.
Acute Kidney Injury Nursing Diagnosis
Nursing Care Plan for Acute Kidney Injury 1
Fluid Volume Excess
Nursing Diagnosis: Fluid Volume Excess related to impaired regulatory mechanism of the kidneys secondary to acute kidney injury as evidenced by generalized edema, decreased urine output with low urine specific gravity, distended neck veins, elevated blood pressure, sudden weight gain, congested lungs in x-ray, electrolytes imbalance, and decreased hematocrit level.
Desired Outcome:
The patient will have adequate urine output, acceptable laboratory tests results, steady weight, normal range of vital signs, and absence of edema.
| Nursing Interventions for Acute Kidney Injury | Rationale |
| Monitor and document the patient’s intake and output (I & O) accurately. | Acute failure, especially in high-risk patients, may be characterized by a decreased output of about less than 400 ml per 24 hours. I & O must be closely monitored to reduce the risk of fluid overload, determine the kidney function, and recognize the need for fluid replacement in the patient. |
| Closely monitor urine specific gravity of the patient. | The ability of the kidney to concentrate urine is measured by its specific gravity. The ability to concentrate urine is usually compromised if the specific gravity is less than or equal to 1.010. |
| Weigh the patient every day at the same time, on the same scale, and in the same clothes and equipment. | The best way to check fluid levels is to weigh the patient every day, as fluid retention is usually demonstrated by a daily weight gain of more than 0.5 kg. |
| Using a scale of +1 to +4, assess the degree of edema on the skin, face, and dependent body parts. | Pitting edema can only be recognized once the patient accumulates up to 10 lbs. (4.5 kg) of fluid in the dependent parts of the body, such as the hands, feet, or lumbosacral area. On the other hand, periorbital edema could already indicate a fluid shift, since even a few amounts of fluid can quickly widen these delicate tissues. |
| Monitor the patient’s heart rate (HR), blood pressure, and presence of jugular vein distention (JVD), as well as the sounds of the lungs and heart. | Increased heart rate and blood pressure occur when the functions of the kidneys are impaired. Invasive monitoring may be required, especially in patients with impaired cardiac function. Similarly, fluid overload may lead to pulmonary edema and heart failure. These complications can be recognized in the presence of adventitious breath sounds and abnormal heartbeat. |
| Fluids should be offered and/or restricted as necessary. | Fluid management is usually done to stimulate kidney function. |
| Administer medications as prescribed. | Medications such as diuretics and anti-hypertensives are usually prescribed to promote adequate urine volume and control the effects of fluid overload. |
| Evaluate the patient’s state of consciousness and note any changes in mental function or apparent restlessness. | Fluid imbalances, toxins buildup, acidosis, electrolyte imbalances, or emerging hypoxia may all contribute to changes in mental state. |
| Ensure adequate safety precautions, such as raising the side rails. | This condition can cause dizziness and/or confusion in a patient with Central Nervous System impairment. |
| Monitor diagnostic tests such as blood urea nitrogen (BUN), creatinine, serum sodium/potassium, hemoglobin (Hb) or hematocrit (Hct), chest x-rays. | Abnormal values of these tests may signify renal dysfunction, impaired absorption/excretion, fluid overload, dehydration, or pulmonary congestion. |
Nursing Care Plan for Acute Kidney Injury 2
Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to fluid overload and electrolyte imbalance secondary to acute kidney injury
Desired Outcome: The patient will maintain cardiac output as evidenced by an acceptable range of blood pressure and heart rate, firm peripheral pulses, and good capillary refill time.
| Nursing Interventions for Acute Kidney Injury | Rationale |
| Monitor the patient’s blood pressure and heart rate. | When accompanied by hypertension and the consequences of uremia, fluid volume overload increases cardiac workload that can lead to heart failure. Fortunately, this type of heart failure is frequently reversible in patients with acute kidney injury. |
| Observe the patient’s ECG for rhythm alterations. | In response to progressive renal failure, toxins accumulation, and electrolyte imbalance, changes in electromechanical function may become apparent. |
| Auscultate the heart and notify the healthcare provider of any significant heart sounds. | Heart failure is signaled by the presence of extra heart sounds (S3 or S4) during auscultation, which may necessitate immediate treatment and possibly dialysis. |
| Take note of the capillary refill time and the color of the skin, mucous membranes, and nail beds. | The skin’s unusual paleness could indicate a blood vessel narrowing or anemia, whereas cyanosis, or bluish discoloration, is a late indicator of lung congestion and/or heart failure. |
| Evaluate complaints of muscle cramps, numbness, twitching muscles, and hyper-reactive reflexes. | These are neuromuscular signs of hypocalcemia or low levels of calcium in the blood, which can also affect the function and contractility of the heart. |
| Watch out for low pulse, low blood pressure, flushing, nausea and vomiting, and a low level of consciousness. | Hypermagnesemia can be caused by some medications, such as magnesium-containing antacids, which can exacerbate neuromuscular impairment and increase the risk of respiratory or cardiac arrest. |
| Promote sufficient rest and provide assistance on preferred activities of the patient. | Oxygen intake and heart workload are both reduced when the patient has sufficient rest. |
| Administer supplemental oxygen, as necessary | To reduce cardiovascular activity and cellular hypoxia |
| Administer prescribed medications accordingly | The healthcare provider may prescribe some medications to increase myocardial contractility and stroke volume in order to enhance cardiac output. |
Nursing Care Plan for Acute Kidney Injury 3
Risk for Imbalanced Nutrition
Nursing Diagnosis: Risk for Imbalanced Nutrition: Less Than Body Requirements related to dietary restrictions to reduce nitrogenous waste products, increased metabolic needs, and nausea/vomiting secondary to acute kidney injury
Desired Outcome: The patient will maintain acceptable weight.
| Nursing Interventions for Acute Kidney Injury | Rationale |
| Evaluate and document the patient’s dietary patterns. | Evaluation of the dietary intake of the patient aids in identifying imbalances and nutritional requirements. |
| Encourage and provide small but frequent feedings. | It reduces nausea and vomiting that come with a uremic state and/or poor peristaltic movement. |
| Educate the patient about the recommended foods and drinks and encourage participation in the menu selections. | It increases the patient’s control over dietary requirements and may help him to eat more. |
| Take the patient’s weight on a daily basis. | The average weight loss of a fasting patient is 0.2 kg to 0.5 kg per day. Changes over 0.5 kg could indicate a change in the fluid equilibrium in the body. |
| Consult the dietitian’s support team for advice. | The dietician calculates the most effective route and product for each person’s calorie and nutrient needs within the dietary restrictions. |
| To meet caloric needs, provide a high-calorie, low-to-moderate-protein diet with complex carbohydrates and fat sources, but avoid concentrated sugar sources. | Unless the patient is undergoing dialysis, the amount of supplemental protein required is lower than usual. Carbohydrates provide energy while limiting tissue breakdown. In severe kidney injury, diabetes mellitus (DM) might develop. Therefore, concentrated sugar sources must be avoided. |
| Limit the patient’s consumption of potassium, sodium, and phosphorus as required. | Limiting these electrolytes may be necessary to prevent further kidney damage, especially if dialysis is not part of the treatment plan and/or if the acute kidney injury is in its early stages of recovery. |
| Maintain a decent electrolyte balance in the patient by constantly checking on his or her levels. | Electrolyte imbalances and a decrease in Glomerular Filtration Rate (GFR) might lead to additional kidney injury. |
| Administer medications as prescribed by the healthcare provider. | To improve cardiac and neuromuscular function, blood coagulation, and bone metabolism, several medications may be prescribed to restore normal serum levels of deficient minerals. In addition, antiemetics may be administered to increase oral intake by relieving nausea and vomiting. |
Nursing Care Plan for Acute Kidney Injury 4
Risk for Infection
Nursing Diagnosis: Risk for Infection secondary to weakened immune system, invasive interventions such as urinary catheterization, and changes in nutritional consumption secondary to acute kidney injury
Desired Outcome: The patient will not manifest any signs and symptoms of infection.
| Nursing Interventions for Acute Kidney Injury | Rationale |
| Strongly encourage patients and staff to wash their hands properly. | Handwashing is the most effective yet simplest method of reducing the risk of cross-contamination. |
| Practice aseptic techniques when caring for and managing IV and invasive lines, and avoid manipulating indwelling catheters wherever possible. | These methods prevent bacteria from entering the body and causing infection. |
| Remove the indwelling catheter as soon as possible and provide thorough perineal and routine catheter care. | To reduce bacterial growth and the risk of Urinary Tract Infection (UTI). |
| Promote breathing techniques, coughing, and changing positions on a regular basis. | These techniques mobilize secretions and lessen the risk of lung infections. |
| Monitor the patient’s vital signs. | A common symptom of an inflammatory process is a fever of more than 100.4 degrees Fahrenheit, accompanied by increased pulse and respirations. |
| Monitor the patient’s white blood cells (WBC) count. | Leukocytosis is a common complication of acute kidney injury, despite the fact that increased white blood cells may also indicate a widespread infection. |
| Assess the condition of the patient’s skin. | When the kidneys are unable to maintain the proper balance of minerals and nutrients in the blood, dry and itchy skin might develop as a result of acute kidney injury or other kidney disorders. Scratching excoriations have the potential to become secondarily infected. |
Nursing Care Plan for Acute Kidney Injury 5
Risk for Deficient Fluid Volume
Nursing Diagnosis: Risk for Deficient Fluid Volume related to excessive loss of fluid secondary to acute kidney injury
Desired Outcome: The patient will demonstrate good skin turgor, moist mucosal membranes, acceptable input and output balance, palpable peripheral pulses, electrolytes within normal range, and steady weight and vital signs.
| Nursing Interventions for Acute Kidney Injury | Rationale |
| Accurately measure the patient’s input and output by daily weighing and calculating the insensible fluid losses. | Fluid replacement needs can be estimated through accurate measurement. The amount of fluid consumed should also be comparable to the amount lost through urination, nasogastric or wound drainage, and insensible water loss. |
| Ensure that allowable fluids are available for a 24-hour period. | If fluid intake is not maintained or nighttime dehydration occurs, the diuretic phase of acute kidney injury may revert to oliguric phase. |
| Monitor heart rate and blood pressure by taking note of postural changes. | Hypovolemia is demonstrated by postural hypotension and tachycardia. |
| Assess the patient for signs and symptoms of dehydration which include frequent thirst, dry mucous membranes, decreased sensorium, peripheral vasoconstriction. | Urine excretion can surpass 3 Liters per day in diuretic or post-obstructive kidney injury. The thirst center is activated when the extracellular fluid volume is depleted, and sodium depletion induces persistent thirst that cannot be satiated by drinking water. Hypovolemia can develop as a result of prolonged fluid loss and insufficient replenishment. |
| Restrict the use of bed linens as necessary and control the temperature of the room. | These interventions may reduce excessive sweating, which contributes to overall fluid depletion. |
| Monitor the patient’s laboratory tests | Large urine deficits may result in sodium depletion in non-oliguric acute kidney injury or in the diuretic phase, while high urinary sodium works osmotically to augment fluid losses. To stop the cycle, sodium restriction may be recommended. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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