Question

Patient Profile

A.S. is a 70-year-old female who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness
• Reported that she had not been taking her medications regularly at home because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
• 24-hour urine output = 380 mL
• Laboratory Tests:
  • Hemoglobin 8 g/dL
  • Hematocrit 23.8%
  • RBC 2.57 million/mm³
  • WBC 4.7 mm³
  • Sodium 132 mEq/L
  • Potassium 5.2 mEq/L
  • Calcium 9 mg/dL
  • BUN 36 mg/dL
  • Creatinine 4.9 mg/dL
  • BNP 182 pg/mL

Questions: (1-3 are the priority for me, but the rest would be great as well)

1) Is this cause of AKI classified as prerenal, intrarenal, or postrenal? Explain your answer.

2) What phase of AKI is A.S. in?

3) What additional tests, if needed, could be done to determine the cause of AKI?

4) What are the priority nursing diagnoses to address the concern of fluid retention?

5) What are the priority nursing interventions for these nursing diagnoses?

6) What are the goals of conservative therapy for a patient with AKI?

7) What is the most likely cause of A.S.’s AKI?

8) Interpret A.S.’s laboratory test results and describe their significance.


(nursing, med-surg, critical care)

Answer 1

Answer 1: The cause of AKI classified as prerenal. This is due to the presence of the chronic diseases such as hypertension and diabetes, which causes severe impact on the blood supply to the kidney.

Answer 2: The A. s. Is in the phase of the oliguric phase of AKI. As the patient urine output is less than the 400ml which means that the patient has excessive fluid volume.

Answer 3: The collection of blood sample taken to do the diagnostic test and identify the various serum levels. The ultrasound and CT scan can reve about the dysfunction of the kidney.

Answer 4:The nurse need to intervene such as:

• Providing oxygen to the patient.
• Restrictions of the fluid intake.
• Position the patient correctly.
• Patient should be provided psychological support.