Of the following patients in an intensive care unit, the nurse identifies which patient as being at highest risk for the development of acute kidney injury with a prerenal cause? A patient who is:
1. Experiencing acute status asthmaticus
2. Being treated for hypertension following a cerebral vascular accident
3. In skeletal traction following a motor vehicle accident
4. Post-operative from a ruptured abdominal aortic aneurysm
4
Rationale 1: Status asthmaticus is a severe airway obstruction that results in respiratory acidosis. There is not an associated reduction in cardiac output linked with this problem.
Rationale 2: Hypertension is associated with the development of chronic renal failure and end stage renal disease.
Rationale 3: Long bone fractures can result in blood loss but the amount of blood lost is less than what would be considered as a prerenal cause for acute kidney injury.
Rationale 4: Prerenal failure commonly results from a pronounced reduction in cardiac output due to severe hypotension, hypovolemia, or severe vasoconstriction. The patient who has experienced significant blood loss as in a ruptured aortic aneurysm would be at greatest risk for the development of acute kidney injury with a prerenal cause.
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