The next week, the patient's urine output increases to 3500 mL over 24 hours. The BUN and creatinine remain elevated and the GFR is now 48 mL/min
Which collaborative and nursing actions will you plan to implement during the diuretic phase of acute kidney injury?
What will be an ideal response?
Important Points:
During the diuretic phase of acute kidney injury, the kidneys are unable to concentrate urine and urine output increases to as much as 5 L/day.
The patient may develop dehydration and hypovolemia, with potential shock and recurrent kidney injury.
The kidney continues to be unable to perform other functions, such as remove metabolic wastes, control acid-base balance, and maintain normal electrolyte levels.
The patient may develop hyponatremia and hypokalemia during this phase.
Nursing and collaborative interventions include:
Careful assessment for manifestations of dehydration and hypovolemia: vital sign changes, such as hypotension and tachycardia, poor pulse quality, flat neck veins, dry oral mucosa, poor skin turgor, and changes in orientation and alertness.
Assessment for electrolyte disturbances, such as hyponatremia or hypokalemia caused by diuresis.
Infusion of fluids (based on the patient's I & O and fluid balance) and monitoring for signs of fluid excess, such as hypotension or hypertension, tachycardia, increased respiratory rate and dyspnea, crackles in the lungs, pericardial and pleural friction rubs, peripheral edema, and increases in daily weights.
You might also like to view...
One of the differences in using the Z-track method of IM medication administration and the usual IM injection is that the Z-track method:
a. takes more time b. does not have the site rubbed or wiped after administration c. is more painful d. requires a larger needle and syringe
The nurse will instruct a patient with an automatic implantable cardioverter-defibrillator (AICD) to avoid:
a. static electricity from synthetic fabric. b. airport security detection devices. c. constricting clothing and belts. d. high altitudes.
The nurse is assessing a client's susceptibility to rejecting a transplanted kidney. Which result does the nurse recognize as increasing the client's chances of rejection?
a. Decreased T-lymphocyte helper b. Decreased white blood cell count c. Increased cytotoxic-cytolytic T cell d. Increased neutrophil count
The client's arterial blood gas reveals pH 7.49, PaCO2 31, and HCO3– 25. Which acid-base imbalance does the nurse determine the client has?
1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis