Acute Kidney Injury Nursing Management
Monitor for complications, participate in emergency treatment of fluid and electrolyte
imbalances, assess the patient’s progress and response to treatment, and provide physical and
emotional support. In addition, keep family members informed about the patient’s condition,
help them understand the treatments, and provide psychological support. Although the
development of AKI may be the most serious problem, continue to provide nursing care
indicated for the primary disorder
Nursing Interventions Rationale
Monitoring Fluid and Electrolyte Balance
Monitor the patient’s serum electrolyte To monitor kidney function and fluid retention
levels Determine levels generally within reference
ranges in patients before treatment
Assess heart rate, blood pressure, To monitor physical indicators of these
jugular venous pressure, capillary refill complications during all phases of the acute
(should be <3 secs), conscious level kidney injury
Aids in evaluating status
IV solutions must be carefully selected Treatment is to administer fluid to try to
based on the patient’s fluid and manage the cause of AKI.
electrolyte status as ordered by the Fluid restrictions, as well as extracellular
physician shifts, can aggravate drying of mucous
membranes, and the client may desire more
fluids that are prudent.
Frequent monitoring of patient’s CVP measurements and musculoskeletal
cardiac function and musculoskeletal monitoring are helpful in determining the
degree of fluid deficit and response to
replacement therapy
Status are monitored closely for signs Hyperkalemia is the most immediate life-
of hyperkalemia threatening imbalance seen
Parenteral fluids, all oral intake, and all To ensure that sources of potassium are not
medications are screened carefully inadvertently given or consumed
Monitor fluid status by paying careful Determine signs of hyperkalemia and help
attention to fluid intake (IV formulate appropriate interventions to prevent
medications should be given in the further complications
smallest volume possible), urine output,
apparent edema, distention of the Decreased renal perfusion, cardiac
jugular veins, alterations in heart insufficiency, and fluid shifts may cause
sounds and breath sounds, and decreased urinary output and edema formation.
increasing difficulty in breathing.
Accurate daily weights, as well as I&O Aids in evaluating status
records
Indicators of deteriorating fluid and Severe fluid and electrolyte disturbances may
electrolyte status are reported be treated with hemodialysis, PD, or CRRT.
immediately to the primary provider,
and preparation is made for emergency
treatment.
Reducing Metabolic Rate
Bed rest may be indicated To reduce exertion and the metabolic rate
during the most acute stage of the disorder
Fever and infection, both of which Prevent worsening of condition
increase the metabolic rate and
catabolism, are prevented or treated
promptly
Promoting Pulmonary Function
Assist patient to turn, cough, and take To prevent atelectasis and respiratory tract
deep breaths frequently infection.
Asses for drowsiness and lethargy May prevent the
patient from moving and turning
Preventing Infection
An indwelling urinary catheter is Due to the high risk of UTI associated with its
avoided whenever possible use but may be required to provide ongoing
data required to accurately monitor fluid I&O.
Providing skin care and meticulous skin Asepsis is essential with invasive lines and
care is important catheters to minimize the risk
of infection and increased metabolism
Bath the patient with cool water, Excoriation and itching of the skin may result
frequent turning, and keep the skin from the deposit of irritating toxins in the
clean and well moisturized and the patient’s tissues.
fingernails trimmed To avoid excoriation are often comforting and
prevent skin breakdown.
Providing Psychosocial Support
Patient with AKI may require treatment The length of time that these treatments are
with hemodialysis, PD, or CRRT. The necessary varies with the cause and extent of
patient and family need assistance, damage to the kidneys. Ensure patient and
explanation, and support during this family are informed regarding the condition
period.
and procedure
High levels of anxiety and fear may The purpose of the treatment is explained to
necessitate repeated explanation and the patient and family to alleviate anxiety and
clarification by the nurse fear
Family members should be encouraged It is essential that the psychological needs and
and assisted to talk to the patient during other concerns of the patient and family be
these procedures addressed. Continued assessment of the patient
for complications of AKI and precipitating
causes is essential
Gerontologic Considerations
All medications need to be monitored Compromising already decreased renal
for potential side effects that could function.
result in damage to the kidney either
through reduced circulation or
nephrotoxicity.
Require careful monitoring of fasting or Outpatient procedures that require fasting or a
a bowel preparation bowel preparation may
cause dehydration
Nutritional Therapy
Weigh patient daily Identify fluid retention
Encourage patient to have Caloric Because carbohydrates have a protein-sparing
requirements met with high effect
carbohydrate meals
Foods and fluids containing potassium Compromising already elevated potassium
or phosphorus are restricted. levels
Patient is placed on a high-protein, Following the diuretic phase
high-calorie diet and is encouraged to
resume activities gradually
Reference:
Hinkle, J. L., & Cheever, K. H. (n.d.). Management of Patients with Kidney Disorders. In
Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed., Vol. 2, pp. 1576-
1581). Wolters Kluwer.
