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Nursing Care Plan for Acute Kidney Injury (AKI)

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Nursing Care Plan for Acute Kidney Injury (AKI)

Introduction

Acute Kidney Injury (AKI) is a regular and dangerous medical situation that results from

swift kidney function loss. The condition occurs commonly among hospitalized patients who

either have hypertension or diabetes or encounter nephrotoxic substances during their treatment.

For both patients and their healthcare providers, AKI establishes formidable difficulties because

its swift development holds the risk of advancing to persistent kidney disease as well as causing

damage to multiple organs (Chicca, 2020). Through early warning detection, nurses oversee

immediate action response while teaching patients about complications prevention strategies. A

patient with AKI admission provides a care plan that illustrates the nursing process application

for complete patient-focused care delivery.

Problem-Based Care Plan

Case Scenario

The 55-year-old female patient Mrs. L visited the emergency department because she

experienced severe fatigue combined with reduced urine volume as well as confusion. Mrs. L

has failed to produce any significant urine during the previous 24 hours while also revealing

hypertension as her medical history along with managing it using ACE inhibitors. After

receiving a recent abdominal surgery, she treated her postoperative pain with NSAIDs as she

chose to manage her symptoms on her own. Her vital signs showed hypotension together with

tachycardia. The analysis through blood tests showed high creatinine at 3.2 mg/dL alongside

BUN elevation at 45 mg/dL and potassium reached 6.0 mEq/L and signs of metabolic

acidosis. The test revealed a diagnosis of AKI because of hypovolemia and nephrotoxic drug

exposure.
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Pathophysiology of the Disease process:

Acute Kidney Injury (AKI) produces a fast reversible process that diminishes renal function

which ultimately causes metabolic waste collection and fluid along with electrolyte and acid-

base imbalances (Chicca, 2020). Decreased glomerular filtration rate (GFR) stands as a major

indicator of AKI because it blocks the kidneys from removing nitrogenous wastes including

urea and creatinine. Three separate subtypes compose the classification structure of AKI:

prerenal intrinsic and postrenal. Most cases of Prerenal AKI develop because reduced renal

perfusion occurs through factors that include hypovolemia and dehydration as well as

hemorrhage and heart failure.

The failure to treat prerenal AKI causes the condition to advance into intrinsic injury. Renal

structures which include the glomeruli tubules and interstitium suffer damage as part of

intrinsic AKI. Acute tubular necrosis (ATN) appears as the prominent intrinsic form of AKI

and develops because of nephrotoxin exposure and medication use of NSAIDs and

aminoglycosides together with ischemic causes (Dainton, 2024). Obstructed urine flow

because of kidney stone tumors or prostatic hypertrophy creates elevated pressure which

diminishes kidney functions to produce Postrenal AKI.

Pathophysiologically, AKI results in fluid overload, electrolyte abnormalities such as

hyperkalemia), and metabolic acidosis due to hydrogen ion retention. Clinical manifestations

of these disturbances include oliguria combined with generalized edema and changes in

mental status and cardiovascular instability that require both fast diagnosis and treatment.

Relevant assessment data Nursing Diagnoses:

Subjective:
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a) Reports feeling very weak and dizzy, a) Excess Fluid Volume

likely due to fluid imbalance, A direct relationship exists between

hypotension, or electrolyte impaired renal excretion from AKI

disturbances. because patients show urinary volume

b) Evaluate operational indicators of reduction and generalized edema and

oliguria and kidney filtration abnormal lab results with elevated

dysfunction (Goyal et al., 2023). BUN/creatinine levels.

c) Uremia and accumulated nitrogenous b) Risk for Electrolyte Imbalance

waste products are believed to be (Hyperkalemia)

responsible for his nausea symptoms. The patient demonstrates renal clearance

d) Headaches could be caused by reduction from AKI according to potassium

hypertension or accumulation of toxic measurements of 6.0 mEq/L and ECG

uremic substances. indications of peaked T waves.

e) Generalized tiredness due to a c) Impaired Skin Integrity

combination of reduced renal function The patient shows generalized swelling along

together with metabolic acidosis. with fragile skin because of edema and

immobility caused by fluid overload

conditions.
Objective:
d) Decreased Cardiac Output

The patient shows evidence of dysrhythmias

caused by hyperkalemia through ECG

changes as well as hypotension combined

with tachycardia.
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e) Risk for Infection

The patient faces two main risk factors for

infection: invasive lines alongside weak

immune response which stems from both

surgery events and implanted medical

devices.

Outcome (Patient’s Goals)

Short term:

Diagnosis 1: Excess Fluid Volume

a) The patient will produce at least 0.5 mL of urine for each kilogram of body weight

during the two-day observation period.

b) The patient will present reduced peripheral edema, especially in their lower extremities

within 72 hours.

c) Complete assessment of the patient's lungs through listening while determining the

absence of wheezing or breathing difficulties during the 48-72-hour timeframe.

d) The patient needs to lose at least 1 kg through fluid removal within the 72-hour

timeline.

e) A patient’s blood pressure reaches the target range (systolic BP ≥100 mmHg) during

the initial 48 hours following treatment implementation.

Long term:

a) Urine output exceeding 0.5 mL/kg/hr becomes observable in the patient within 48

hours as an improvement sign.

b) Peripheral edema will diminish in the lower extremities in less than 72 hours according
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to assessment results.

c) Symptoms of dyspnea or crackles and obstructed lung sounds will not be detected

during 48-72 hours of patient evaluation through auscultation.

d) Achieves blood pressure control within the target range (systolic BP ≥ 100 mmHg)

during the first 48 hours.

Nursing Diagnosis 2: Risk for Electrolyte Imbalance (Hyperkalemia)

Short term

a) The intervention will result in potassium measurements reaching ≤ 5.0 mEq/L within

48 hours of starting the treatment.

b) In 48 hours’ patients will maintain stable ECG readings without the presence of peaked

T waves and arrhythmias (Goyal et al., 2023).

c) Within 72 hours the patient will demonstrate knowledge about the approaches to lower

potassium levels which include taking medications as well as dietary restrictions.

d) A normal level between 3.5–5.0 mEq/L of potassium will develop in the patient during

48-72 hours.

e) The patient will show normal serum potassium results along with mental status

improvement to alertness and orientation during the 72-hour observation period.

Nursing Interventions. Evidence-base rationale.

Diagnosis 1: Excess Fluid Volume Rationale 1: Monitoring intake and output

Intervention 1: Managing Excess Fluid regularly helps to detect imbalances early

Volume
Monitoring of fluid intake and output
Proper management of excessive fluid
becomes essential for Acute Kidney Injury
quantity remains central when treating Acute
cases since this condition affects renal
Kidney Injury patients to stop pulmonary
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edema and hypertension from developing. function which decreases kidney fluid

I&O measurements should be tracked by excreting ability. Two-hour I&O

nurses at least twice every 2 hours as a documentation helps healthcare staff monitor

critical nursing practice. Close evaluation of fluid retention and excretion by patients (Hsu

fluid balance identification enables clinicians et al., 2020). Healthcare providers should

to detect worsening fluid overload rapidly detect early fluid imbalances swiftly because

which allows better treatment adjustments. this provides appropriate time to modify their

Monitoring I&O allows accurate assessment treatment approaches including diuretic

of renal function as well as therapy response administration and fluid quantity adjustments.

which directs the need for medical When healthcare providers do not monitor

interventions such as diuretics or dialysis. patients often they will miss fluid overload

Nurses must monitor daily for increasing which results in pulmonary congestion and

edema as well as lung crackles and weight worsens edema while causing cardiovascular

changes besides other signs. issues including hypertension (James et al.,

Intervention 2 2020). The detection of fluid imbalances

A second intervention involves administering through I&O assessments prompts healthcare

the prescribed diuretics while following providers to implement safe fluid

healthcare provider orders regarding fluid management systems that prevent the

intake levels (James et al., 2020). The worsening of conditions.

utilization of furosemide diuretics happens Rationale 2: Administering diuretics

cautiously in AKI patients to achieve both promotes excretion of excess fluid and

diuresis objectives and fluid retention prevents complications.

reduction. Nurses exercise crucial The medical treatment of fluid overload in

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responsibility for infusing fluids according to patients with AKI who produce urine includes

patients' hemodynamic parameters their test a prescription of loop diuretic medicine

results and their urine output amount. Patients furosemide among other options. The

need limited fluid intake to stop worsening medication induces diuresis to eliminate

edema and hypertension symptoms. A critical excess fluids which minimizes edema and

aspect of care includes instructing patients improves lung condition through decreased

about the necessary limits on fluid pulmonary congestion (James et al., 2020).

consumption. The interventions work to This therapeutic strategy both alleviates

achieve fluid balance while easing discomfort swelling pressures caused by increase body

for patients and stopping pulmonary weight and prevents dangerous medical

congestion and heart failure from occurring. conditions like pleural effusion and

Multiple assessments of the patient’s state pulmonary edema. As part of their role,

help healthcare providers tailor their nurses evaluate patients receiving diuretic

treatment methods according to how their treatment to monitor their responses and

condition develops. maintain electrolyte balance stability while

adjusting medications when fluid balance

needs adjustment.

Rationale 1: Administering insulin with

glucose helps shift potassium

intracellularly, reducing serum potassium

levels.

Provide insulin and glucose to patients as an

immediate solution. Insulin enables

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potassium to exit from the bloodstream into

cells thus decreasing serum potassium at first

followed by diminished cardiac dysrhythmia

probability (James et al., 2020). Glucose

administration runs alongside insulin at the

same time to stop insulin-induced

hypoglycemia events from developing.

Hospital patients with severe hyperkalemia

that exceeds 6.0 mEq/L will benefit most

from this life-saving treatment regimen along

with sodium polystyrene sulfonate as these

medicines combine to remove potassium

from the bloodstream through the intestine.

Rationale 1: Continuous ECG monitoring

detects life-threatening dysrhythmias

related to hyperkalemia.

The electric activity of the heart undergoes

direct effects from hyperkalemia which

produces distinct abnormalities on the ECG

including peaked T waves and widened QRS

complexes alongside life-threatening

arrhythmias such as ventricular fibrillation

and asystole. The continuous ECG

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monitoring system quickly detects dangerous

heart rhythms that permit nurses to perform

rapid calcium gluconate treatments to restore

cardiac membrane stability (Rankin, 2021).

The responsibility of nurses includes both

ECG interpretation and reporting significant

abnormalities to providers while

simultaneously performing necessary

emergency procedures to safeguard patients’

lives.

Evaluation of goal and patient response to interventions

For Diagnosis 1: Excess Fluid Volume

a) The patient’s urinary output reached 35 mL/hr as edema decreased notably during the

first two days after starting treatment (Rankin, 2021). The patient displayed

understanding about fluid restrictions by speech along with showing improvements in

their cardiovascular balance.

b) The risk of electrolyte imbalance presents a new diagnosis.

c) Laboratory tests revealed a reduction of potassium level to 4.8 mEq/L since the

intervention began while the ECG reading returned to normal.

d) Electrocardiogram monitoring revealed no arrhythmias so the patient stayed in a stable

condition continuously.

Patient Education

a) The patient should know about nephrotoxic drugs including NSAIDs and need to
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follow their prescribed hypertension medications and diuretic treatments.

b) The patient needs to learn why monitoring daily weights and following fluid

restrictions as directed protects against fluid overload (Rankin, 2021).

c) The patient requires instruction about kidney dysfunction warning signals (including

oliguria and swelling) as well as early medical intervention to stop AKI occurrence.

Conclusion

Timely identification of Acute Kidney Injury becomes critical because it needs complex

nursing interventions for its management. The care plan shows how nurses serve as essential

components by monitoring and treating fluid and electrolyte problems in patients with AKI

through strategic interventions combined with patient education. Proper management enables

medical professionals to lower adverse effects and stabilize kidney function while enhancing

patient recovery. Preventing renal relapses and maintaining permanent kidney wellness depends

on giving patients whole-person care together with complete comprehension of their situation.

References
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Chicca, J. (2020, March 3). American Nurse: The Official Journal of the American Nurses

Association (ANA). American Nurse. https://www.myamericannurse.com/adults-with-

chronic-kidney-disease-overview-and-nursing-care-goals/

Dainton, M. (2024). Acute Kidney Injury. 115–131. https://doi.org/10.1002/9781394178797.ch5

Goyal, A., Daneshpajouhnejad, P., Hashmi, M. F., Bashir, K., & John, B. K. (2023). Acute

Kidney Injury (Nursing). PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK568593/

Hsu, C., Chinchilli, V. M., Coca, S., Devarajan, P., Ghahramani, N., Go, A. S., Hsu, R. K.,

Ikizler, T. A., Kaufman, J., Liu, K. D., Parikh, C. R., Reeves, W. B., Wurfel, M.,

Zappitelli, M., Kimmel, P. L., & Siew, E. D. (2020). Post–Acute Kidney Injury

Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial

Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study.

JAMA Internal Medicine, 180(3), 402–410.

https://doi.org/10.1001/jamainternmed.2019.6390

James, M. T., Bhatt, M., Pannu, N., & Tonelli, M. (2020). Long-term outcomes of acute kidney

injury and strategies for improved care. Nature Reviews Nephrology, 16(4), 193–205.

https://doi.org/10.1038/s41581-019-0247-z

Rankin, H. (2021). Reducing Incidence of Contrast-Induced Acute Kidney Injury Through

Nursing Education. JSU Digital Commons.

https://digitalcommons.jsu.edu/etds_nursing/18/