Nursing Care Plan on Acute Kidney Injury - Nurseslab.in (2025)

Acute kidney injury (AKI), also known asAcute Renal Failure (ARF)occurs when thekidneys lose their filtering ability resulting in the build-up of waste products in the blood. This condition develops rapidly, in hours or days, and iscommon in critically ill patients.

This condition affects other organs in the body if not treated promptly and can be life-threatening. Common signs and symptoms include oliguria, fluid retention,edema,dyspnea,confusion,fatigue,nausea, weakness, andseizuresand coma in severe cases.

Causes

Advanced age, already being hospitalized, and chronic conditions likediabetes,hypertension,heart failure, and liver disease increase the risk of AKI. The causes of AKI are categorized into 3 sections.

1.Impaired blood flow from:

• Blood loss
• Liver failure
• Severe dehydration
• Myocardial infarction
• Blood pressure medications

2.Direct kidney damage due to:

• Blood clots
• Glomerulonephritis
• Lupus
• Medications likechemotherapydrugs or IV contrast
• Alcohol or drug use
• Rhabdomyolysis

3.Urinary blockage from:

• Cancer of the bladder, cervix,colon, and prostate
• Kidney stones
• Nerve damage

The diagnosis of AKI can be confirmed through blood work, urinalysis, ultrasounds or CT scans, and biopsy.

Nursing Process

Assessment and monitoring play an essential role in the nursing care for patients with AKI, as subtle changes can signal progression of the disease or the development of complications. Nurses are involved in treatment by administering medications like diuretics, potassium-lowering drugs, and calcium supplements. In severe cases, dialysis is indicated to help remove toxins from the blood. Nurses may care for patients before, during, and after dialysis treatments.

Patient education is also important to address the patient’s and the family member’sknowledge deficitsrelated to the causes and prevention of AKI.

Nursing Assessment

Nursing assessment of patients with suspected AKI involves a thorough evaluation of the patient’s history, physical examination, and diagnostic tests. Key components of the assessment include:

Nursing Interventions

Nursing interventions for patients with AKI focus on addressing the underlying cause, preventing complications, and supporting renal function. Key interventions include:

Nursing Care Plans

Once the nurse identifiesnursing diagnosesfor acute kidney injury,nursing care planshelp prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for acute kidney injury.

Decreased Cardiac Output

Decreased cardiac output in patients with acute kidney injury may be caused by heart failure, acute myocardial infarction, or pulmonary embolus. This results in decreased pumping of the heart and reduced blood flow to the rest of the body.

Nursing Diagnosis:Decreased Cardiac Output

Related to:

• Fluid overload
• Fluid shifts, fluid deficits
• Electrolyte imbalance

As evidenced by:

• Dysrhythmias, EKG changes
• Jugular vein distention
• Decreased central venous pressure
• Dyspnea
• Prolonged capillary refill
• Color changes (pallor, cyanosis)
• Decreased peripheral pulses
• Crackles in lungs
• Cough

Expected outcomes:

• Patient will maintain normal cardiac output as evidenced by stable heart rate and blood pressure along with renal perfusion observed by urine output
• Patient will demonstrate activity tolerance as evidenced by performing ADLs without dyspnea

Assessment:

1. Assess and monitor heart rate and blood pressure.
Excess fluid volume and hypertension can increase cardiac workload which may lead to cardiac failure.

2. Monitor heart sounds and EKG.
The new onset of gallop (S3, S4) rhythm, fine crackles in the lungs, andtachycardiacan indicate the onset of heart failure. In pulmonary edema, the patient will exhibit coarse crackles during inspiration and severe dyspnea. The development of dysrhythmias can signal cardiac dysfunction.

Interventions:

1. Administer oxygen.
High-flow oxygen or a ventilator may be necessary to increase oxygenation for cardiac function andtissue perfusion.

2. Encourage bed rest.
Frequent rest is required to prevent overexertion and stress on the heart. Group activities and assessments to reduce interruptions and maximize sleep.

3. Monitor electrolytes.
Increased and decreased levels of potassiumcan affect the heart muscle and cause arrhythmias. Calcium has cardiac effects and decreased levels can enhance the toxic effects of potassium.

4. Administer medications as indicated.
Inotropic agents may be prescribed to improve cardiac output though care must be taken to preserve renal function. Antidysrhythmics, vasopressors, and blood products may be required. Monitor administration closely to prevent fluid overload.

Deficient Fluid Volume

Intravascular volume depletion is a risk factor for acute kidney injury. During the diuretic phase of acute kidney injury, the patient’s daily urine output can reach up to 5 L or more due to osmotic diuresis and the inability of the tubules to concentrate urine.

Nursing Diagnosis:Deficient Fluid Volume

Related to:

• Disease process
• Kidney dysfunction
• Blood loss
• Dehydration
• Excessive fluid loss

As evidenced by:

• Altered mental status
• Altered skin turgor
• Decreased blood pressure
• Decreased pulse pressure
• Tachycardia
• Decreased urine output
• Dry skin
• Dry mucous membranes
• Increased temperature
• Thirst
• Weakness

Expected outcomes:

• Patient will maintain a urine output of 0.5 to 1.5 mL/kg/hr.
• Patient will exhibit heart rate, body temperature, and blood pressure within normal limits.

Assessment:

1. Monitor lab values.
Serum osmolality, BUN, creatinine, and hematocrit will be elevated with decreased intravascular volume.

2. Assess and monitor the patient’s vital signs.
Patients with AKI exhibit alterations in vital signs, including tachycardia, orthostatic hypotension, and decreased pulse pressure to compensate for problems with deficient fluid volume caused by loss of kidney function.

3. Assess and monitor the patient’s urine characteristics.
Assessing and monitoring the patient’s urine characteristics can help determine fluid volume deficits in patients with AKI. A decrease in urine output is less than 0.5mg/kg/hr. Urine specific gravity measures the kidney’s ability to concentrate urine. A urine specific gravity above 1.030 and dark-colored urine signals dehydration.

Interventions:

1. Administer intravenous fluid replacement as indicated.
Fluid administration in AKI is indicated to help optimize circulating volume, increase cardiac output, promote perfusion pressure, and ultimately improve renal blood flow and function. Blood products may also be necessary if fluid volume deficit is caused by blood loss.

2. Encourage adequate fluid intake 24/7 as indicated.
During the diuretic phase, AKI may progress to the oliguric phase if fluid intake is not maintained. Reversal and prevention of hypovolemia are vital in preventing further kidney damage. Provide fresh water and foods with high water content throughout the day.

3. Insert a urinary catheter as indicated.
The placement of a urinary catheter allows for accurate measurement of urine output. Intensive monitoring of urine output is associated with improved outcomes in AKI.

4. Treat factors contributing to deficient fluid volume.
If the patient is experiencing vomiting,diarrhea, and fever and is unable to tolerate PO intake, treat these symptoms to prevent further fluid loss.

Excess Fluid Volume

Excess fluid volume is common in patients with AKI due to the kidneys inability to filter and get rid of excess fluid in the body. Its management will include volume status determination, fluid resuscitation, fluid overload management, nephrotoxicity prevention, and adjustment of medications based on the patient’s renal function.

Nursing Diagnosis:Excess Fluid Volume

Related to:

• Compromised regulatory mechanism (kidney/renal failure)
• Excess fluid intake
• Excess sodium intake

As evidenced by:

• Fluid intake is greater than output; oliguria
• Jugular vein distention
• Blood pressure changes
• Generalized edema
• Weight gain
• Restlessness
• Changes in mental status
• Adventitious lung sounds
• Dyspnea

Expected outcomes:

• Patient will display balanced fluid volume as evidenced by balanced I&O without weight gain.
• Patient will exhibit stable vital signs with the absence of edema.

Assessment:

1. Assess and monitor intake and output accurately.
Normal urine output is at least 30mL/hour. Accurate monitoring of intake and output is necessary to preserve renal function, replace fluids as needed, and reduce the risk of fluid overload.

2. Assess and observe for edema of the hands, feet, and lumbosacral area.
Edema occurs primarily in dependent tissues throughout the body like the lumbosacral area, feet, and hands. The patient can gain about 10 lbs or 4.5kg before pitting edema occurs.

3. Assess and monitor the patient’s level of consciousness.
Changes in the level of consciousness may indicate fluid shifts, accumulation of toxins, developing hypoxia, andelectrolyte imbalance.

4. Monitor and review laboratory tests.
Rises in serum creatinine levels and blood urea nitrogen (BUN) can identify AKI. Proteinuria can also indicate kidney damage.

Interventions:

1. Monitor weight daily.
Daily weights will help monitor fluid status. Sudden weight gain of more than 0.5kg/day can indicate fluid retention.

2. Auscultate lung and heart sounds.
Fluid overload can lead to heart failure andpulmonary edemaas evidenced by the development of extra heart sounds and adventitious breath sounds.

3. Administer or restrict fluids as indicated.
Fluid management is essential in the treatment of AKI. Excess fluid volume requires a calculated administration of fluids and also the restriction of fluids orally.

4. Administer prescribed medications as indicated.
Diuretics are prescribed to promote urine output and reduce edema.

Imbalanced Nutrition: Less Than Body Requirements

AKI is associated with the imbalance of protein breakdown and production, resulting in muscle wasting, protein wasting, and weight loss. As kidney function continues to deteriorate, protein-energy wasting accelerates, appetite decreases, andmalnutritionwill start to develop.

Nursing Diagnosis:Imbalanced Nutrition

Related to:

• Dietary restrictions to reduce nitrogenous waste products
• Increased metabolic needs
• Anorexia

As evidenced by:

• Joint and muscle pain
• Fatigue
• Lack of appetite
• Decreased albumin

Expected outcomes:

• Patient will remain free of malnutrition as evidenced by nutritional markers and electrolytes within normal limits

Assessment:

1. Assess and monitor weight.
Monitoring the patient’s weight will help determine a loss of weight or weight gain which can signal malnutrition or fluid overload.

2. Assess and document dietary intake.
Monitoring dietary intake will help in identifying the patient’s dietary deficiencies and needs. The patient’s general physical condition and lack of appetite may be affecting intake.

3. Monitor laboratory studies.
Assess albumin, transferrin, iron,glucose, BUN, and amino acid levels to identify gaps in nutrition.

Interventions:

1. Educate the patient about appropriate dietary regimens and restrictions.
This will provide the patient with a certain measure of control within his or her dietary restrictions. Recent dietary guidelines recommend controlled and moderate protein intake for patients with AKI.

2. Encourage mouth care before meals.
Mucous membranes may be cracked or dry and can develop mouth sores. Clean oral hygiene makes eating more pleasant and may help with increasing appetite.

3. Consult with a dietitian for support.
Dietitians can help determine individual calorie and nutrient needs within the patient’s dietary restrictions. They can help formulate the most effective routes and regimens for the patient’s nutritional needs.

4. Encourage and provide small but frequent meals.
Small frequent meals promote appetite, provide nutrients, and reduce nausea and vomiting which are common in patients with AKI.

Risk for Electrolyte Imbalance

Acute kidney injury can range from slight deterioration in kidney function to severe impairment, which can alter the balance of fluid and electrolytes.

Nursing Diagnosis:Risk for Electrolyte Imbalance

Related to:

• Disease process
• Kidney dysfunction
• Excess fluid volume
• Insufficient fluid volume
• Compromised regulatory mechanism

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred.Nursing interventionsare aimed at prevention.

Expected outcomes:

• Patient will maintain serum potassium, sodium, calcium, and phosphorus levels within normal range.
• Patient will remain free from signs of fluid and electrolyte imbalance, including muscle cramping, edema, and irregular heart rate.

Assessment:

1. Assess the patient’s heart rate and rhythm.
Potassium and calcium imbalances are common complications of AKI and will manifest with heart palpitations, muscle pain and spasms, nausea, or paresthesias.

2. Assess and monitor the patient’s neurologic status and alterations in consciousness.
Sodium imbalance is associated with AKI and will cause neurologic changes in patients, including confusion, headache, irritability, and seizures.

3. Assess and monitor the patient’s intake and output.
Intake that doesn’t match output is an obvious sign of fluid overload, which can result in imbalanced electrolytes.

4. Assess laboratory values.
AKI causes damage to the renal tubules, preventing them from conserving sodium and excreting potassium, resulting in low serum sodium and high potassium levels. BUN and creatinine levels will also increase with AKI.

Interventions:

1. Record accurate intake and output and weight changes.
Meticulous intake, output, and daily weight measurements offer a consistent and sensitive indicator of excess fluid volume.

2. Administer IV fluids with caution.
AKI commonly results from severe dehydration. Rapid fluid resuscitation may be necessary but can adversely affect electrolytes.

3. Restrict potassium intake.
Patients with AKI tend to exhibit high levels of potassium as it is not excreted optimally by the kidneys. Potassium restrictions in the diet are vital in reducing the risk of hyperkalemia.

4. Review the effects of the patient’s ordered medications.
Medications such as diuretics, IV contrast, chemotherapy, and some antibiotics can adversely affect the patient’s kidney function and subsequent electrolyte balance.

5. Educate the patient on symptoms of alterations in electrolytes.
Signs and symptoms of hypokalemia include muscle weakness, nausea, vomiting, irregular pulse, and constipation, while symptoms of hyperkalemia include restlessness, slow heart rate, muscle weakness, cramping, and diarrhea. Early signs ofhyponatremiainclude muscle cramps, nausea, disorientation, and mental status changes. Symptoms of hypernatremia include thirst, dry mucous membranes, hypotension, tachycardia, confusion, and seizures.

Nursing Diagnosis and Rationale for Acute Kidney Injury

1. Fluid Volume Excess

Rationale: Acute Kidney Injury (AKI) can lead to the kidneys’ inability to excrete excess fluid, resulting in fluid volume overload. This can manifest as edema, hypertension, and pulmonary congestion. Nurses should monitor the patient’s fluid balance by keeping track of intake and output, daily weights, and assessing for signs of fluid overload. Interventions may include fluid restriction, administering diuretics as prescribed, and providing education on managing fluid intake.

2. Electrolyte Imbalance

Rationale: AKI can disrupt the kidneys’ ability to maintain electrolyte balance, leading to conditions such as hyperkalemia, hyponatremia, and hyperphosphatemia. Nurses should regularly monitor the patient’s electrolyte levels through blood tests and assess for signs and symptoms of imbalance, like muscle weakness, cardiac arrhythmias, and confusion. Interventions include administering electrolyte supplements or medications to correct imbalances and educating the patient about dietary modifications.

3. Risk for Infection

Rationale: Patients with AKI are at increased risk for infections due to compromised immune function and the potential need for invasive procedures such as dialysis. Nurses should monitor for signs of infection, including fever, increased white blood cell count, and localized signs of infection at catheter sites. Implementing strict hand hygiene, aseptic techniques during procedures, and educating the patient on infection prevention strategies are crucial in mitigating this risk.

4. Impaired Skin Integrity

Rationale: Fluid retention and edema associated with AKI can lead to increased skin fragility and risk for breakdown. Nurses should regularly assess the patient’s skin for signs of pressure ulcers, edema, and other abnormalities. Interventions include repositioning the patient frequently, using pressure-relieving devices, maintaining skin hygiene, and applying moisturizers or barrier creams to protect the skin.

5. Impaired Gas Exchange

Rationale: Fluid overload in AKI can lead to pulmonary edema, resulting in impaired gas exchange and respiratory distress. Nurses should monitor the patient’s respiratory status, including respiratory rate, oxygen saturation, and the presence of crackles or wheezes. Interventions may include providing supplemental oxygen, positioning the patient to enhance lung expansion, and administering medications such as diuretics or bronchodilators as prescribed.

6. Anxiety

Rationale: The sudden onset of AKI and the potential for severe complications can cause significant anxiety for patients and their families. Nurses should assess the patient’s anxiety levels and provide emotional support, reassurance, and education about the condition and its management. Encouraging participation in support groups and providing resources for psychological counseling can help patients and families cope with the emotional challenges associated with AKI.

7. Deficient Knowledge

Rationale: Patients and families may have a limited understanding of AKI, its causes, and management strategies. Nurses should assess the patient’s and family’s knowledge and provide comprehensive education about the condition, treatment options, and the importance of adherence to prescribed regimens. Providing written materials, visual aids, and encouraging questions can help patients and families feel more confident in managing AKI.

REFERENCES

1. Acute Kidney Injury (AKI). Medscape. Updated: Jun 10, 2022.https://emedicine.medscape.com/article/243492-overview
2. Acute Kidney Injury. NHS. 2019. Fromhttps://www.nhs.uk/conditions/acute-kidney-injury/
3. Acute Kidney Injury (AKI). National Kidney Foundation. 2022. Fromhttps://www.kidney.org/atoz/content/AcuteKidneyInjury
4. Goyal A, Daneshpajouhnejad P, Hashmi MF, et al. Acute Kidney Injury. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK441896/
5. Mayo Clinic. (2020, July 23). Acute kidney failure – Symptoms and causes. Mayo Clinic. Fromhttps://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048
6. Ostermann, M., Straaten, H.M.Ov. & Forni, L.G. Fluid overload and acute kidney injury: cause or consequence?. Crit Care 19, 443 (2015).https://doi.org/10.1186/s13054-015-1163-7

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