AKI Nursing Diagnosis Care Plan: Comprehensive Guide for Nurses

Acute Kidney Injury (AKI), previously known as Acute Renal Failure (ARF), is a critical condition characterized by the sudden loss of kidney function. This abrupt decline in renal function leads to the kidneys’ inability to effectively filter waste products from the blood. Consequently, there is a rapid accumulation of these toxins within the body. AKI develops swiftly, often within hours or days, and is particularly prevalent among patients in intensive care settings and those with critical illnesses.

If left unaddressed, AKI can have cascading effects on other organ systems and pose a significant threat to life. Recognizing the signs and symptoms of AKI is crucial for prompt intervention. Common indicators include oliguria (decreased urine production), fluid retention manifesting as edema, dyspnea (shortness of breath), confusion, fatigue, nausea, generalized weakness, and in severe instances, seizures and coma.

This article provides an in-depth exploration of Aki Nursing Diagnosis Care Plans, designed to equip nurses with the knowledge and strategies necessary for optimal patient care. We will delve into the causes, nursing processes, and specific nursing diagnoses relevant to AKI, offering practical guidance for assessment, interventions, and expected outcomes.

Understanding the Etiology of Acute Kidney Injury

Several factors can predispose individuals to AKI, including advanced age, pre-existing hospitalization, and chronic health conditions such as diabetes mellitus, hypertension, heart failure, and liver disease. The underlying causes of AKI are broadly categorized into three distinct groups:

1. Reduced Renal Blood Flow (Prerenal AKI): Conditions that compromise blood flow to the kidneys can trigger AKI. These include:

   • Significant blood loss due to trauma or surgery
   • Liver failure leading to circulatory dysfunction
   • Severe dehydration resulting in hypovolemia
   • Myocardial infarction (heart attack) impairing cardiac output
   • Certain blood pressure medications that can reduce renal perfusion

2. Direct Kidney Damage (Intrarenal AKI): Direct insults to the kidney tissues themselves can cause AKI. These include:

   • Blood clots obstructing renal blood vessels
   • Glomerulonephritis, an inflammation of the kidney’s filtering units
   • Systemic lupus erythematosus (lupus), an autoimmune disease
   • Nephrotoxic medications such as chemotherapy agents and intravenous contrast dyes
   • Substance abuse, including alcohol and illicit drugs
   • Rhabdomyolysis, muscle breakdown releasing harmful substances into the bloodstream

3. Urinary Tract Obstruction (Postrenal AKI): Blockages in the urinary tract that impede urine outflow can lead to AKI. These include:

   • Cancers of the bladder, cervix, colon, or prostate, causing urinary obstruction
   • Kidney stones obstructing the ureters or urethra
   • Nerve damage affecting bladder function and leading to urinary retention

Diagnosing AKI typically involves a combination of laboratory and imaging studies. Blood work, urinalysis, renal ultrasounds, CT scans, and kidney biopsies may be utilized to confirm the diagnosis and determine the underlying cause.

The Essential Role of Nursing Process in AKI Care

Nurses play a pivotal role in the comprehensive care of patients with AKI. Diligent assessment and continuous monitoring are paramount, as subtle changes in patient status can indicate disease progression or the onset of complications. Nurses are integral to the treatment plan, administering prescribed medications such as diuretics to manage fluid overload, potassium-lowering agents to address hyperkalemia, and calcium supplements to correct electrolyte imbalances. In severe AKI cases, dialysis becomes necessary to remove accumulated toxins from the blood, and nurses are crucial in providing care before, during, and after dialysis procedures.

Patient and family education is equally important. Nurses address knowledge deficits regarding AKI causes, prevention strategies, and the importance of adherence to the treatment regimen. Empowering patients and their families with knowledge promotes better understanding and engagement in their care.

Nursing Care Plans for Acute Kidney Injury: Prioritizing Patient Needs

Once nursing diagnoses are established for a patient with AKI, nursing care plans serve as roadmaps for prioritizing assessments and interventions. These plans guide nurses in setting both short-term and long-term goals of care, ensuring a structured and patient-centered approach. The following sections detail examples of nursing care plans for common nursing diagnoses associated with AKI.

Nursing Care Plan: Decreased Cardiac Output

Decreased cardiac output is a potential complication of AKI, often stemming from conditions like heart failure, acute myocardial infarction, or pulmonary embolism. These conditions impair the heart’s pumping efficiency, leading to reduced blood flow throughout the body.

Nursing Diagnosis: Decreased Cardiac Output

Related Factors:

• Fluid overload secondary to impaired kidney function
• Fluid shifts and fluid imbalances
• Electrolyte disturbances, particularly hyperkalemia and hypocalcemia

As Evidenced By:

• Cardiac dysrhythmias and electrocardiogram (EKG) changes
• Jugular vein distention (JVD) indicating increased central venous pressure
• Decreased central venous pressure (CVP) in some cases of fluid shifts
• Dyspnea (shortness of breath) due to pulmonary congestion
• Prolonged capillary refill time indicating poor peripheral perfusion
• Changes in skin color (pallor, cyanosis) reflecting reduced oxygenation
• Diminished peripheral pulses indicating reduced blood flow to extremities
• Crackles in lung sounds indicative of pulmonary edema
• Cough, potentially productive of frothy sputum in pulmonary edema

Expected Outcomes:

• The patient will maintain adequate cardiac output, evidenced by stable heart rate and blood pressure, and renal perfusion indicated by appropriate urine output.
• The patient will demonstrate improved activity tolerance, able to perform Activities of Daily Living (ADLs) without experiencing dyspnea or excessive fatigue.

Nursing Assessments:

1. Regularly assess and monitor heart rate and blood pressure. Rationale: Excess fluid volume and hypertension, common in AKI, increase cardiac workload, potentially leading to heart failure.

2. Auscultate heart sounds and monitor EKG. Rationale: The appearance of new heart sounds like S3 or S4 gallop rhythms, fine crackles in the lungs, and tachycardia can be early indicators of heart failure. Coarse crackles and severe dyspnea suggest pulmonary edema. Dysrhythmias can signal underlying cardiac dysfunction related to electrolyte imbalances or fluid overload.

Nursing Interventions:

1. Administer supplemental oxygen as prescribed. Rationale: High-flow oxygen or mechanical ventilation may be necessary to improve oxygenation, supporting cardiac function and tissue perfusion.

2. Promote rest and energy conservation. Rationale: Frequent rest periods reduce cardiac workload and prevent overexertion. Cluster nursing activities and assessments to minimize interruptions and maximize rest periods.

3. Closely monitor serum electrolyte levels, especially potassium and calcium. Rationale: Hyperkalemia and hypokalemia can significantly affect myocardial function and trigger arrhythmias. Hypocalcemia can exacerbate the toxic effects of hyperkalemia on the heart.

4. Administer prescribed medications as indicated. Rationale: Inotropic agents may be ordered to enhance cardiac contractility and improve cardiac output. However, renal function must be carefully considered when administering these medications. Antidysrhythmics, vasopressors, and blood products may also be necessary depending on the patient’s condition. Closely monitor medication administration to prevent fluid overload.

Nursing Care Plan: Deficient Fluid Volume

Intravascular volume depletion is a significant risk factor for the development and progression of AKI. During the diuretic phase of AKI, patients can experience substantial fluid loss, with daily urine output potentially exceeding 5 liters due to osmotic diuresis and impaired tubular concentrating ability.

Nursing Diagnosis: Deficient Fluid Volume

Related Factors:

• Underlying disease process causing AKI
• Kidney dysfunction leading to fluid loss
• Blood loss contributing to hypovolemia
• Dehydration from inadequate fluid intake
• Excessive fluid loss through various routes (e.g., vomiting, diarrhea)

As Evidenced By:

• Altered mental status, ranging from confusion to lethargy
• Decreased skin turgor, indicating dehydration
• Hypotension (decreased blood pressure)
• Decreased pulse pressure (the difference between systolic and diastolic pressure)
• Tachycardia (rapid heart rate) as a compensatory mechanism
• Decreased urine output, often below 0.5 mL/kg/hr
• Dry skin and mucous membranes
• Increased body temperature
• Complaints of thirst
• Generalized weakness

Expected Outcomes:

• The patient will maintain adequate fluid volume, evidenced by a urine output of 0.5 to 1.5 mL/kg/hr.
• The patient will exhibit stable vital signs within normal limits, including heart rate, body temperature, and blood pressure.

Nursing Assessments:

1. Monitor laboratory values, particularly serum osmolality, BUN, creatinine, and hematocrit. Rationale: Elevated serum osmolality, BUN, creatinine, and hematocrit levels are indicative of hemoconcentration and decreased intravascular volume.

2. Assess and monitor vital signs frequently. Rationale: Patients with deficient fluid volume due to AKI often exhibit tachycardia, orthostatic hypotension, and decreased pulse pressure as the body attempts to compensate for fluid loss and decreased kidney function.

3. Assess and monitor urine characteristics, including output and specific gravity. Rationale: Decreased urine output (less than 0.5 mL/kg/hr) is a key indicator of fluid volume deficit. Urine specific gravity above 1.030 and dark-colored urine further suggest dehydration.

Nursing Interventions:

1. Administer intravenous fluid replacement as prescribed. Rationale: Fluid administration is crucial in AKI to optimize circulating volume, increase cardiac output, improve renal perfusion pressure, and ultimately enhance renal blood flow and function. Blood products may be necessary if fluid volume deficit is due to blood loss.

2. Encourage adequate oral fluid intake around the clock, as indicated and tolerated. Rationale: During the diuretic phase of AKI, inadequate fluid intake can exacerbate hypovolemia and potentially lead to the oliguric phase. Maintaining and preventing hypovolemia is essential to minimize further kidney damage. Offer fresh water and foods with high water content throughout the day.

3. Insert a urinary catheter if indicated and prescribed. Rationale: Urinary catheterization allows for precise measurement of urine output, a critical parameter in monitoring fluid status and guiding fluid replacement therapy. Close monitoring of urine output is associated with improved outcomes in AKI.

4. Address and treat underlying factors contributing to deficient fluid volume. Rationale: If the patient is experiencing fluid losses from vomiting, diarrhea, or fever, implement appropriate interventions to manage these symptoms and prevent further fluid depletion.

Nursing Care Plan: Excess Fluid Volume

Excess fluid volume is a common complication of AKI, resulting from the kidneys’ impaired ability to filter and eliminate excess fluid from the body. Effective management requires careful assessment of volume status, appropriate fluid resuscitation when needed, management of fluid overload, prevention of nephrotoxicity, and adjustments to medication dosages based on renal function.

Nursing Diagnosis: Excess Fluid Volume

Related Factors:

• Compromised regulatory mechanisms due to kidney/renal failure
• Excessive fluid intake, exceeding the body’s ability to excrete it
• Excess sodium intake, contributing to fluid retention

As Evidenced By:

• Fluid intake exceeding urine output, leading to oliguria
• Jugular vein distention (JVD)
• Elevated blood pressure or fluctuating blood pressure readings
• Generalized edema, particularly in dependent areas
• Weight gain, often rapid and unexplained
• Restlessness and anxiety
• Changes in mental status, such as confusion or lethargy
• Adventitious lung sounds (crackles, wheezes) indicating pulmonary congestion
• Dyspnea (shortness of breath)

Expected Outcomes:

• The patient will achieve balanced fluid volume, evidenced by balanced intake and output and absence of weight gain.
• The patient will exhibit stable vital signs and absence of edema.

Nursing Assessments:

1. Accurately assess and monitor intake and output. Rationale: Normal urine output is at least 30 mL/hour. Meticulous intake and output monitoring are essential to assess fluid balance, guide fluid management, and detect early signs of fluid overload or dehydration.

2. Assess for and observe edema in dependent areas such as hands, feet, and the lumbosacral area. Rationale: Edema typically develops in dependent tissues due to gravity. Significant fluid retention can occur before pitting edema becomes apparent; a weight gain of approximately 10 lbs (4.5 kg) may precede the onset of pitting edema.

3. Assess and monitor the patient’s level of consciousness. Rationale: Changes in level of consciousness can indicate fluid shifts, accumulation of metabolic toxins, developing hypoxia, and electrolyte imbalances, all of which can be associated with fluid overload in AKI.

4. Monitor and review relevant laboratory tests, including serum creatinine and blood urea nitrogen (BUN). Rationale: Elevated serum creatinine and BUN levels are key indicators of AKI. Proteinuria may also be present, suggesting kidney damage.

Nursing Interventions:

1. Monitor weight daily. Rationale: Daily weight measurements are a sensitive indicator of fluid status. Sudden weight gain of more than 0.5 kg/day strongly suggests fluid retention.

2. Auscultate lung and heart sounds regularly. Rationale: Fluid overload can lead to heart failure and pulmonary edema. Adventitious breath sounds (crackles, wheezes) and extra heart sounds (S3, S4 gallops) can indicate these complications.

3. Administer or restrict fluids as prescribed and indicated. Rationale: Fluid management is a cornerstone of AKI treatment. Excess fluid volume necessitates careful fluid restriction, while calculated fluid administration may be required in specific situations. Fluid restriction should be implemented in collaboration with the physician and dietitian.

4. Administer prescribed medications as indicated, particularly diuretics. Rationale: Diuretics are commonly prescribed to promote urine output and reduce edema by facilitating fluid excretion.

Nursing Care Plan: Imbalanced Nutrition: Less Than Body Requirements

AKI disrupts the balance between protein breakdown and synthesis, leading to muscle wasting, protein depletion, and weight loss. As kidney function deteriorates, protein-energy wasting accelerates, appetite diminishes, and malnutrition can develop.

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements

Related Factors:

• Dietary restrictions implemented to limit nitrogenous waste products and manage electrolyte imbalances
• Increased metabolic demands associated with illness and kidney injury
• Anorexia (loss of appetite) common in AKI patients

As Evidenced By:

• Joint and muscle pain, potentially related to muscle wasting
• Fatigue and weakness
• Lack of appetite and decreased oral intake
• Decreased serum albumin levels, reflecting protein depletion

Expected Outcome:

• The patient will maintain adequate nutritional status, evidenced by nutritional markers and electrolytes within normal limits, and absence of signs of malnutrition.

Nursing Assessments:

1. Assess and monitor weight trends. Rationale: Weight loss or unexplained weight gain can indicate malnutrition or fluid overload, respectively. Regular weight monitoring helps track nutritional status.

2. Assess and document dietary intake patterns and amounts. Rationale: Monitoring dietary intake helps identify nutritional deficiencies and needs. Factors such as the patient’s general condition, nausea, and anorexia can significantly impact oral intake.

3. Monitor relevant laboratory studies, including albumin, transferrin, iron, glucose, BUN, and amino acid levels. Rationale: These laboratory values provide objective data on protein status, iron stores, glucose metabolism, and nitrogen balance, helping to identify specific nutritional deficits.

Nursing Interventions:

1. Educate the patient and family about appropriate dietary regimens and restrictions. Rationale: Providing education empowers patients and families to actively participate in dietary management within the context of their restrictions. Current guidelines recommend controlled and moderate protein intake for AKI patients to minimize nitrogenous waste buildup while meeting nutritional needs.

2. Encourage meticulous mouth care before meals. Rationale: Dry mucous membranes, cracked lips, and mouth sores are common in AKI and can impair appetite and oral intake. Good oral hygiene enhances taste and makes eating more comfortable and appealing, potentially improving appetite.

3. Consult with a registered dietitian for comprehensive nutritional support. Rationale: Dietitians are experts in medical nutrition therapy and can precisely determine individual calorie and nutrient needs within the patient’s dietary restrictions and medical condition. They can develop personalized nutrition plans and recommend the most effective routes of nutritional support (oral, enteral, or parenteral).

4. Encourage and provide small, frequent meals. Rationale: Small, frequent meals are often better tolerated than large meals in patients with AKI who may experience anorexia, nausea, and early satiety. This approach promotes appetite, ensures consistent nutrient intake, and can reduce nausea and vomiting.

Nursing Care Plan: Risk for Electrolyte Imbalance

AKI, even mild kidney injury, can disrupt fluid and electrolyte balance. The kidneys play a critical role in regulating electrolyte concentrations in the body, and impaired kidney function can lead to significant imbalances.

Nursing Diagnosis: Risk for Electrolyte Imbalance

Related Factors:

• Underlying disease process causing AKI
• Kidney dysfunction impairing electrolyte regulation
• Excess fluid volume or fluid overload
• Insufficient fluid volume or dehydration
• Compromised regulatory mechanisms of the kidneys

As Evidenced By:

• Risk diagnoses are not evidenced by existing signs and symptoms, as the problem has not yet occurred. Nursing interventions are focused on prevention.

Expected Outcomes:

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

Nursing Assessments:

1. Assess the patient’s heart rate and rhythm regularly. Rationale: Potassium and calcium imbalances are common in AKI and can manifest as cardiac arrhythmias, palpitations, muscle weakness, pain, spasms, nausea, and paresthesias (abnormal sensations).

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

3. Assess and monitor fluid intake and output balance. Rationale: Discrepancies between intake and output can indicate fluid overload or deficit, both of which can contribute to electrolyte imbalances.

4. Regularly assess and monitor laboratory values, particularly serum electrolytes (sodium, potassium, calcium, phosphorus), BUN, and creatinine. Rationale: AKI can damage renal tubules, impairing sodium conservation and potassium excretion, leading to hyponatremia (low sodium) and hyperkalemia (high potassium). BUN and creatinine levels are indicators of kidney function and will typically be elevated in AKI.

Nursing Interventions:

1. Maintain accurate records of fluid intake and output and monitor daily weight changes. Rationale: Meticulous intake and output monitoring, along with daily weights, provide sensitive and consistent indicators of fluid balance and potential electrolyte shifts associated with fluid volume changes.

2. Administer intravenous fluids with caution and as prescribed. Rationale: While fluid resuscitation may be necessary in AKI, especially if dehydration is a contributing factor, rapid fluid administration can exacerbate electrolyte imbalances, particularly sodium and potassium. Fluid administration should be carefully guided by the patient’s fluid and electrolyte status.

3. Implement potassium restrictions as prescribed and indicated. Rationale: Patients with AKI are prone to hyperkalemia due to impaired potassium excretion. Dietary potassium restriction is often necessary to reduce the risk of hyperkalemia and its cardiac complications.

4. Carefully review the potential effects of the patient’s ordered medications on renal function and electrolyte balance. Rationale: Many medications, including diuretics, IV contrast media, chemotherapy agents, and certain antibiotics, can be nephrotoxic and/or affect electrolyte balance. Monitoring medication effects and adjusting dosages as needed based on renal function is crucial.

5. Educate the patient and family about the signs and symptoms of electrolyte imbalances. *Rationale: Providing education empowers patients and families to recognize early symptoms and seek timely medical attention. Key symptoms to educate about include:

   • Hypokalemia: Muscle weakness, nausea, vomiting, irregular pulse, constipation.
   • Hyperkalemia: Restlessness, slow heart rate, muscle weakness, cramping, diarrhea.
   • Hyponatremia: Muscle cramps, nausea, disorientation, mental status changes.
   • Hypernatremia: Thirst, dry mucous membranes, hypotension, tachycardia, confusion, seizures.*

References

(List of references would be included here in a complete article, but as per instructions, this section is omitted for this response.)