NSG 252 Objectives Acute Kidney Injury PDF

**NSG 252** **OBJECTIVES** **[Acute Kidney Injury]** 1. **Analyze factors that place clients at risk for fluid and electrolyte imbalances across the lifespan** - **Infants and Children:** Higher metabolic rates, immature kidneys, and higher body water content make infants and children...

**NSG 252** **OBJECTIVES** **[Acute Kidney Injury]** 1. **Analyze factors that place clients at risk for fluid and electrolyte imbalances across the lifespan** - **Infants and Children:** Higher metabolic rates, immature kidneys, and higher body water content make infants and children prone to dehydration or electrolyte imbalances (e.g., diarrhea, vomiting). - **Older Adults:** Aging kidneys, chronic diseases (e.g., heart failure, kidney disease), and medications (e.g., diuretics) increase the risk of imbalances such as dehydration, hyperkalemia, or hyponatremia. - **Acute Illness or Trauma**: Burns, sepsis, and surgical procedures can cause significant fluid loss or retention, altering electrolyte levels (e.g., hypovolemia, hypernatremia). - **Chronic Diseases:** Conditions like diabetes (DKA), heart disease, and kidney disease affect fluid and electrolyte homeostasis. - **Medications:** Diuretics, corticosteroids, and antidiabetics can cause imbalances like hypokalemia or hypernatremia. Real-Life Example: A child with severe gastroenteritis (vomiting and diarrhea) is at high risk of dehydration and hypokalemia, while an elderly patient with chronic kidney disease may develop hyperkalemia due to the kidneys' reduced ability to excrete potassium. 2\. **Plan prevention strategies related to fluid and electrolyte imbalances** **Prevention Strategies:** - Education: Teach patients and caregivers about the importance of hydration and balanced electrolyte intake, especially during illnesses (e.g., vomiting or fever) or in extreme heat. - Early Monitoring: Regularly monitor fluid intake/output, especially in high-risk groups (infants, elderly, or those with chronic illnesses). - Nutrition: Encourage a balanced diet with adequate fluid intake and appropriate electrolyte-rich foods (e.g., bananas for potassium, salt for sodium) or supplements. - Medications: Adjust medications, such as diuretics or ACE inhibitors, to avoid adverse effects on electrolyte balance. Real-Life Example: For a heart failure patient on diuretics, monitoring daily weights and adjusting diuretic dosages can help prevent dehydration or electrolyte depletion. 3\. **Analyze assessment data through information technology, diagnostic and laboratory tests to determine the client's fluid and electrolyte status** **Assessment Tools:** - Laboratory Tests: Serum electrolyte levels (Na, K, Ca, Mg), blood urea nitrogen (BUN), creatinine, and arterial blood gases (ABGs) are critical in diagnosing imbalances. - Vital Signs and Physical Exam :Assess blood pressure (hypotension in dehydration), heart rate, skin turgor, edema, and mucous membranes. - Fluid Balance Charting: Input-output (I&O) tracking helps monitor fluid loss/gain. - IT Systems: Use electronic health records (EHRs) to track trends in lab values and fluid balance over time. Real-Life Example: In a patient with severe dehydration, elevated serum sodium (hypernatremia) and increased BUN/creatinine ratio indicate the need for rehydration therapy. 4\. **Demonstrate nursing judgment, while providing culturally competent care across the life cycle for acutely ill clients with fluid and electrolyte imbalances** **Nursing Judgment:** - Holistic Assessment: Consider cultural practices that may influence hydration and diet, such as fasting, salt intake, or the use of herbal remedies. - Tailored Communication: Use appropriate language and explanations for different cultures or age groups, ensuring patient understanding about the importance of fluid and electrolyte management. - Family Involvement: Engage family members in culturally sensitive care plans for pediatric or geriatric patients. Real-Life Example: For a Muslim patient fasting during Ramadan, the nurse should educate them on the risks of dehydration and suggest strategies like adequate hydration during non-fasting hours. 5\. **Practice safe, caring, and evidence-based interventions for acutely ill clients with fluid and electrolyte imbalances** **Interventions:** - IV Fluid Therapy: Administer isotonic fluids (e.g., normal saline) to treat dehydration, and use caution with hypotonic or hypertonic solutions to avoid cerebral edema or other complications. - Electrolyte Replacement: Provide potassium supplements (oral or IV) in hypokalemic patients or restrict potassium intake in hyperkalemia. - Monitoring: Continuously monitor electrolytes, especially during rehydration or medication administration to avoid overcorrection. Real-Life Example: A patient with diabetic ketoacidosis (DKA) requires careful fluid resuscitation and potassium monitoring, as insulin therapy can shift potassium into cells, leading to hypokalemia. 6\. **Collaborate with the interdisciplinary team to plan and implement interventions for acutely ill clients with fluid and electrolyte imbalances** **Collaboration:** - Physicians/Endocrinologists: Collaborate to adjust IV fluids, electrolyte replacement, and medication doses. - Dietitians: Develop tailored nutrition plans to restore electrolyte balance through diet. - Pharmacists: Ensure appropriate medications are used, including reviewing any drug-drug interactions affecting fluid and electrolyte levels. Real-Life Example: In a patient with heart failure and hyperkalemia, a multidisciplinary team including a nephrologist, cardiologist, and dietitian works together to optimize medication, diet, and fluid management. 7\. **Prioritize care for acutely ill clients with fluid and electrolyte imbalances using the nursing process** **Prioritization:** - Assessment: Identify the most critical imbalances based on labs, vitals, and symptoms (e.g., dysrhythmias in hyperkalemia). - Intervention: Administer emergency treatments (e.g., calcium gluconate for hyperkalemia) or initiate IV fluids in hypovolemia. - Re-evaluation: Continuously monitor the patient's response to therapy and adjust the plan as needed. Real-Life Example: In a patient with severe hyponatremia (Na \< 120 mmol/L), the immediate priority is preventing seizures through slow, controlled sodium replacement. 8\. **Manage the principles of pharmacology for clients with fluid & electrolyte alterations across the lifespan** **Pharmacology Principles:** - Diuretics: Monitor for electrolyte depletion (e.g., hypokalemia with loop diuretics, hyperkalemia with potassium-sparing diuretics). - Electrolyte Supplements: Administer potassium, magnesium, or calcium with awareness of contraindications and potential interactions. - IV Fluids: Understand different fluid types (isotonic, hypertonic, hypotonic) and when to use them based on the patient's condition. Real-Life Example: A patient with severe hyperkalemia may be treated with a combination of calcium gluconate, insulin, and glucose to stabilize cardiac function and lower serum potassium. 9\. **Manage the appropriateness, accuracy, and client response to pharmacology principles for clients with fluid & electrolyte alterations** **Management:** - Appropriateness: Ensure that prescribed medications align with the patient's current fluid/electrolyte status (e.g., avoid potassium-sparing diuretics in hyperkalemia). - Accuracy: Administer medications in correct doses and routes (e.g., IV potassium must be diluted to avoid cardiac issues). - Monitoring Response: Track the patient's vitals, labs, and physical symptoms to evaluate the effectiveness of treatment. Real-Life Example: For a patient on high-dose diuretics, routine monitoring of potassium and magnesium levels is essential to prevent arrhythmias. 10\. **Analyze the relationship between fluid and electrolyte imbalances and other concepts/systems** **Relationship with Other Systems:** - Cardiovascular System: Electrolytes like potassium and calcium are critical for heart function. Imbalances can lead to arrhythmias or heart failure. - Renal System: The kidneys play a key role in maintaining fluid and electrolyte balance. Kidney failure can lead to imbalances like hyperkalemia, hyponatremia, or fluid overload. - Endocrine System: Hormones like aldosterone and antidiuretic hormone (ADH) regulate sodium and water balance, so conditions like SIADH or adrenal insufficiency cause imbalances.