The nurse is caring for a post-op client after renal artery bypass for an arterial occlusion. To promote the goal of effective kidney function, the nurse includes which intervention(s) in the plan of care?
• By definition, Acute Kidney Injury (AKI) is an abrupt decrease (within 48 hours) in kidney function that includes an increase in serum creatinine (either an absolute increase of greater than 0.3 mg/dL or a percentage increase of 50%) or a decrease in urine output (less than 0.5 mL/kg/hour for more than 6 hours). It may be caused by disease or injury. Kidney function usually returns to baseline if AKI is identified early and appropriately treated.
• To promote effective kidney function, the nurse should include interventions that support renal perfusion, monitor the patient's kidney function by evaluating labs and data being collected, and reporting noteworthy findings.
• Administering IV fluids ensures adequate fluid volume for circulation of oxygenated blood to the renal and peripheral tissues.
• Maintaining strict I&O promotes the goal of effective tissue perfusion by collecting data on the progression and treatment of the acute kidney injury.
• Monitoring serial creatinine levels evaluates kidney function following response to treatment.
• Monitoring urine specific gravity is important. This measures the kidney’s ability to concentrate urine. In AKI, specific gravity is usually equal to or less than 1.010, indicating loss of ability to concentrate the urine. If urine specific gravity trends lower in the recovery phase, this requires reporting to the provider to facilitate evaluation and intervention.
• Blood and drainage may appear on dressings or beneath the site because of gravity. Monitoring for this is important, and it contributes toward the goal of kidney function by monitoring for complications that would compromise renal perfusion.
• Remember that “interventions” may include monitoring, evaluating, or observing. These are interventions when implemented to address patient problems already identified in the assessment phase.
• Evaluating the effectiveness of pain medication helps determine the adequacy of analgesia, but does not address kidney function directly.