Managing Acute Kidney Injury: Case Scenario and Nursing Care Plan for Mr. Ron Fraser

In this document we will discuss about Managing Acute Kidney Injury and below are the summary points of this document:- The scenario presents a case of acute kidney injury in a patient named Mr. Ron Fraser. The patient exhibits clinical features and abnormal values in vital signs, indicating a severe state of the disease. Nursing actions are required to address the abnormal values and manage the symptoms of the patient.

UNIVERSITY
NAME
Unit
ASSIGNMENT
Tutor
Date

CARE PLAN
Name of patient: Mr. Ron Fraser Scenario situation
number
Scenario 3a:
Case scenario
Acute kidney injury results from a sudden episode of kidney failure damage occurring within a shorter duration of time. Acute kidney injury can
lead to build up of waste products in the body and affect other body organs. Diagnosing acute kidney injury is key for treatment engagement. A
history of the symptoms by the patient is relevant in making a clear diagnosis. Relevant history on volume restriction such as fluid intake is key.
The patient in the case study portrays clinical features and cues which depict acute kidney injury. Cues such as urine output are key in
assessing kidney functionality.
The patient has the following clinical features;
Na 130mm/L, K 5.5 mmol/mol, Urea 14.0mm/L creatine 150umol/l, RR 28, Oxygen Saturation 89%Bp 160/90, pitting Oedema, pain score 3/10
and body temperature 38.4 degree Celsius.
Comparative normal values
Patient feature Normal values
RR -28bps 12-20bps
Oxygen saturation rate 89% 95%-100%
Blood pressure 160/90 120/80-140/90
Temperature 38.4degrees Celsius 34 degrees Celsius
Creatine level 150umol/L 60-120 umol.L
Sodium level 130mm/L 135mm/l to 145mm/L

CARE PLAN
Urea level 14.0mm/L 2.5-7.1 mmol/L
Table indicating the patient comparative values to normal levels. The table indicated elevated or abnormal values on all patient vitals reflecting
severe state of the disease. Clinical management is geared towards addressing the abnormal values of the patient.
Process information
The patient is experiencing a slow gradual urine flow of 30ml/hr. He has episodes of tiredness and lethargy. The nutrition shows that he has
gradually resumed normal eating and gained 3 kg of weight while his ankles are puffy signifying fluid retention in the body. The symptoms of
the patient reflect an elevated level of cretin, sodium elevated levels. Other symptoms portrayed by the patient include decreased urine output,
fatigue, shortness of breath and ankle swelling signifying fluid retention.
The blood samples show elevated levels of cretin and urea in the blood which signify the presence of kidney dysfunction. Further, the slow
increase in urine output in the blood shows fluid retention in the body. A key function of the kidney is to facilitate filtration and excretion of
nitrogenous was from the blood. Cretin levels are indicative of renal function with defects resulting in limited filtration of creatinine the blood
(Cerda et al., 2008).
Further, patient blood pressure has declined to signify a low supply of blood. Pitting edema shows elevated levels of urine retention in the
body. Further, observed fatigue experienced by the patient signifies that there is a slow body functionality process. Risk factors associated with
Acute Kidney injury include diabetes which the patient has already. Further, he has hypertension which is a risks factor for kidney disease
(Basile, Anderson & Sutton, 2012).
The above data shows that the patient vital signs are elevated hence dignifying a serious state of the disease. All vital assessments are
beyond the normal value range for normal persons, indicating severity of the disease. Normal serum creatine levels include its increase by
0.3mg/dl or 26umol observed within 24 hours and a decrease of urine output by 0.5 ml per kg/h, (Kellum, 2015).

CARE PLAN
Actual nursing
diagnosis with
related to and
evidenced by
statements
The goal of care
including SMART
outcome criteria
Priority Nursing actions (4) including
specific detail
Rationales for actions clearly
explained with in-text reference
The excess fluid
volume as witnessed
by the compromised
mechanism for
regulation secondary
to acute kidney injury
as displayed by pitting
edema at mid-calves
and sacral area
- The patient will
attain a negative or
equal level and output
level during the
continued hospital say.
- The patient will
experience lowered
levels of peripheral
edema of 1+ during a
window period of fewer
than 48 hours.
- The patient will get
an average of 30 ccs or
higher urine output
during the 24 hours post
stay at the hospital.
1. Monitoring of diagnostic studies such
as chest x-rays, ultrasound, and CT of
lab tests such as urinalysis and blood
tests.
- A chest x-ray will be beneficial in
assessing any increase in cardiac size,
pleural fusion or any signs of
pericardial congestion related to an
overload of the fluid.
- Urinalysis assesses the urine
creatinine with indicators on the
decline in urine cretin when there is an
increase in the serum cretin.
- Potassium levels are elevated
indicating kidney disease and lack of
excretion and retention leading to
hyperkalemia.
Diagnostic procedures are
essential tools in confirming the
presence of neurological disorders.
Significant tests entail blood urine and
other substance which aid in diagnosing
and enabling a better understanding of
the diseases (Majumdar, 2010). The
diagnostics tests are essential in
assessing chemical and metabolic
factors on blood. Neurological
assessment aid in visualizing the
functioning of the vital organs such as
the kidney thus being a key aspect in
the diagnosis of acute kidney failure
(Jensen et al., 2009).
Assessment of urine volume
retention is a critical aspect as daily
monitoring of fluid urinated over time

CARE PLAN 2. Monitoring of intake and output of fluid
retention
- Assessment for decrease output levels
with less than 400mL / 24 hours which
can reflect evidence of dependent
edema.
- Assessment of daily weights with keen
interest on less than 0.5 kg per day
indicating fluid retention.
- Identifications of urine characteristics
of urine including its odor, mucus, and
present of sediment.
3. Administration of medications as
prescribed.
- IV fluids recommended, however, can
be withdrawn when signs of fluid
overload are notices.
- Diuretics drugs management may be
offered to flush kidney debris and
decrease fluid overload.
- Administration of calcium channel
blockers offered well in advance so as
to reduce calcium influx in the kidney
cells so as to maintain the integrity of
depicts kidney functionality and ability.
Urine volume analysis is useful in
assessing and diagnosing acute kidney
failure. A critical level of this is referred
to oliguria, which is associated with
acute kidney injury and is linked to
abnormal small volumes of urine hence
key for the patent as a key indicator and
severity of the patient.
Medication regime in acute kidney
injury will be beneficial for the
management of acute kidney injury.
Currently, there are limited
pharmacological approaches to manage
acute kidney injury (Fard et al., 2012).
Frequent doses of IV are essential in
maintaining the output of urine, thus IV
infusions will be essential for this patient
(McDaniel & Bentley, 2015).
Nutrition management in acute
kidney injury is relevant and paramount.
Patients having AKI has elevated
protein catabolism, insulin resistance
and disrupted fat metabolism. The key

CARE PLAN the cell.
4. Nutrition education management
- There is a need for the patient to
limited intake of excess fluids, limit
sodium intake.
- Increase consumption of vegetables
and fruits
- Decrease foods high in potassium
such as beans, rice, and oranges.
- Lowering consumption of whole foods
as they have high phosphorus content.
objective of nutritional management in
AKI patients is attenuate protein
catabolism and replace with associated
lost micronutrients. Hence the need to
review nutrition management as part of
the nursing intervention is key as it
facilitates the healing process (Downs,
2014).
References:
Basile, D. P., Anderson, M. D., & Sutton, T. A. (2011). Pathophysiology of acute kidney injury. Comprehensive Physiology, 2(2), 1303-1353.
Cerdá, J., Lameire, N., Eggers, P., Pannu, N., Uchino, S., Wang, H., ... & Levin, A. (2008). Epidemiology of acute kidney injury. Clinical journal of the American Society of
Nephrology, 3(3), 881-886.
Downs, J. (2014). Nutritional management of acute kidney injury in the critically ill: a focus on enteral feeding. South African Journal of Clinical Nutrition, 27(4), 187-193.
Fard, A., Iqbal, N., Mehta, R. L., Xue, Y., & Maisel, A. S. (2012). Assessing Kidney Injury in Heart Failure: The Role of Biomarkers. Cardiac Biomarkers: Expert Advice for
Clinicians, 168.
Jensen, A. M., Nørregaard, R., Topcu, S. O., Frøkiær, J., & Pedersen, M. (2009). Oxygen tension correlates with regional blood flow in the obstructed rat kidney. Journal of
experimental biology, 212(19), 3156-3163.

CARE PLAN
Kellum, J. A. (2015). Diagnostic criteria for acute kidney injury: present and future. Critical care clinics, 31(4), 621-632.
Majumdar, A. (2010). Sepsis-induced acute kidney injury. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine,
14(1), 14.
McDaniel, B. L., & Bentley, M. L. (2015). The role of medications and their management in acute kidney injury. Integrated pharmacy research & practice, 4, 21.