Acute Kidney Injury (AKI) Case Study
Fluid and Electrolyte Concept
NUR 443 Spring 2020
A.S. is a 70-year-old Caucasian woman who presented to the emergency
department because of a 4-day history of increased shortness of breath and
generalized weakness. A.S. stated that she has been able to do her daily chores at
home independently, but for the last few days it was getting difficult for her to get
around and that she needed to take frequent breaks because she was short of
breath and had no energy. She has a long history of heart failure, diabetes mellitus
type 2, and hypertension. She is admitted with a tentative diagnosis of acute
kidney injury (AKI).
Subjective Data
• Has been having headaches on and off, with nausea and dizziness
• Reported that she hadn’t been taking her medications regularly at home
because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands
Objective Data
• Physical Examination
• Blood pressure 178/96, pulse 110, temperature 98.9° F, respirations 24
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands
• ↑Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, negative for glucose and ketones,
• 24-hour urine output = 300 mL
• Laboratory Tests:
✓
✓
✓
✓
✓
✓
✓
✓
✓
Hemoglobin
Hematocrit
RBC
WBC
Sodium
Potassium
BUN
Creatinine
8 g/dL ↓
18% ↓
2.57 million/mm3 ↓
4.7 mm3 WNL ↓
132 mEq/L ↓
5.9 mEq/L ↑
36 mg/dL ↑
4.9 mg/dL ↑
Case Study Questions: Please fill out answers and submit work to 443 Blueline
1. Interpret all of A.S.’s laboratory test results and describe their significance.
Damaged kidneys do not make enough EPO= ↓RBC production which then ↓in
O2 being delivered to the body. ↓Na d/t decreased glomerular filtration and the
loss of free water. ↑K+ from leakage from intracellular space, break down of
muscle/tissue can lead to cardiac dysrhythmias. ↑BUN/CR d/t lack of perfusion to
kidneys
2. What is the most likely cause of A.S.’s AKI and explain why?
Heart failure. Decrease in blood flow lead to decrease in glomerular perfusion and
filtration of the kidneys.
3. Is this cause of AKI classified as prerenal, intrarenal, or postrenal?
Prerenal (disorder that causes decreased systemic circulation)
4. What phase of AKI is A.S. in? (Oliguric, Diuretic, Recovery) Explain how you
know this. Oliguric phase
Based on lab results. UO <400ml/day as evidenced by 24-hour urine = 300ml;
serum electrolyte imbalance: ↓Na, ↑K+, ↑BUN/Cr
Neurologic disorder r/t weakness
5. What are the priority nursing diagnoses to address the concern of fluid
retention?
Risk for dysrhythmia r/t electrolyte imbalance
Excess fluid volume r/t acute kidney injury
6. What are the priority nursing interventions for these nursing diagnoses?
Restrict fluid
Administer diuretics
Monitor electrolytes
Monitor VS
Assess lungs for crackles
Monitor I&O’s
Daily weights
Hemodialysis