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Acute Kidney Injury (AKI) in Pediatric, Sheila Hasinna 1906349772…
Acute Kidney Injury (AKI) in Pediatric
Nursing Interventions
Diagnosis
Excess fluid volume
Interventions
Accurately record intake and output
Monitor urine specific gravity.
Weigh daily at same time of day, on same scale, with same equipment and clothing.
Assess skin, face, dependent areas for edema. Evaluate degree of edema (on scale of +1–+4).
Monitor heart rate (HR), BP, and JVD/CVP.
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Edema occurs primarily in dependent tissues of the body, (hands, feet, lumbosacral area). Patient can gain up to 10 lb (4.5 kg) of fluid before pitting edema is detected.
Daily body weight is best monitor of fluid status. A weight gain of more than 0.5 kg/day suggests fluid retention.
Measures the kidney’s ability to concentrate urine. In intrarenal failure, specific gravity is usually equal to or less than 1.010, indicating loss of ability to concentrate the urine.
Accurate monitoring of I&O is necessary for determining renal function and fluid replacement needs and reducing risk of fluid overload. Do note that hypervolemia usually occurs in anuric phase of ARF and may mask the symptoms.
Outcomes
Display appropriate urinary output with specific gravity/laboratory studies near normal; stable weight, vital signs within patient’s normal range; and absence of edema.
Risk for Decreased Cardiac Output
Interventions
Monitor BP and HR.
Observe ECG or telemetry for changes in rhythm.
Auscultate heart sounds.
Assess color of skin, mucous membranes, and nail beds. Note capillary refill time.
Note occurrence of slow pulse, hypotension, flushing, nausea and vomiting, and depressed level of consciousness.
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Pallor may reflect vasoconstriction or anemia. Cyanosis is a late sign and is related to pulmonary congestion and/or cardiac failure.
Development of S3/S4 is indicative of failure. Pericardial friction rub may be only manifestation of uremic pericarditis, requiring prompt intervention and possibly acute dialysis
Fluid volume excess, combined with hypertension (common in renal failure) and effects of uremia, increases cardiac workload and can lead to cardiac failure. In ARF, cardiac failure is usually reversible.
Fluid volume excess, combined with hypertension (common in renal failure) and effects of uremia, increases cardiac workload and can lead to cardiac failure. In ARF, cardiac failure is usually reversible.
Outcomes
Maintain cardiac output as evidenced by BP and HR/rhythm within patient’s normal limits; peripheral pulses strong and equal with adequate capillary refill time.
Risk for Imbalanced Nutrition: Less Than Body Requirements
Interventions
Assess and document dietary intake.
Provide frequent, small feedings.
Give patient/SO a list of permitted foods or fluids and encourage involvement in menu choices.
Offer frequent mouth care or rinse with diluted acetic acid solution. Give gums, hard candy, breath mints between meals.
Weigh daily.
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Mucous membranes may become dry and cracked. Mouth care soothes, lubricates, and helps freshen mouth taste, which is often unpleasant because of uremia and restricted oral intake.
Provides patient with a measure of control within dietary restrictions. Food from home may enhance appetite.
Minimizes anorexia and nausea associated with uremic state and/or diminished peristalsis.
Aids in identifying deficiencies and dietary needs. General physical condition, uremic symptoms (nausea, anorexia), and multiple dietary restrictions affect food intake.
Outcomes
Maintain/regain weight as indicated by individual situation, free of edema.
General Interventions
Treat or remove the underlying cause.
Adjust current medication dosing based on estimated GFR = (Gromerular Filtration Rate)
Optimize renal perfusion while minimizing fluid overload.
Assessment
Varies depending on clinical scenario and suspected cause.
Pre-Renal
Injury related to decreased renal perfusion
Hypovolemia (e.g. shock)
Hypotension (e.g. gastroenteritis, hemorrhage)
Hypoxia (e.g. birth asphyxia)
Renal/Intrinsic
Glomerular
Vascular
Tubular/Interstitial
Post-Renal
Injury related to obstruction of urine flow
Congenital anomalies
UPJ and UVJ obstruction
Acquired
Tumors and masses
CBC, electrolytes, BUN, creatinine, calcium, phosphorus
Urinalysis with microscopy
Sediment may provide clues to etiology.
Urine indices (e.g. urine sodium) may help distinguish pre-renal AKI
from ATN in oliguric patient
Evaluations
A successful nursing care plan has achieved the following:
Improved nutritional intake.
Restored fluid balance.
Reduced metabolic rate.
Promoted pulmonary function.
Prevented infection.
Sheila Hasinna 1906349772 Keperawatan Anak Sakit-A