A client who has developed acute kidney injury (AKI) due to an aminoglycoside antibiotic has moved from the oliguric phase to the diuretic phase of AKI. Which parameters are most important for the nurse to plan to carefully monitor?
Elevated creatinine and blood urea nitrogen (BUN).
Hypovolemia and electrocardiographic (ECG) changes.
Uremic irritation of mucous membranes and skin surfaces.
Side effects of total parenteral nutrition (TPN) and intralipids.
The Correct Answer is B
A. While elevated creatinine and BUN are important indicators of kidney function, in the diuretic phase, the focus shifts to monitoring for complications, particularly fluid and electrolyte balance.
B. Hypovolemia can occur due to excessive diuresis during the diuretic phase, which can lead to significant cardiovascular effects, including ECG changes related to electrolyte imbalances, particularly potassium levels.
C. Monitoring for uremic irritation is important but less critical than monitoring for hypovolemia and ECG changes that can lead to acute complications.
D. While monitoring for side effects of TPN is relevant, it is not the priority in the context of AKI transitioning phases where fluid and electrolyte balance are paramount.
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Correct Answer is C
Explanation
A. While monitoring blood glucose levels is important for managing diabetes, this instruction alone does not specifically address the goal of lowering blood glucose levels and increasing HDL levels.
B. Monthly appointments with a dietitian can be beneficial but are not as essential as incorporating regular exercise into the client’s lifestyle.
C. Regular exercise is a key component in managing type 2 diabetes, as it helps to lower blood glucose levels and can improve HDL cholesterol. Medical approval ensures that the exercise regimen is safe for the client.
D. Limiting calories on days unable to exercise is not a primary focus for managing diabetes and may not be practical or effective in promoting overall health.
Correct Answer is B
Explanation
A. While having the client sign permits is important, it is not the priority action in this situation.
B. Notifying the healthcare provider about the client's current heparin therapy is critical, as it may influence the timing of surgery and the risk of excessive bleeding during and after the procedure.
C. While explaining the potential for bleeding is important, it should occur after ensuring the surgical team is aware of the heparin use.
D. Observing injection sites for bruising is relevant but does not address the immediate concern regarding heparin use and potential bleeding during surgery.