Page 1829 - Saunders Comprehensive Review For NCLEX-RN

clothes, same time of day), noting that an increase of
0.5 to 1 lb/day (0.25 to 0.5 kg/day) indicates fluid
retention.
4. Monitor for changes in the BUN, serum creatinine, and
serum electrolyte levels.
5. Monitor for acidosis (may need to be treated with
sodium bicarbonate).
6. Monitor urinalysis for protein level, hematuria, casts,
and specific gravity.
7. Monitor for altered level of consciousness caused by
uremia.

8. Monitor for signs of infection because the

client may not exhibit an elevated temperature or an
increased WBC count.

9. Monitor the lungs for wheezes and rhonchi

and monitor for edema, which can indicate fluid
overload.
10. Administer the prescribed diet, which is usually a low-
to moderate-protein (to decrease the workload on the
kidneys) and high-carbohydrate diet; ill clients may
require nutritional support with supplements, enteral
feedings, or parenteral nutrition.
11. Restrict potassium and sodium intake as prescribed
based on the electrolyte level.
12. Administer medications as prescribed; be alert

to the mechanism for metabolism and excretion of all
prescribed medications.
13. Be alert to nephrotoxic medications, which may be
prescribed (see Box 54-3).
14. Be alert to the PHCP’s adjustment of medication
dosages for kidney injury.

15. Prepare the client for dialysis if prescribed;

continuous renal replacement therapy may be used in
AKI to treat fluid volume overload or rapidly
developing azotemia and metabolic acidosis.
16. Provide emotional support by allowing opportunities
for the client to express concerns and fears and by
encouraging family interactions.
17. Promote consistency in caregivers.
18. Also refer to Section IV, E in this chapter (Special
problems in kidney disease and interventions).

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