Question

The patient has now been on the medical unit for 3 days. She was diagnosed with pyelonephritis on admission. Vital signs this morning: Temperature 98.8 (37.1◦C ), blood pressure 100/50 mm Hg, pulse 110 bpm, respirations 24 breaths per minute. The patient is oriented to self only but is awake and alert. Her daughter is at her bedside. The urine culture results showed enterococci, and therefore the broad-spectrum antibiotic the patient was receiving was replaced with sensitivity-guided antibiotic therapy. Abnormal serum laboratory results are as follows: WBC = 14500/mm3 (normal=5000-10000/mm3), BUN = 27 mg/dL (normal = 7-20 mg/dL), creatinine 2.0 mg/dL (normal = 0.5-1.1 mg/dL). She has now been diagnosed with acute kidney injury.

NGN Item Type: Matrix
Use an X for the nursing actions listed below that are Indicated (appropriate or necessary), Contraindicated (could be harmful), or Nonessential (makes no difference or not necessary) for the patient’s care at this time. Only one selection can be made for each nursing action.
Nursing Action
Indicated
Contraindicated
Nonessential
Consult with dietician to provide a low caloric diet.
Obtain daily weights.
Medicate with ibuprofen every 6 hours as needed for complaint of pain.
Focus on providing holistic nursing care to patient.
Carefully consider the type, frequency, and dosage of the patient’s prescribed antibiotic therapy.
Assess for the presence of bowel sounds every 4 hours.
Rationale:
Cognitive Skill: Take Action

Answer 1

Consult with dietician to provide a low caloric diet: Nonessential

Obtain daily weights: Nonessential

Medicate with ibuprofen every 6 hours as needed for complaint of pain: Contraindicated

Focus on providing holistic nursing care to patient: Indicated

Carefully consider the type, frequency, and dosage of the patient's prescribed antibiotic therapy: Indicated

Assess for the presence of bowel sounds every 4 hours: Nonessential

Why is this correct?

1. In the acute phase of AKI, consulting a dietitian isn't a primary focus. The immediate priority in nursing care is to stabilize the patient, with other considerations addressed subsequently.

2. While the patient currently shows no severe dehydration symptoms or specific conditions requiring regular weight monitoring, it may not be an immediate necessity.

3. Ibuprofen exacerbates AKI, and all NSAIDs carry renal side effects in both acute and chronic usage.

4. Irrespective of diagnosis, nurses are mandated to deliver comprehensive, holistic nursing care to every patient.

5. Managing sepsis and bloodstream infections primarily involves antibiotics. Therefore, closely monitoring their dosage and administration is integral to nursing care.

6. In acute care, assessing bowel sounds typically targets GIT obstructive pathology. As the origin of the disease here is renal, continuous monitoring of bowel sounds isn't required.

See image below for the correct nursing actions marked with X

Answer 2

Consulting with the healthcare team is crucial for individualized patient care. The actions indicated or contraindicated here may also depend on specific patient factors or clinical judgment, so always confirm with the patient's healthcare provider for precise care directions.

Nursing Action - Indicated - Contraindicated - Nonessential

1. Consult with dietician to provide a low caloric diet.

2. Obtain daily weights.

3. Medicate with ibuprofen every 6 hours as needed for complaint of pain.

4. Focus on providing holistic nursing care to the patient.

5. Carefully consider the type, frequency, and dosage of the patient’s prescribed antibiotic therapy.

6. Assess for the presence of bowel sounds every 4 hours.

Rationale:

1. Consult with dietician to provide a low caloric diet: Indicated. This action is relevant due to the patient's altered renal function and acute kidney injury. A low caloric diet may be necessary to manage the patient's condition effectively.

2. Obtain daily weights: Indicated. Monitoring weight daily can provide essential information about fluid balance, especially important in cases of kidney injury and infection.

3. Medicate with ibuprofen every 6 hours as needed for complaint of pain: Contraindicated. Ibuprofen is not recommended in cases of acute kidney injury as it can further compromise kidney function.

4. Focus on providing holistic nursing care to the patient: Indicated. Holistic care is always beneficial for a patient's overall well-being and is relevant in this case too.

5. Carefully consider the type, frequency, and dosage of the patient’s prescribed antibiotic therapy: Indicated. Given the change in antibiotic therapy due to the sensitivity results of the urine culture, careful consideration is crucial for effective treatment.

6. Assess for the presence of bowel sounds every 4 hours: Indicated. Regular assessment of bowel sounds is a part of routine nursing care, although it may not directly impact the acute kidney injury, it is important for overall patient assessment and management.