The client has a history of Wilms tumor with left radical nephrectomy diagnosed at age five for which he completed treatment nine months ago. A septic episode, while undergoing treatment for his Wilms tumor, resulted in an acute kidney injury. This Injury, along with antibiotic therapy and chemotherapy, has resulted in chronic kidney disease. The client is followed by oncology and nephrology services.
The healthcare provider has assessed the client and completes initial orders. Which three care needs should the nurse prioritize for this client?
A. Collaborating with dietician to prepare low protein diet
B. Identifying cardiac arrhythmias
C. Performing diagnostic testing to determine cause of fever
D. Educating client and family on the importance of fluid restrictions
E. Administering antipyretic medication as needed
F. Monitoring fluid status
G. Reassessing vital signs
H. Assessing for worsening respiratory status
I. Investigating acid/base complications
The Correct answer and Explanation is:
In this scenario, the client’s complex medical history—including a history of Wilms tumor, recent acute kidney injury, chronic kidney disease, and treatment complications—requires careful prioritization of care needs. Based on this context, the three care needs the nurse should prioritize are:
D. Educating client and family on the importance of fluid restrictions
F. Monitoring fluid status
G. Reassessing vital signs
Explanation:
- Educating Client and Family on Fluid Restrictions (D): Given the client’s chronic kidney disease (CKD), managing fluid intake is crucial. Excessive fluid intake can lead to fluid overload, which may exacerbate hypertension and heart failure, particularly in patients with compromised kidney function. Education empowers the family to understand dietary restrictions and maintain adherence to the prescribed fluid limits.
- Monitoring Fluid Status (F): Continuous monitoring of fluid status is essential in CKD patients. This includes assessing for signs of edema, monitoring urine output, and tracking weight changes. By doing so, the nurse can detect early signs of fluid overload or dehydration, allowing for timely interventions. Effective monitoring also informs adjustments in dietary and fluid intake recommendations.
- Reassessing Vital Signs (G): Vital signs are critical indicators of the patient’s overall condition. In patients with CKD and a history of septic episodes, fluctuations in blood pressure, heart rate, and respiratory rate can signal complications, such as infection, dehydration, or worsening renal function. Regular reassessment helps ensure any deviations from baseline are promptly addressed, facilitating early detection of potential complications.
Rationale for Exclusions:
- Collaborating with a dietitian (A) is important, but educating the family directly about fluid restrictions can have a more immediate impact on care.
- Identifying cardiac arrhythmias (B) and investigating acid/base complications (I) are vital but may not be prioritized initially unless there are clear indications of these issues based on vital signs or clinical status.
- Performing diagnostic testing (C) and administering antipyretics (E) are necessary but secondary to immediate needs that can be addressed through monitoring and education.
- Assessing for worsening respiratory status (H) is also important but typically follows initial assessments of fluid status and vital signs in this specific context.
In conclusion, prioritizing fluid management and monitoring vital signs aligns with the client’s immediate health needs, ensuring safe and effective care in the context of CKD.