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Anita Brown is 45 years of age and weighs 100 kgs. She was transferred to your surgical ward 24 hours ago following a laparoscopic cholecystectomy which had to proceed to an open cholecystectomy. Post operatively her pain has been controlled with the use of patient
controlled analgesia (PCA) containing morphine. Anita has been vomiting repeatedly. She remains nil by mouth and is receiving intravenous fluids of 1000mls Dextrose/Saline over 12 hours. Her observations are as follows: Blood Pressure 105/60 mm/Hg; pulse 108 beats/minute; respiratory rate 22/minute, temperature 37.0oC; pulse oximetry 94% on air; Glasgow Coma Scale 15; Urine – oliguric in the last 6 hours. Anita has undergone surgical review and a diagnosis of acute kidney injury is suspected because of severe dehydration due to insufficient fluid replacement inter/post operation.
I would like a systematic approach to be used to identify the priorities of care, and the nursing management Anita Brown would require for the next 48 hours. Please could you discuss the nursing interventions used and justify why in relation to the pathophysiology of acute renal injury and back up with evidence please. Also could you discuss why it is important to be able to recognise and how to identify this patient’s altering condition and the appropriate interventions required.
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