Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing:
A. Hypovolemia
B. Renal failure
C. Metabolic acidosis
D. Hyperkalemia
Correct Answer: A. Hypovolemia
In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced. The diuretic stage usually lasts for 1-2 weeks but can persist longer. In this stage, an increase in urine output is noted and uremia begins to resolve as the kidney continues to heal.
Option B: The client is already experiencing renal failure. In the initiating stage, which begins when the kidney is injured and lasts from hours to days, signs of renal impairment are present such as altered BUN and creatinine levels and decreased urine output. During this phase, the cause of acute renal failure is sought and treatment is initiated.
Option C: Metabolic acidosis is caused by a build-up of too many acids in the blood. Differentiating between pre-renal azotemia and ATN can be difficult. In prerenal azotemia, urine output is diminished. In ATN, urine output may or may not be diminished. In pre-renal assaults, the urinalysis will show normal urinary sediment with hyaline or granular casts, high specific gravity, high osmolality, low urinary sodium and urea, and normal urine creatinine.
Option D: People with chronic kidney disease have a high risk for hyperkalemia, due in part to the effects of kidney dysfunction on potassium homeostasis. Other complications can include cardiac arrest from hyperkalemia due to the decrease in urine output, elevated phosphorus levels due to impaired renal regulation of calcium and phosphates, metabolic acidosis due to decreases in excretion hydrogen ions, GI bleeding, and decreased nutritional status. In treating hyperkalemia, all sources of dietary potassium should be stopped and a low potassium diet prescribed.