A55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is appropriate to include in the care plan?

• Restricting fluid intake is essential in acute kidney injury (AKI) to prevent fluid overload, as the kidneys are unable to excrete excess fluid efficiently. Maintaining the prescribed fluid restriction helps reduce the risk of pulmonary edema, hypertension, and worsening renal function.
• Monitoring daily weight provides a direct measure of fluid balance and helps detect subtle changes in fluid retention. In AKI, weight gain may indicate fluid accumulation, and tracking it allows timely adjustments in fluid management and treatment interventions.
• Increasing carbohydrate consumption is not directly relevant to managing AKI. Nutritional adjustments may be considered for overall health, but they do not address fluid retention, electrolyte imbalance, or kidney function directly.
• Administering antibiotics is only indicated if there is evidence of infection. The client’s lab values and vital signs do not indicate infection, so antibiotics are not a priority intervention.
• Applying a sterile dressing is appropriate for wound care or infection prevention but does not address the acute renal condition or its complications. It is unrelated to the current management needs of AKI.
• Diabetes mellitus can lead to chronic kidney disease over time, but the acute rise in BUN, creatinine, and potassium, along with hypertension, suggests an acute renal event rather than a chronic endocrine condition.
• Chronic liver disease can cause fluid retention and electrolyte imbalances, but the lab pattern and acute elevation in renal markers point to kidney injury rather than liver pathology.
• Acute kidney injury is characterized by rapid increases in BUN, creatinine, and potassium, along with changes in urine output and blood pressure. The client’s elevated BUN (28→30 mg/dL), creatinine (2.6→2.8 mg/dL), and hyperkalemia (5.2→5.5 mmol/L) confirm AKI as the most likely condition.
• Peritonitis would typically present with abdominal pain, tenderness, fever, and sometimes changes in dialysate if the client is on peritoneal dialysis. These findings are absent in this scenario, making peritonitis unlikely.
• Monitoring temperature is important for detecting infection but does not directly indicate kidney function or fluid status. While useful, it is not the primary parameter for assessing AKI progression.
• Monitoring respiratory rate is essential for general health but only becomes critical if fluid overload or pulmonary edema develops. It is not as direct a measure of renal status as blood pressure or heart rate.
• Monitoring dialysate color is relevant for clients on peritoneal dialysis to detect infection, but there is no mention of peritoneal dialysis in this client’s scenario, making it irrelevant for assessing AKI.
• Monitoring blood pressure is crucial because hypertension is both a cause and complication of AKI. Elevated blood pressure can worsen kidney injury, and tracking it helps guide fluid and medication management.
• Monitoring heart rate is important to assess cardiovascular response to fluid shifts, electrolyte imbalances, and overall hemodynamic stability in AKI. Changes in heart rate can indicate worsening fluid overload or hyperkalemia effects.

A. Adjust the rate of the bladder irrigant: Changing the irrigant rate before assessing the catheter system could worsen obstruction or compromise drainage. Interventions should follow a stepwise assessment, starting with identifying mechanical issues.

B. Notify the provider: Notifying the provider is important if initial troubleshooting does not restore catheter function, but it is not the first action. The nurse should first assess for correctable causes of obstruction.

C. Irrigate the catheter: Manual irrigation may be necessary if a blockage is suspected, but this should be done after confirming there are no kinks or mechanical issues in the tubing. Immediate irrigation without assessment could introduce infection or cause trauma.

D. Check the tubing for kinks: Inspecting the catheter tubing for kinks or obstruction is the first and simplest action. Mechanical blockage is a common cause of absent drainage and can often be corrected immediately, restoring urine flow safely.