You are planning the care for a client for a client with acute kidney injury (AKI). What should you prioritize in the client's plan of care? (Select all that apply)

A. Clinical manifestations: hematuria (urine is smoky, brown tinged): Hematuria is a hallmark sign of acute glomerulonephritis. The smoky or cola-colored urine results from red blood cells leaking through the damaged glomeruli, often seen in post-infectious cases.

B. Clinical manifestations: oliguria: Decreased urine output is common due to impaired glomerular filtration. Oliguria reflects reduced kidney function, which contributes to fluid retention, hypertension, and accumulation of waste products.

C. Treatment: Antibiotics, corticosteroids, cytotoxic agents, anticoagulants: Depending on the cause and severity, treatment may include antibiotics for infection, corticosteroids or cytotoxic agents for inflammation, and anticoagulants if there's risk of thrombosis due to nephrotic syndrome features.

D. Treatment: Prescription dose ibuprofen: NSAIDs like ibuprofen are generally avoided in glomerulonephritis because they can reduce renal perfusion and worsen kidney injury, especially in patients already experiencing compromised kidney function.

E. Clinical manifestations: Proteinuria that exceeds 3–5g/day with albumin: This level of proteinuria is characteristic of nephrotic syndrome, not acute glomerulonephritis. While proteinuria may be present, it is typically moderate and not in the nephrotic range.

A. Optimizing pain: While pain management is important in any patient care plan, acute kidney injury typically does not cause significant pain unless associated with another condition such as obstruction or infection. It is not a primary focus unless the patient reports discomfort requiring intervention.

B. Protecting from falls: Fall prevention is a general safety measure but is not a specific priority related to AKI management unless the patient has associated risks like altered mental status, weakness, or dialysis-related hypotension. It is not a primary priority in early AKI care planning.

C. Monitoring electrolyte levels: AKI commonly leads to imbalances in potassium, sodium, calcium, and phosphorus due to impaired renal clearance. Hyperkalemia in particular poses serious cardiac risks, making electrolyte monitoring a top priority to prevent complications such as arrhythmias.

D. Assessing fluid balance: AKI affects the kidneys’ ability to excrete or conserve fluid, resulting in potential fluid overload or dehydration. Accurate intake and output tracking, daily weights, and edema assessment are essential to guide treatment and prevent respiratory or cardiovascular compromise.

E. Promoting infection control: Infection is both a potential cause and a complication of AKI, especially in hospitalized or catheterized patients. Maintaining strict aseptic technique, monitoring for signs of infection, and preventing sepsis are critical components of AKI management.