Patient Profile: A. S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A. S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data:
Has been having headaches on and off, with nausea and dizziness.
Reported that she hadn’t been taking her medications regularly at home because of "forgetfulness"
Has not been urinating a lot
Feels "puffy" in her legs and hands

Objective Data

Physical Examination

Blood pressure 178/96, pulse 110, temperature 98.9° F, respirations 24
Alert and oriented to person, place, and time
Mild jugular venous distention
Fine crackles in bilateral lower lobes
Heart rate regular, no murmurs
Bowel sounds normoactive and present in all four quadrants
2+ edema bilateral lower extremities and hands

Echocardiogram shows decreased left ventricular function
Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
24-hour urine output = 380 mL

Laboratory Tests:
Hemoglobin 8 g/dL abnormal result normal is 120-160 g/dl

Hematocrit 23.8%

RBC 2.57 million/mm3 abnormal result …normal value is
WBC 4.7 mm3
Sodium 132 mEq/L
Potassium 5.2 mEq/L
Calcium 9 mg/dL
BUN 36 mg/dL
Creatinine 4.9 mg/dL
BNP 182 pg/mL

Required:
a. Interpret A. S.’s laboratory test results and describe their significance.
b. What is the most likely cause of A. S.’s AKI?
c. Is this cause of AKI classified as prerenal, intrarenal, or postrenal? Explain your answer.
d. What phase of AKI is A. S. in?
e. What are the priority nursing diagnoses (there are to address the concern of fluid retention?
f. What are the priority nursing interventions for these nursing diagnoses?