Nursing care
Nursing care plan for acute kidney injury: diagnoses that change with each phase
Written and reviewed by Nicole Ramirez, BSN, RN, CMSRN · 5 min read · Updated November 2026
Short answer
A nursing care plan for acute kidney injury usually ranks risk for electrolyte imbalance from high potassium first, then excess fluid volume during the low urine phase, risk for acute confusion from uremia, imbalanced nutrition and, in recovery, risk for deficient fluid volume. AKI plans must be rewritten as urine output changes, because the fluid problem can reverse.
AKI care plan table: five problems ranked for the low urine output phase
These labels come from NANDA-I. The order fits a hypothetical adult in the oliguric phase after a period of low blood pressure. Row five is written ahead of time because the recovery phase brings the opposite fluid problem.
| Nursing diagnosis | Goal or outcome | Nursing interventions | Rationale |
|---|---|---|---|
| 1. Risk for electrolyte imbalance related to reduced potassium and acid excretion | Potassium stays in the prescribed range; no new ECG changes | Continuous cardiac monitoring if ordered, review potassium and acid-base results, report ECG changes or rising potassium, give prescribed potassium-lowering treatment, hold potassium in IV fluids and diet unless told otherwise | High potassium is the AKI complication most likely to stop the heart |
| 2. Excess fluid volume related to oliguria | Weight stable or falling, lungs clear, no new edema | Daily weight, hourly urine output if catheterized, strict intake and output, follow the fluid limit, assess lungs every check, report crackles or breathlessness | Fluid taken in without matching output can collect in the lungs |
| 3. Risk for acute confusion related to uremia | Remains oriented with no new drowsiness | Assess orientation each check, report new confusion, drowsiness or seizure activity, keep fall precautions | Waste products that the kidneys cannot clear affect the brain |
| 4. Imbalanced nutrition related to nausea and diet limits | Eats most of each meal within the prescribed limits | Small frequent meals, mouth care, antiemetics as prescribed, coordinate with the dietitian on protein, salt and potassium | Uremia causes anorexia and nausea, and diet limits narrow choices |
| 5. Risk for deficient fluid volume related to recovery phase diuresis | Heart rate and blood pressure stable as urine output rises | Watch for a sudden rise in urine output, trend vital signs and weight, report dizziness or falling pressure, review sodium results | As the kidneys recover, they can lose large amounts of water and sodium before they regain control |
Stopping nephrotoxic drugs, ordering potassium treatment and deciding on dialysis are provider actions. The plan has the nurse flag drugs such as NSAIDs on the medication list, report the trigger values and give treatments as prescribed.
Why potassium edges out fluid overload in this plan
Both rows threaten circulation or breathing. MSD Manuals describes hyperkalemia as potentially life-threatening in AKI and lists pulmonary edema, acidosis and uremic symptoms as the other main complications. A dangerous rhythm can occur with no warning on the outside of the body, while fluid overload usually builds over hours with visible weight and lung changes, so potassium goes first unless the client is already breathless.
MSD Manuals lists dialysis triggers that match the top rows: potassium above 6 mmol/L, pulmonary edema that persists, acidosis that does not respond and uremic symptoms. Knowing these helps the nurse explain why a result needs a call now rather than at morning rounds.
Turning the urine output criterion into a measurable goal
Under the KDIGO criteria cited by MSD Manuals, AKI includes a creatinine rise of 0.3 mg/dL or more within 48 hours, a rise to 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/hour for 6 hours. That last threshold gives a ready-made SMART goal. The figures below are practice numbers, not orders.
Worked example
- Weight is 70 kg.
- 0.5 mL/kg/hour x 70 kg = 35 mL/hour.
- Over 6 hours this is 35 mL/hour x 6 hours = 210 mL.
MSD Manuals also describes limiting water intake to the previous day's urine output plus 500 to 1,000 mL for insensible losses. If yesterday's output was 400 mL, a limit set this way would fall between 900 and 1,400 mL, but the prescriber sets the actual number.
Statement and evaluation across the three phases
Hypothetical example: a 66-year-old client after a hypotensive episode has 18 mL/hour of urine for 6 hours, a 2 kg gain since admission and crackles at the bases. Statement: excess fluid volume related to oliguria as evidenced by urine output below 0.5 mL/kg/hour, weight gain of 2 kg and bibasilar crackles. MedlinePlus lists reduced urination, leg swelling, confusion, nausea and shortness of breath among AKI symptoms.
MSD Manuals describes three phases: a prodromal phase, an oliguric phase with roughly 50 to 500 mL a day, and a postoliguric phase where output climbs, sometimes with polyuria, while labs lag behind. Evaluating the plan means watching for the switch. When output jumps, row two may be resolved and row five becomes active, so a plan still restricting fluids at that point is out of date.
Sources and further reading
Acute Kidney Injury (AKI) - MSD Manual Professional Edition. KDIGO creatinine and urine output criteria, three phases and oliguric volume, hyperkalemia, pulmonary edema, acidosis, uremia, fluid limit formula, dialysis triggers.
Acute kidney failure: MedlinePlus Medical Encyclopedia. AKI symptoms, causes including NSAIDs and low blood pressure, fluid restriction, limiting potassium and salt, dialysis when needed.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our renal and genitourinary practice questions are the closest set to what this page covers.
Common questions
What is the priority nursing diagnosis for acute kidney injury?
Risk for electrolyte imbalance from high potassium usually leads because it can cause a fatal rhythm with little warning. If the client is already breathless with crackles, excess fluid volume moves to the top by the ABCs.
What are SMART goals for a patient with acute kidney injury?
Tie them to numbers and time: urine output at least 0.5 mL/kg/hour each hour; potassium within the prescribed range with no new ECG changes over 24 hours; weight stable or falling and lungs clear by day 3.
What are nursing interventions for acute kidney injury?
Monitor potassium and ECG, measure hourly output and daily weight, keep strict intake and output within the fluid limit, assess lungs and orientation, flag nephrotoxic drugs such as NSAIDs, give prescribed treatments, and watch for diuresis during recovery.
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