The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?
A. Encourage fluid intake
B. Administration of diuretics
C. Irrigation of Foley catheter
D. Restricting fluids
Correct Answer: B. Administration of diuretics
To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Given early in the oliguric phase of ARF in an effort to convert to non-oliguric phase, flush the tubular lumen of debris, reduce hyperkalemia, and promote adequate urine volume.
Option A: Fluid intake would not be encouraged. Fluid management is usually calculated to replace output from all sources plus estimated insensible losses (metabolism, diaphoresis). Prerenal failure (azotemia) is treated with volume replacement and/or vasopressors.
Option C: Irrigation of the Foley catheter will not assist in alleviating this oliguria. Accurately record intake and output (I&O) noting to include “hidden” fluids such as IV antibiotic additives, liquid medications, frozen treats, ice chips. Religiously measure gastrointestinal losses and estimate insensible losses (sweating), including wound drainage, nasogastric outputs, and diarrhea.
Option D: The oliguric patient with adequate circulating volume or fluid overload who is unresponsive to fluid restriction and diuretics requires dialysis. Note: During the oliguric phase, “push/pull” therapy (push IV fluids and diuresis with diuretics) may be tried to stimulate kidney function.
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