# A nurse is caring for a patient with severe COVID-19 who has been on mechanical ventilation for 10 days. The patient develops acute kidney injury (AKI) with oliguria, elevated creatinine (3.2 mg/dL), and fluid overload. The physician orders continuous renal replacement therapy (CRRT). What is the most critical nursing intervention during the initiation of CRRT? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541874 > language: ko > subject: Infectious Diseases ## 문제 A nurse is caring for a patient with severe COVID-19 who has been on mechanical ventilation for 10 days. The patient develops acute kidney injury (AKI) with oliguria, elevated creatinine (3.2 mg/dL), and fluid overload. The physician orders continuous renal replacement therapy (CRRT). What is the most critical nursing intervention during the initiation of CRRT? ## 보기 1. Monitor blood pressure every 15 minutes for the first 2 hours 2. Ensure strict aseptic technique during vascular access care 3. Assess for signs of hemodynamic instability and circuit clotting **✔ 정답** 4. Document fluid intake and output hourly **정답: 3** ## 해설 During CRRT initiation, continuous assessment for hemodynamic instability and circuit clotting is the most critical intervention as these complications can be life-threatening and require immediate intervention. Other options are important but secondary to preventing acute complications. ## 심화 해설 Clinical Judgment This question assesses which Core Concept a nurse should base the priority of interventions on when initiating a new treatment (CRRT) for a critically ill patient with multi-organ failure. The key is to prevent and detect early **immediate, life-threatening complications that can occur when starting the therapy**. Option 3 (Assessing for hemodynamic instability and circuit clotting) encompasses the two most common and dangerous major complications in the initial phase of CRRT. The importance of this intervention is further highlighted because COVID-19 patients present with a hypercoagulable state and cardiovascular instability. While the other options are important, they rank lower than option 3 in terms of urgency and comprehensiveness as the 'most critical' initial intervention. Memory Tip: **H**emodynamics & **C**lotting = **H**igh **C**riticality. The two things to check first when starting CRRT are "**H** and **C**". KR vs US While the importance of hemodynamic monitoring and circuit management during CRRT is the same in Korea, the US NGN exam particularly emphasizes clinical judgment and prioritization in risky situations. The question "What is the most critical intervention?" requires Clinical Judgment that integrates an analysis of the patient's condition and the risks of the therapy, not just simple technical performance. ## 임상 시나리오 Clinical Practice Guide Key nursing roles when starting CRRT: 1. Notify HCP! Immediately report if there is a sudden drop in blood pressure, a sharp rise in circuit pressure (signs of clotting), severe tachycardia, etc. 2. Circuit monitoring: Continuously observe arterial pressure, venous pressure, and TMP (transmembrane pressure) to detect early signs of clotting. 3. Patient monitoring: Comprehensive hemodynamic status assessment including vital signs, level of consciousness, and peripheral perfusion. Caution In SATA (Select All That Apply) questions, if the question asks "What interventions are needed?" rather than "What is the most critical single intervention?", options 1, 2, 3, and 4 could all be correct. The first step is to accurately identify the question type (single best answer vs. multiple choice). ## 핵심 개념 - **Continuous Renal Replacement Therapy** — Continuous Renal Replacement Therapy. This is a treatment method that slowly and continuously removes fluid and waste products for patients with severe acute kidney injury (AKI) or fluid overload, especially critically ill patients who are hemodynamically unstable. - **Hemodynamic Instability** — Hemodynamic instability. A state where the heart fails to pump enough blood, leading to reduced tissue perfusion, with symptoms like low blood pressure, rapid heart rate, and constriction of peripheral blood vessels. It can easily occur when starting CRRT due to fluid removal. - **Circuit Clotting** — Circuit clotting. This refers to the formation of blood clots within the blood circuit of the CRRT machine. It is a major complication that can lead to treatment interruption and blood loss due to blood trapped in the circuit. - **Acute Kidney Injury** — Acute kidney injury. A condition in which kidney function rapidly declines over hours to days. It is characterized by elevated creatinine and oliguria. - **Oliguria** — Low urine output. In adults, this refers to a condition where urine output is less than 0.5 mL/kg per hour or less than 400 mL over 24 hours. ## 같은 주제 문제 - [A nurse is assessing a 65-year-old patient admitted with suspected COVID-19. Which assessm…](https://mymerci.kr/pages/nclex_q.php?qn_id=541869) - [A 45-year-old patient with COVID-19 pneumonia has been managed at home for 5 days. Which a…](https://mymerci.kr/pages/nclex_q.php?qn_id=541870) - [A nurse is assessing a 65-year-old patient who was admitted with suspected COVID-19. 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