一名病患被診斷為急性腎損傷（AKI），護理師預期會觀察到下列哪些徵象？（選所有適合的）
A client is diagnosed with acute kidney injury (AKI). Which findings should the nurse expect to observe? (Select all that apply.)
- AHyperkalemia✓ 正解高血鉀症
- BMetabolic alkalosis代謝性鹼中毒
- CElevated BUN and Creatinine✓ 正解BUN 和肌酸酐升高
- DDecreased urinary output (Oliguria)✓ 正解尿量減少（少尿）
- EHypocalcemia✓ 正解低血鈣症
急性腎損傷（AKI）導致排泄功能失效，導致代謝產物與電解質滯留。鉀離子無法排出造成高血鉀，這是最需警覺的致命併發症。腎臟無法排除酸性代謝物，因此會出現代謝性酸中毒（而非鹼中毒）。肌酸酐與尿素氮升高代表腎絲球過濾率下降。少尿（Oliguria）是腎損傷的典型表現。此外，腎臟活化維生素 D 的能力下降，且磷排泄受阻，導致磷升高進而結合鈣離子，造成血鈣過低。正確處理需嚴格監控心律變化與液體平衡，避免鉀離子過高導致心律不整。這是內外科病人極需關注的生理適應議題。
Acute kidney injury (AKI) results in loss of excretory function, leading to retention of metabolic waste products and electrolytes. Potassium cannot be excreted, resulting in hyperkalemia, which is the most concerning life-threatening complication. The kidneys cannot eliminate acidic metabolites, resulting in metabolic acidosis (not alkalosis). Elevated creatinine and BUN reflect a decreased glomerular filtration rate. Oliguria is a typical manifestation of renal injury. In addition, the kidney's ability to activate vitamin D is impaired and phosphate excretion is blocked, leading to elevated phosphate that binds calcium and causes hypocalcemia. Proper management requires strict monitoring of cardiac rhythm and fluid balance to prevent arrhythmias secondary to hyperkalemia. This is a critical physiologic adaptation issue for medical-surgical patients.
美國護理師常參與 CRRT（連續性腎臟替代療法）的日常監測，台灣則多由專門的血液透析護理師或受訓過的 ICU 護理師執行，權責分工較明確。