Advanced Clinical Scenarios: Cardiovascular, Endocrine, and Renal Management

Nephrology / Medical-Surgical

Scenario: A 70-year-old patient with Chronic Kidney Disease (CKD) Stage 4 is scheduled for a CT scan with intravenous contrast. The patient’s current Creatinine is 2.8 mg/dL and GFR is 22 mL/min.

What is the most appropriate nursing action to minimize the risk of Contrast-Induced Nephropathy (CIN)?

A. Restrict fluid intake for 12 hours prior to the procedure.

B. Administer high-dose Vitamin C post-procedure.

C. Ensure adequate IV hydration with Normal Saline before and after the procedure.

D. Request the physician to increase the contrast dose for better visualization.

Rationale: Contrast-Induced Nephropathy (CIN) is a major risk for patients with pre-existing renal impairment. IV hydration (C) with isotonic saline is the most effective evidence-based strategy to maintain renal perfusion and dilute the contrast media within the renal tubules, facilitating its excretion and reducing direct toxicity. Restricting fluids (A) would worsen the risk.

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