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141 Class 3
Renal
| Question | Answer |
|---|---|
| Which potential complication would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease? | tachycardia, cloudy outflow, abdominal pain |
| What instruction would the nurse provide to help a client prevent future attacks of glomerulonephritis? | "Seek early treatment for respiratory infections" (a common cause is streptococcal infection) |
| Which intervention would the nurse include in the plan of care of a client with end-stage renal disease who has mature arteriovenous fistula (AVF)? | auscultate the fistula for the presence of a bruit, palpate the site to ID the presence of a thrill, and avoid drawing blood from the affected extremity |
| Give an example of a statement that indicates family understanding of age-related changes and required care after family members received discharge instructions for an older adult male recovering from a UTI? | "I provide privacy and standby assistance to help him void" |
| Which intervention would be in the plan of care of a client with kidney dysfunction who is about to undergo renal testing using a contrast medium? | assess for history of cirrhosis (due to the increased chance of developing kidney failure after the procedure), shellfish allergies, iodine allergies, and evaluate the client's hydration status by checking BP and RR |
| Which prescribed hemodialysis protocol would the nurse implement when a client with end-stage renal failure, beginning hemodialysis for the first time, reports nausea and headache, and then is confused? | Decrease the rate of hemodialysis exchange because of disequilibrium syndrome |
| Which action would the nurse take before a client's scheduled hemodialysis treatment? | Weigh the client to establish a baseline for later comparison |
| Which dietary instruction would the nurse provide a client receiving continuous ambulatory peritoneal dialysis for chronic glomerulonephritis? | high-quality proteins |
| A test result of 6.3 potassium would indicate a possible diagnosis of what? | end-stage renal disease |
| Which clinical manifestation would indicate the cancer is in an early stage in a male client with a preliminary diagnosis of cancer of the urinary bladder? | Hematuria |
| When preparing a patient for a radiologic procedure what allergy is important to assess for? | Contrast Dye, seafood, shellfish allergies |
| Removing transdermal patches and piercings is important to instruct in what procedure? | MRI |
| When caring for a patient who is a post Arteriogram/Angiogram what is your priority assessment? a. monitor output b. restrict activity x 1 day c. monitor peripheral pulses d. monitor bleeding @ femoral artery | D. Monitor bleeding at femoral artery |
| What is a major complication of a Renal biopsy? | Bleeding at the site |
| A 24 hour urine is collected for creatinine clearance. What would the nurse expect to see if the kidneys are not functioning properly? | Creatinine clearance level would be low in impaired kidney function. Rationale: creatinine is "cleared" totally by kidneys. If not working you will see low urine cr levels and high serum cr levels |
| A patient develops urinary incontinence. What should the nurse further investigate? | Potential cause of incontinence UTI, trauma, menopause... |
| Renal neoplasms often have silent symptoms in early stages name some late s/s of renal neoplasms, what are they? | gross hematuria, flank pain, palpable mass |
| A patient is in your office states that they have had blood in their urine that does not cause pain. What would you infer based on this data? | The patient should be evaluated for a possible bladder neoplasm. Rationale: painless hematuria is a common s/s in patients with bladder neoplasms |
| Which of the following is considered an incomplete protein and is not recommended in patients with ESRD on hemodialysis. a. eggs b. fish c. milk d. nuts | Nuts |
| A patient in ESRD is experiencing fluid overload. Which of the following assessment findings would the nurse see that would be suspicious of fluid overload a. bilateral pedal edema b. b/p 110/60 c. crackles in lung fields d. urine output 200 ml in 24hrs | a, c, d |
| What is the primary purpose of dialysis? | To remove waste products and excess fluid therefore restoring balance |
| A patient receiving hemodialysis had an AVF (arteriovenous Fistula) placed 3 weeks ago. You are assessing your patient in the morning name 2 important assessments and nursing care r/t a AVF. | Palpate fistula for a thrill no B/P or labs in affected arm monitor site for bleeding and s/s of infection make sure sign is posted on wall NO LABS OR B/P |
| What intervention is done by the nurse in a patient receiving dialysis in order to determine if correct amount of fluid is removed from the patient? | Obtain a weight before and after dialysis. Rationale: Weight is way to determine the fluid status of the patient. Sometimes referred to as a "wet" or "dry" weight (before and after) |
| A patient c/o not feeling good after dialysis. This is caused by a condition that delays the removal of waste from the brain. What is this condition called? | Disequilibrium syndrome |
| While monitoring a patient at home perform peritoneal dialysis what assessment finding would alert you that the patient is developing an infection? | Cloudy dialysate fluid is returned |
| What is most accurate indicator of fluid loss or gain in a renal patient? | weight |
| Pyelonephritis is usually a result of what? | Recurrent Infections. Rationale: bacteria enters renal pelvis causing inflammatory response edema, fibrosis, scarring. Scarring causes permanent renal tissue damage |
| A patient with end stage renal disease will typically show what diagnostic findings? Select all that apply a. vomiting b. anemia c. hyperkalemia d. hypocalcemia | B. anemia r/t decreased erythropoietin production c. hyperkalemia: kidney function decreased cannot maintain electrolyte balance D. hypocalcemia - Calcium varies in renal patients but typically it is low |
| What is the cause of glomerulonephritis? | Antigen-Antibody reaction with glomerular tissue |
| Name 2 lab values that you will significantly see elevated when kidneys are unable to filter waste products adequately? | Elevation in BUN and serum creatinine Rationale: BUN measures urea which should be excreted in kidneys NOT seen elevated in serum. Creatinine: evaluates kidney function. Cr is by-product of the breakdown of muscle and is excreted by kidneys |
| Why is TUMS given to chronic renal failure patients? | binds with phosphorus to lower serum phosphate levels since kidneys are not functioning properly |
| Why is Epoetin (Epogen) given to a patient with ESRD? | To increase RBC production. Rationale: Kidneys that are damaged do not produce erythropoietin that stimulates RBC production hence they are often anemic |
| A nurse has been monitoring at patient's labs and sees that the GFR (glomerular filtration rate) has been consistently < 30 for the past 5 months. What conclusion does the nurse come to based on these lab values? | Patient is in chronic renal failure. Rationale: GFR <60 ml/min for 3 months or longer is indicative of renal failure |
| Patients are often given Kayexalate (sodium polystyrene sulfonate) who are in ESRD. Why is this given and what is its action? | Kayexalate lowers potassium levels in ESRD patients by binding to potassium and excreting through the GI tract |
| A patient in ESRD is receiving a Phosphate binding medication such as: TUMS, Renagel, Fosrenaol, sodium bicarbonate. What lab value is important to monitor with this classification of medication? | Calcium Levels Rationale: phosphate binders bind to phosphorus and normalize serum calcium levels (LeMone 812). Important to monitor calcium to make sure stays within normal range. |
| List some foods high in potassium | artichoke, avocado, banana, beans, beets, bok choy, carrots, chocolate, dried fruits, guava, greens, kiwi, mango, melons, milk, soy milk, nectarine, nuts, peanuts, orange, papaya, peas, peppers, potato, prune, pumpkin, rutabaga, salt sub, cabbage, seeds |
| List some foods high in both potassium and phosphorus | milk, eggnog, cocoa, hot chocolate, coconut milk, ovaltine, latte, cappuccino, instant breakfast drinks, pasta with tomato and cheese, pizza, mexican food with beans, tomatoes and cheese, lasagna, chili, beans, cream soup, cheese, nuts, peanutbutter, seed |
| What is the regulatory function of kidneys? | Maintains fluid & electrolyte balances Acid-base balance Accomplished through- Urine elimination Glomerular filtration Tubular reabsorption and secretion |
| What is the hormonal function of kidneys? | Control RBC formation- erythropoietin stimulate bone marrow to produce RBCs. BP regulation- renin production Vitamin D activation- kidneys convert Vit. D to its active form which helps regulate calcium balance by promoting absorption of ca in GI tract. |
| What hormone is secreted by the kidneys that helps BP | renin |
| What are some age related changes to the renal system? | Blood flow to kidneys declines by 10% per decade as blood vessels thicken. Glomerular & tubular linings thicken resulting in decreased ability to filter blood & excrete waste products. Reduced kidney size GFR < w age increasing risk of fluid overload. |
| What are some MORE age related changes to the renal system? | Detrusor muscle loses elasticity = < bladder capacity.Urinary sphincters lose tone= urgency/incontinence Women- weakened pelvic floor/short urethra promote incomitance/>risk of UTIs. Men- enlarged prostate gland=difficult to start urine/urinary retention. |
| Nursing considerations for age related changes to the renal system | Encourage voiding q2h, refrain from fluids 2 hrs. before sleep. Adequate nighttime lighting to prevent falls. Kegel exercises, monitor hydration status, use caution when giving nephrotoxic meds. |
| Renal assessment what should you ask/ID | age, gender, race, previous kidney/urologic problems (tumors, infection, stones, HTN, DM), heroin, cocaine, drug use, chemical exposure, home meds, incontinence, nocturia, retention, cancer, diet: fluid intake, caffiene, protein, ca, change in appetite |
| Physical assessment of the renal system | Edema- pedal, pretibial, sacral & around eyes common with fluid build up. Cognitive changes- result from build up of waste products. Lung sounds- assess for fluid build up Weight Blood pressure |
| Common labs done for renal system issues | Serum creatinine Blood urea nitrogen (BUN) Cystin-C Urinalysis (UA) Urine creatinine clearance Glomerular filtration rate (e GFR) |
| Common diagnostics done for renal system issues | Kidneys, ureters bladder (KUB) Kidney biopsy Renal angiogram |
| Kidneys, Ureter & Bladder (KUB) X-RAY is what? | Identifies any gross anatomic features & obvious stones. X-ray visualizes kidneys, ureters and bladder. No specific prep needed. More diagnostic tests needed to diagnose functional or structural problems. |
| Kidney biopsy is what? | Helps determine cause of unexplained kidney problems ; guide's care. Performed percutaneously (through skin) with a biopsy needle using ultrasound/CT guidance. Bleeding is a MAJOR risk. |
| Nursing care for a kidneybiopsy? | Informed consent, NPO 4-6 hrs, PT, PTT, B/P, bedrest 24 hr post, Limited bathroom privileges after 24 hr. Discomfort at site. If pain radiates to flank, back and abdomen suspect bleeding. UO, hematuria, VS.Bruising/flank pain , decrease b/p, hypovolemia |
| Renal arteriogram or angiogram is what? | Visualizes renal arteries using radiopaque dye. Dye injected via femoral or brachial artery & x-rays taken Seldom used as stand-alone diagnostic procedure. Usually done at time of renal angioplasty or other intervention. |
| Renal arteriogram nursing interventions | Assess dye allergy & anticoagulant use NPO 8-12 h prior Oral hypoglycemic’s contraindicated with contrast medium |
| Renal arteriogram post procedure | Monitor bleeding @femoral artery Restrict activity x 1 day Monitor output (dye is hard on kidneys) Monitor peripheral pulses |
| If you are taking metformin when you have your imaging test procedure, your kidneys may not be able to properly remove metformin from your blood. True or false | true |
| What might happen if the patient takes an oral insulin before a renal arteriogram? | may increase and cause a serious condition called lactic acidosis, especially if you have kidney problems. |
| Symptoms of lactic acidosis are: | feeling very weak, tired, or uncomfortable, unusual muscle pain, trouble breathing, unusual or unexpected stomach discomfort, feeling cold, dizziness or lightheadedness, suddenly developing a slow or irregular heartbeat. |
| Serum creatinine normal level | 0.5-1.2 |
| Serum creatinine is what | is produced when muscles & other proteins are broken down & excreted by the kidneys. Serum creatinine affected by: Age, race Gender body size When serum creatinine levels doubled, it indicates a 50% reduction in GFR |
| If kidneys are functioning properly, you’d expect to see higher levels of creatinine in blood and less in urine. True or false | False, switch the two, When kidneys do not function well less creatinine is seen in urine and more in the blood. |
| Estimated Glomerular Filtration Rate (eGFR) is what | The glomerular filtration rate (GFR) shows how well the kidneys are filtering. The standard way to estimate GFR is with a simple blood test that measures your creatinine levels. Formula based on age, gender, race, body size. |
| Why is Estimated Glomerular Filtration Rate (eGFR) testing done | Early-stage kidney disease doesn’t usually cause symptoms, but your doctor may recommend a eGFR test if you are at higher risk. CKD risk factors include: Having DM or high BP High blood pressure Being overweight Family history of kidney failure |
| Blood urea nitrogen BUN level | 10-20 |
| How does BUN measure the effectiveness of kidney excretion of urea nitrogen | Urea nitrogen is by-product of protein breakdown in the liver. Kidneys filter urea nitrogen from the blood and excrete in the urine. Elevated BUN does not always mean kidney disease is present. Normal range 10-20 mg/dl. Slightly higher in older adults. |
| Contributing factors to increased BUN levels NOT r/t kidney disease: | Rapid cell destruction from infection, cancer Tx., or steroid therapy. Blood (protein) from injured tissues, GI bleed. Dehydration – common reason. |
| 24 hr. Urine Creatinine Clearance is what | Urine sample that is collected for 24 h period. ( can be shorter 8-12 hrs.) Compares urine creatinine to serum creatinine levels. |
| 24 hr. Urine Creatinine Clearance normal levels | Men- 107-139 ml/min Women- 87-107 ml/min Values decrease per decade of life r/t age-related decline of GFR. Expect low levels if kidney function impaired. |
| 24 hr. Urine Creatinine Clearance nursing interventions | 1 urine is discarded, Keep urine on ice or in refrigerator during 24h period, Instruct pt. and family to save all urine during 24h Assess meds: thiazides steroids may decrease creatinine while Methyldopa, vit c, cimetidine may increase levels. |
| Thought: “kidneys clear creatinine from blood” So higher levels would be seen in... | urine of normal kidneys; Creatinine is removed, or cleared, from the body entirely by the kidneys. If kidney function is abnormal, creatinine level increases in the blood because less creatinine is released through the urine. |
| Cystatin C is what | Measures glomerular filtration rate. Is a protein produced in the body at a constant rate & can be used as indicator of GFR. |
| When GFR is reduced what increases | cystatin C |
| Increased levels can be considered a predictor of chronic renal disease. Not influenced by factors that influence BUN and creatinine. Maybe be better indicator of GFR. Increased blood concentration = indicate decrease GFR & kidney dysfunction. T or F | T |
| Urinalysis (UA) | Provides useful info for pts. w suspected kidney disorders. 1st morning urine. Other specimens may be too dilute.Specimens become more alkaline when left unrefrigerated for more than 1 hr or when bacteria are present. Promptly cover and deliver to the lab |
| Chronic pyelonephritis is what | Repeated upper UTIs in pts who have anatomic abnormalities of the UT. Urinary stasis, structural deformities, reflux from the bladder tumors, enlarged prostate, kidney stones |
| Repeated infections causing scar tissue to develop from chronic inflammation in the kidney glomerular and tubular structures. Results in impaired reabsorption and kidney function is reduced, is what | chronic pyelonephritis |
| Acute pyelonephritis looks like an infection; Chronic looks like kidney failure, true or false | true |
| Chronic Pyelonephritis | Common cause of CKD, develop r/t UTI’s or conditions that damage kidneys (HTN or vascular conditions), obstructions, reflux, May be asymptomatic or have mild manifestations (frequency, dysuria, flank pain), HTN may occur as kidney tissue is destroyed |
| Conditions causing chronic pyelonephritis: | Kidney stones, scaring from pelvic radiation, reflux, diabetic neuropathy, SCI, neurodegenerative diseases (MS, spina bifida). E-coli urine infections, immune diseases that cause systemic inflammatory response (lupus). |
| Chronic Pyelonephritis- Generate Solutions Take Action | prevent UTI- take full course of antibiotics, Encourage fluid intake, Avoid holding urine, Vit. C and Cranberry juice intake, Avoid excess milk/ milk products (renal stone risk), reporting change in urine color, clarity, of s/s of infection. |
| Chronic Glomerulonephritis (GN)- aka chronic Nephritic syndrome | Think Immune Reaction!!! Develops over years to decades. Always leads to end-stage kidney/renal disease (ESKD). |
| Chronic Glomerulonephritis (GN)- aka chronic Nephritic syndrome cause | Exact cause unknown, but changes in kidney tissue result from: Inflammation from immunity excess (Lupus) Infection. Hypertension Poor kidney blood flow. Diabetic nephropathy- |
| Chronic Glomerulonephritis what is it | Inflammation of the glomerular capillary membrane in the kidney. |
| Chronic Chronic Kidney Disease (CKD) is what | Progressive, irreversible damage lasting > 3months. 5 stages of CKD based on GFR. When kidney function & waste elimination are too poor to sustain life, CKD becomes ESKD. |
| Chronic Chronic Kidney Disease (CKD) common causes | Glomerular disease- Glomerulonephritis Infection- pyelonephritis Metabolic- DM, gout, sarcoidosis Genetics- polycystic kidneys…. Urinary tract disease - obstructions Connective tissue diseases (Lupus, polyarteritis) |
| Stage 1 of renal failure | Normal GFR >90 Have abnormal urine findings, structural abnormalities or genetic trats pointing to kidney disease. Screen for: nephrotoxic meds, glucose control, HTN to reduce progression |
| Stage 2 of renal failure | Mildly decreased GFR 60-89 ml/min Albuminuria may be present. Kidney nephron damage has occurred. May be slight elevation of waste products in the blood. Focus on reduction of risk factors. Increased dilute urine output= risk of dehydration. |
| Stage 3 of renal failure | Moderate GFR decrease 30-59 ml/min Albuminuria usually present. Mgmt. of conditions DM HTN essential to prevent further nephron damage. Restrict: Fluid, protein, electrolytes is needed. |
| Azotemia: | high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen rich compound) in the blood. It is largely r/t insufficient filtering of blood by the kidneys It can lead to uremia if not controlled |
| Uremia | can be translated as "urea in the blood". Metallic taste in mouth, anorexia N&V, muscle cramps, fatigue, hiccups Edema, dyspnea, paresthesia's Uremic frost on skin |
| Azotemia | is another word that refers to high levels of urea, but is used primarily when the abnormality can be measured chemically but is not yet so severe as to produce symptoms. Uremia is the pathological manifestations of severe azotemia.[ |
| Stage 4 of renal failure | Severely decreased GFR 15-29 ml/min Waste elimination is poor. High levels of urea & creatinine in blood. Severe fluid & electrolyte imbalances Acid-base imbalances occur. |
| Stage 5 of renal failure | GFR <15 mL/ min Kidney failure with azotemia and overt uremia Multi-system problems Kidney transplant/dialysis. Hiccups |
| Stage 3 of renal failure is when you start dialysis, true or false | false, 4 |
| Nephrotoxic Medications | Antibiotics- antimicrobials & aminoglycosides Diuretics: furosemide (overuse) NSAIDs Chemotherapy agents Magnesium containing antacids & laxatives Metformin Heavy metals- lead Radiologic contrast dyes |
| Multisystem effects of ESKD | Fluid and electrolytes Cardiovascular Hematologic Immune system Gastrointestinal Neurologic Musculoskeletal Endocrine/Metabolic Dermatologic Psychosocial |
| Cardiovascular effects of ESKD | accelerated atherosclerosis , HTN from fluid volume excess, pulmonary edema from heart failure. |
| Hematologic effects of ESKD | anemia from decreased erythropoietin that controls rbc production, impaired platelet function (reason not fully known) bleeding risks. |
| Immune effects of ESKD | Uremia increases risk of infection by impairing aspects of inflammation and immune function. Fever is suppressed delaying diagnosis of infection. |
| GI effects of ESKD | n/v anorexia common with uremia. Hiccups also common. Peptic ulcer disease common in uremia, uremic fetor, urine smelling breath affects taste. |
| Neurologic effects of ESKD | Uremia affects CNS system causing fatigue, insomnia, difficulty concentrating |
| Musculoskeletal effects of ESKD | renal osteodystrophy or renal rickets from softening of the bones from high phosphorus levels and low calcium levels. |
| Endocrine effects of ESKD | Glucose intolerance r/t tissues becoming resistant to the effects of insulin in uremia. |
| Dermatologic effects of ESKD | anemia and retained pigmented metabolites cause pallor and a yellowish hue to the skin. Bruising seen r/t platelet involvement, dry skin poor skin turgor r/t dehydration. Itching r/t waste products being deposited in the skin. |
| Psychosocial effects of ESKD | not being able to spend time out and with people since they are on the machine |
| Lab values in ESKD | Creatinine up, BUN up, Potassium up, calcium down, phosphorus up, magnesium up, serum glucose up, RBC/Hbg down, GFR down |
| When/why is protein restricted in a ESKD patient? | Done early in disease may preserve kidney function. GFR & treatment is used to guide safe levels of protein intake Pt. in ESKD on dialysis needs more protein r/t loss during dialysis. |
| When/why is sodium restricted in a ESKD patient? | Needed if little tor no urine output to maintain fluid & electrolyte balance Most pts. With CKD retain sodium |
| When/why is potassium restricted in a ESKD patient? | May be needed- high potassium causes cardiac dysrhythmias. Avoid high potassium foods Avoid salt substitutes (high in potassium) |
| When/why is phosphorus restricted in a ESKD patient? | Started early to avoid renal osteodystrophy (due to low calcium) Phosphate binder medications given at mealtime. Reduce phosphorus intake (high protein foods generally high in phosphorus). |
| Common phosphorus foods/drinks: | canned colas, drinks, & other bottled drinks high Phosphorus Prepared foods read labels for “phos” containing ingredients |
| Vitamin & mineral supplementation for ESKD patient | Need daily supplements- low-protein diets also low in vitamins. Water-soluble vitamins removed during dialysis. Anemia is common problem in CKD due to low protein diets (heme-iron), decreased erythropoietin production. |
| Renal Osteodystrophy is a form of | metabolic bone disease seen in patients with chronic renal insufficiency characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients present with osteomalacia, osteonecrosis and pathologic fractures |
| Priority Problems for patients with CKD: | Fluid overload,< cardiac function, r/t < stroke volume, dysrhythmias, > peripheral vascular resistance, Weight loss r/t inability to ingest, digest/absorb, Risk for injuryr/t bone density, blood clotting & drug elimination, Psychosocial effects of CKD |
| Generate Solutions- Take Action in CKD: managing fluid volume | weight, I and O, LOC, cognition, HA, blurred vision, s/s of fluid overload |
| S/S of fluid overload | Decreased urine output, rapid bounding pulse Shallow rapid respirations Dependent edema Crackles or wheezes Distended neck veins in sitting position Decreased oxygen sats Elevated blood pressure Narrowing pulse pressure |
| Common CKD medications | phosphate binders, diuretics, Ca channel blockers, ACE's, erythropoietin, sodium polystyrene sulfonate, statin drugs |
| Goals of Dialysis in ESKD | Remove waste products & excess fluid Restore electrolyte and acid base balance in body |
| Hemodialysis (HD) is what | Remove waste products & excess fluid restoring fluid & electrolyte & acid-base balances. Manages symptoms does not cure Performed usually 3 times/week 3-4 hrs. each run |
| When does hemodialysis start | usually when uremic symptoms begin (n/v, confusion, bleeding from severe platelet dysfunction, seizures) |
| Safe HD requires what | Meticulous care of the HD machines Proper nursing supervision of HD machines and patient. Technical or human error can result in Hemolysis Air embolisms Dialysate error Contamination Bleeding/ hemorrhage |
| Anticoagulation during HD: | Blood clotting can occur during dialysis, so heparin is given into the pump during dialysis. Heparin active in body 4-6 hrs. after procedure. MONITOR BLEEDING have protamine sulfate on hand. |
| Hemodialysis Access Sites permanent or temporary | Central catheter- temporary Arteriovenous Fistula (AVF) or AV graft. |
| Hemodialysis Access Sites best practices for AVF/AV graft care | Palpate fistula for thrill, No B/P or lab draw in arm, Monitor for bleeding and s/s infection, New AVF takes 8-12 wks. to mature in order to accommodate large bore needles. Instruct pt. not to carry heavy objects on affected arm or sleep on affected arm |
| Common complications of HD | thrombosis, infection, aneurysm, ischemia, heart failure |
| thrombosis | most frequent complication. High-pressure of arterial flow entering venous system causes veins to thicken reducing or occluding blood flow. Interventional radiologist can inject thrombolytic drug to dissolve the clot. |
| infection | prep skin prior to access, clean HD machines meticulously. |
| aneurysm | formed by repeated needle punctures at same site. |
| ichemia | occurs when fistula decreases arterial blood flow to areas below the fistula Cold numb fingers to gangrene can result. |
| heart failure | caused by shunting of blood directly from arterial system to the venous system through the fistula. |
| HD nursing care | Many drugs are dialyzable from the blood. Check with nurse prior to giving any meds. Consult with HD nurse prior to giving antihypertensive drugs before dialysis to prevent hypotension. Distracting activities to fill their 4-hr. time while receiving HD |
| HD post-dialysis care | HA, hypotension, N/V Dizziness muscle cramps. V/S & wt. compare with pre-dialysis. (expect to be reduced) Temp may be elevated r/t HD warms blood slightly. Avoid invasive procedures 4-6 hrs. after HD r/t bleeding risk |
| HD meds dialyzable from HD | Aminoglycosides Antituberculosis meds Antiviral or antifungal Cephalosporins Anticonvulsants Penicillin's Vitamins ASA Cimetidine Enalapril |
| Dialysis Disequilibrium Syndrome- | severe forms rare today. Caused from rapid reduction of electrolytes & other particles. Slowing HD rate can help. Severe: Mental status changes, seizures or coma. Mild: N/V, HA, fatigue, restlessness |
| HD infectious diseases | HIV, Hep B, Hep C from contamination of HD machines, needles, blood transfusions. |
| HD cardiac events | Associated with underlying /cv disease. |
| HD hypoglycemia | more common in diabetics. |
| Peritoneal Dialysis | Exchanges wastes, fluid and electrolytes to occur in the peritoneal cavity. Slower than HD and more time needed to achieve the same effect. |
| Peritoneal Dialysis information | Silicone catheter placed into abdominal cavity. Cannot be done if peritoneal adhesions present or if extensive intra-abdominal surgery has been preformed. Fill, dwell, drain period. Frequency of PD is determined by physician based on s/s and lab data |
| Peritoneal Dialysis advantages | Allows more freedom for pt. Fewer dietary & fluid restrictions required. Fluids/solutes removed slower than HD= less risk to unstable patient. |
| Peritoneal Dialysis disadvantages | Less effective metabolite elimination. Higher risk of infection- peritonitis= cloudy fluid return during drain. Use aseptic technique with catheter. |
| Peritoneal Dialysis complications | Protein loss Peritonitis Constipation (r/t poor dialysate flow) Weight gain during dwell time . Potential back pain or hernia development. Pain |
| Warm dialysate with heating pad or a warming chamber NEVER a microwave. True or false | true |
| Key Points when performing PD | Mask yourself & pt. wash hands. Aseptic technique Drainage bag is lower than pts. Abdomen. Most prefer to do at night |
| Nursing care for PD, prior to | Vital Signs Weigh pt. Labs- electrolytes & glucose |
| Nursing care for PD during and after | Vitals q 15-20 min, leakage, Observe outflow of dialysate, Measure & record total amount of outflow after each exchange. Weigh pt. after to obtain “dry weight” Monitor clarity of fluid drained |
| When looking at a patient with a PD, you note that the drainage is cloudy. What would this indicate? | infection |
| Weight changes more indicative of fluid volume status. 1 kg wt. gain = 1000 ml fluid, true or false | true |
| Urothelial Cancers | Malignant tumors in the lining of the cells in the kidneys, renal pelvis, ureters, bladder & urethra. Most common is bladder cancer followed by kidney cancer. Most are highly invasive. Systemic chemotherapy used only if metastasis present. |
| What are cues to recognize for urothelial cancers | Exposure to passive/ active cigarette smoke or caustic substances. Changes in color of urine. Blood in urine often 1st indication of bladder cancer (usually painless). |
| Urothelial Cancers- Take Action | Treatment begins with surgical removal of the tumor. If kidney cancer nephrectomy often performed. |
| Urothelial Cancers- Take Action intravesical instillation | Immunotherapy where live virus compound is instilled into bladder to prevent tumor recurrence. Dwells in bladder for 2 hrs. Pt. voids and live virus is excreted in the urine. |
| Teaching for patient with urothelial cancers | Prevent contact of live virus with members of household. Don’t share toilet or clean with bleach after. Wear gloves during cleaning. Wash underwear with urine with bleach for 24 hrs. after instillation. Avoid sex for 24 hrs. after installation of virus |
| Urinary Incontinence (UI) | involuntary loss of urine severe enough to cause social or hygienic problems. Not a normal consequence of aging or childbirth. |
| Stress UI | involuntary loss of urine during activities that increase abdominal pressure (cough, sneeze, exercise). |
| Urge UI | overactive bladder (OAB). Involuntary loss of urine with strong desire to urinate. |
| Mixed UI | combination of stress & urge incontinence. |
| Overflow UI | involuntary loss of urine assoc. with overdistention of bladder when bladder has reached capacity. |
| Functional UI | leakage of urine caused by factors other than disease of the lower urinary tract. |
| Bladder & Habit Training | Stroking or pinching abd/inner thigh, glans penis, Pulling pubic hairs, Tapping SP region, Crede method, Insert finger into rectum and stretch anal sphincter, privacy, Void every 2 hrs, staff adhere to training schedule, Don’t place brief |
| Which dietary instruction would the nurse provide a client receiving continuous ambulatory peritoneal dialysis for chronic glomerulonephritis? a. low cal b. high quality protein c. increase fluids d. foods rich in potassium | B. proteins should be high quality to replace those lost during dialysis |
| Which difference between the two methods of access will the nurse consider in planning care for a client with end-stage renal disease who has an internal AVF in one arm and an external AV shunt in the other arm? | the graft is more subject to hemorrhage, clotting, and infection than the fistula is |
Created by:
alexs13