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renal meds

usm son renal meds

When Infusing ammonium chloride slowly to avoid ammonium toxicity and decrease irritation to veins
mom of 4 year old asthma patien calls you to the room because the child is having some diff. breathing when you enter the room you not that the patient has audible inspiratiry and expiratory wheezing and is listless the child's rr=32 and pluse ox=85% whic administer the prn duoneb (albuterol + atrovent) nebulizer treatment.
Nursing assesment of a patient receiving normal serum albumin for treatment of show should include : assessing breath sounds
Your patient admitted for acute exacerbation of chf is receiving dig and fursemide lasix. Which of the following lab levels should you carefully monitor? – potassium
your patient with newly diagnosed HTN will be started on spironolactone (aldactonne) which of the following drug groups should not be used or used with extreeme caution in patients taking this medication? ace inhibitors
Your pt complains of muscle cramping in the calves, paresthesia of the toes and the sensation of the heart skipping a beat. These symptoms make indticated which of the following im balances? hyperkalemia
Your patient will be sent home on duretic therapy and will need to increase the amount of potassium in the diet. What food choices would you suggest to the patient banans, tomatoes, beans fresh meats
Inadequate blood flow to meet body’s needs shock
Considered medical emergency shock
Can lead to irreversible organ damage and death (kidney’s-fail-starts here) shock
Shock Treatment : narrow the pipes because what little blood that we have will seem like a lot
What is the quickest indicator of shock Urine output is the quickest indicator, because if kidneys are not getting enough blood flow they wont be putting out urine should be 30 ml/ hour
Types of Shock Cardiogenic, hypovolemic, neurogenic, septic, and anaphylactic
The types of shock are Classified by Underlying pathological condition; Organ system causing the disease
Cardiogenic shock means ? : from failure of heart to pump sufficient blood
Most fatal type because it doesn’t repsond well to treatment cardiogenic shock
Hypovolemc shock is what: from loss of blood volume
Neurogenic shock is what: from vasodilatation due to changes in autonomic nervous system
Septic shock is what Multiple-organ dysfunction; Result of pathogenic organisms in blood ; starts with an infection that gets into the blood stream
Causes vasodilation and changes in permeability of capillaries septic shock
Often precursor to acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) septic shock
During septic shock 1st thing to treat: stop the immune system, because of the massive overaction of the immune system, massive vasodilation-> a lot of blood to that area.
Anaphylactic shock: acute allergic reaction Not by a bacteria, but same process as septic shock; Inflammation without infection
symptoms of shock are Pale, cold, clammy skin; Feeling of sickness and weakness; Restlessness, anxiety, confusion, depression, apathy – decreased oxygen going to brain; Unconsciousness; Thirst (1st compensatory mech)
what is the first compensatory mech of shock thirst
what happens to the cardiovas. System during shock Cardiovascular system fails to send enough blood to vital organs(407)
Effects seen in the cardiovascular system -Heart and brain affected early - Low BP and diminished cardiac output- Heart rate is rapid and weak- Breathing is shallow and rapid (Going into a metabolic acidosis state )
Pharmacotherapy Goals Restore normal fluid volume and composition, Maintain adequate blood pressure – maintian adequate tissure perfusion
For anaphylaxis the pharmacotherapy :
Causes of fluid loss include Hemorrhage; extensive burns; severe dehydration ; Persistent vomiting(metabolic alkalosis) or diarrhea(poop out bases - metabolic acidosis); intensive diuretic therapy
Patient vomiting for three days what will you use to treat them ...
In Hypovolemic Shock there is Three categories of fluid-replacement agents used (page 408-example) Blood-donated from blood bank; Colloids – plasma protiens ; Crystalloids- electrolytes in it
Intravenous Fluid Therapy Replaces fluids and electrolytes using Uses crystalloids and colloids
Causes of water and electrolyte loss Gastrointestinal fluid loss, vomiting, diarrhea, laxatives, suctioning; Perspiration, burns, hemorrhage, excessive diuresis, ketoacidosis
Whole Blood is Indicated for treatment of acute, massive blood loss; 30% or more of total volume
Supply depends on donors whole blood
Requires careful cross-matching whole blood
Can transmit infections such as hepatitis or HIV whole blood
More the surface antigens the more likely they can reject it
Cant let blood sit out too much, otherwise it hemolyizes, check to make sure it’s the right one, hang quickly
Colloids do what ? Expand plasma volume and maintain blood pressure
Truly like plasma(oily), glass jar, not a big volume infusion – quick IVPB or IVP, synthetic version of your blood colloids
Used when up to one-third of adult client’s blood volume lost colloids
Stay suspended in blood colloids
Problems : Sometimes establishes a too quick of a fluid shift, often see allergic reactions with it because it is a protein –protein allergies colloids
Draw molecules from body’s cells and tissues into blood vessels colloids (Oncotic pressure)
Examples of colloids : normal human serum albumin, plasma protein fraction, dextran, hetastarch
normal human serum albumin, plasma protein fraction, dextran, hetastarch Examples of colloids
cost of colloids Expensive
Colloids Prototype drug : normal serum albumin (Albuminar, Albutein)
to maintain plasma osmotic pressure and transport substances through blood colloids
Colloids are Used for : restoration of plasma volume and blood proteins
Colloid SEs are : allergies and protein overload
Things to look for in side effects of colloids : crackles, CHS sym. BP changes HR and RR changes
Crystalloids are used to Replace lost fluids and electrolytes; increase urine output
IV solutions cause movement of fluid between blood and body’s cells.
Examples of crystalloids are Isotonic, hypertonic, hypotonic (p. 432, 433)
Normal saline, lactated Ringer’s, hypertonic saline, and 5% dextrose in water crystalloids
Hyptonic solution the fluid will shifts out
Hypertonic fluid is going in which will lead to : edema
D5(hypertonic)NS(isotonic) = a little hypertonic
3%-hypertonic if ut in too fast can cause – strong – cerebral edema ( too fast)
D5 (hyper) 1/2NS(hypo) = slightly hypotonic
Lactated ringers are what kind of soluntion : isontonic solution ( IV gatorade) – goto tx for burns
Anaphylaxis Serious hypersensitivity response to allergen
Anaphylaxis May be caused by common drugs
Common drugs that may cause anaphylaxis Penicillins, cephalosporins, Nonsteroidal anti-inflammatory drugs (NSAIDs)ACE inhibitors
Signs and Symptoms of Anaphylaxis Periorbital edema, urticaria, wheezing and difficult breathing
Periorbital edema, urticaria, wheezing and difficult breathing anaphylaxis
Some other sings of shock Palpitations, chest pain, N/V, Sweating, weakness, dizziness, confusion,Sense of impending doomBlurred vision, headache, anxiety, More than likely breathing will only get worse
Treatment of Anaphylaxis sympathomimetics, antihistamines, glucocorticoids used
Therapy is symptomatic for anaphylaxis to To support cardiovascular system, To prevent further hyperreaction of immune system
Random fact: Wit blood products : baseline vitals, check vitals every 15 min, check any complaints that they have; if you notice a change ( fever, rash, hr, ) the best thing to do is stop the blood and then try to figure it out
Treatment of Anaphylaxis immediately Give oxygen immediately
After oxygen is given for anaphylaxis give patient Antihistamine—prevents release of histamine IVP-bennadryl ; Bronchodilator—relieves shortness of breath – NEB – skip the puffer ; Corticosteroids—suppresses inflammation – something IV
Prototype drug for aympathomimetics : epinephrine (Adrenalin)
Adrenalin epinephrine, sympathomimetics
Sympathomimetics Action:
for use as nonselective adrenergic agonist sympathomimetics
sympathomimetics are used to treat anaphylaxis, shock, cardiac arrest
sympathomimetcs SEs: hypertension and dysrhythmias (r/t flight or fight, increase BP – too many red bulls
hypertension and dysrhythmias (r/t flight or fight, increase BP – too many red bulls sympathomimetics
This is only a quick fix- Code meds sympathomimetics
If there is a Cardiac issue how will you administer sympathomimetics – IVP, IV infusion
Vasoconstrictors/Sympathomimetics Prototype drug: norepinephrine (Levaterenol, Levophed)
Norepinephrine levaterenol levophed vasoconstrictors / sympathomimetics
Sympathomimetics Action:
to act directly on alpha-adrenergic receptors to raise BP; also has positive inotropic effects sympathomimetics
Sympathomimetics Use: to treat acute shock and cardiac arrest
To treat acute shock and cardiac arrest sympathomimetics
Sympathomimetics SEs:
When we use this its when we Tried everything that we can, normally don’t come off of alive, family cant let go… sympathomimetics
Keep upping this drug to raise the BP but in turn keep dropping, only temporary sympatho
Inotropic Agents Prototype drug: dopamine (Dopastat, Inotropin)
dopamine (Dopastat, Inotropin) inotropic agents
Inotropic Action for low dose : is dose dependent; low doses = dopaminergic effect,
Inotropic action for high doses = high doses beta-adrenergic effect(be careful of this- watch kidneys when you give)
Inotropics are Used : to treat hypervolemic and cardiogenic shock
SEs of inotropics are : dysrhythmias, hypertension, gangrene
Little doses are good… of this drug inotropics
Increase cardiac contractility, give to people with low bp inotropic
Nursing Implications for Shock Treatment ABCs,Monitor urine output and VS,Assess for s/s of hypo/hypervolemia ,Renal Regulation , Kidneys regulate (Fluid volume, electrolytes, acid-base balance)
Kidneys secrete Renin, Erythropoietin, Calcitrol
Complications of RF – anemia, hyperkalemia, hyperphosphatemia, hypervolemia, hypocalcemia, & metabolic acidosis
Diuretics do what ? Increase rate of urine flow (production) not going to help kidneys work when they arent working
Excretion of excess fluid used to treat Hypertension, heart failure, kidney failure, Liver failure or cirrhosis, pulmonary edema
Side Effects of Diuretic Therapy Fluid and electrolyte disturbances (Dehydration, Orthostatic hypotension, Potassium and sodium imbalances )
Loop Diuretics are the… Most potent, K losing
Loop Diuretics Prototype drug: Fursemide (Lasix)
Lasix fursemide loop diuretics
Loop Action:
Increases GFR by renal vasodilatation lasix, loop
Loops are Used to help with:
Loop Diuretics SEs: hypotension, nocturia, photosensitivity, electrolyte disturbances, muscle weakness
When giving loop diuretics Caution : obstructive urinary elimination pxs, diabetics (increases BS), gout, sulfa allergies, pregnancy
Before administering loops Check K and BP before, will increase GFR,
Loop Diuretics Nursing Implications ototoxic, creatinine (renal function ) daily weights, increase k, watch dehydration, and DIG TOX (HALOS around LIGHT )
Thiazide Diuretics are K losing-but not as much , Increasing dietary intake may be sufficient to cover
Often used with loops thiazide
Thiazide Prototype drug: Hydrochlorathiazide (HCTZ)
Not for immediate diuresis thiazide
Thiazide Action: Inhibits Na reabsorption in the cortical diluting tubule
Thiazide is Used:
When giving Thiazide Diuretics Caution: obstructive urinary elimination pxs, diabetics (increases BS & decreases effectiveness of oral antidiabetics), hx of gout, high chol, sulfa allergies, pregnancy
When giving thiazide worry about Worry about lithium tox. – will kill you quickly, quickest way is through water imbalances.
Thiazide SEs:
Side effects of what hypotension, nocturia, photosensitivity, electrolyte disturbances, muscle weakness thiazide d
Drug interactions when taking Thiazide increases lithium, decreases hyperuricemic agents and DM meds
Thiazide Diuretics Nursing Implications take up to 4 weeks for maximum HTN effects, Check BP and K levels, watch BS and chol , daily weights, dehydration, DIG TOX
K Sparing Diuretics are Weak diuretics
K sparing Prototype drug: Spironolactone (Aldactone)
Spironolactone (Aldactone) k sparing
K sparing Actions: increases Na excretion and decreases K excretion in the distal convoluted tubules
K sparing is Used : HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis
HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis use what ? k sparing
When giving a k sparing use Cautions: Renal insufficiency, hyperkalemia, pregnancy, gout, renal calculi, pregnancy
K was 5.1 are you going to give the next dose ? – don’t give, a little bit is a big deal
If it was k was 4.8 – yes would give but monitor closely
K Sparing Diuretics SEs: previous SE HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis + agranulocytosis
Agranulocytosis side effect k sparing
Nursing Implications for k May take up to 2 weeks to reach maximum HTN effect, Check BP and K level (but you are watching for high levels), Watch for agranulocytosis (WBC, fever, sore throat) Dly wts and I & O
Angranulocytosis include WBC up fever and sore throat
Avoid K in diet and Na substitutes k sparing
Take with food or milk k sparing
Control of Water Balance is essential Essential to homeostasis
Frequent indications for IV therapy include imbalances of Body fluids,Electrolytes, Acid-base
Osmolality Concentration of osmotic solution
Osmolality isDependent on number of dissolved solutes in a body fluid (Usually sodium, glucose, or urea)
Normal osmolality is 275–295 mOsm/kg
Changes in osmolality can cause water to move to different compartments, Greatest contributor is sodium
Sodium controlled by hormone aldosterone
Tonicity is relative concentration of intravenous fluid, General term, not precise measurement
Osmosis is when Water moves from areas of low osmolality to areas of high osmolality
Hypertonic intravenous fluid Water moves from interstitial space to plasma.
Hypotonic intravenous fluid Water moves from plasma to interstitial space.
I sotonic intravenous fluid No fluid shift
Fluid BalanceAchieved through complex mechanisms
Most important regulator of fluid intake is thirst
Primary regulators of fluid output: kidneys
Primary regulators of fluid output is kidneys including :
Renin-angiotensin mechanism – vasoconstriction , makes worse
Aldosterone – holds in Na and holds in water
Antidiuretic hormone (ADH)- prevents release of water
Fluid-Balance Disorders deficit or excess
Deficit-fluid-balance disorders Can cause dehydration or shock
Treated with oral or intravenous fluids deficit
Excess-fluid-balance disorders Treated with diuretics
Electrolytes Essential to Nerve conduction, membrane permeability, Water balance, other critical body functions
Sodium is Essential for maintaining osmolality, water balance, acid-base balance
Major electrolyte in extracellular fluid sodium
Sodium and Water Regulation Water travels with or toward sodium
Sodium movement is link between water retention, blood volume, and blood pressure
Sodium is Regulated by kidneys and aldosterone
Sodium level above 145 mEq/L Hypernatremia
Most commonly caused by kidney disease Hypernatremia
Sodium accumulates because of Decreased excretion, High, net-water loss (watery diarrhea, fever, burns), High doses of glucocorticoids or estrogens
Physiology of Hypernatremia Elevated sodium increases osmolality of the plasma, Draws fluid from interstitial spaces and cells, Causes cellular dehydration
Cells are dehydrated in Hypernatremia
Hypernatremia ---Signs and symptoms Thirst, fatigue, weakness, muscle twitching ; Convulsions, altered mental status, decreased level of consciousness NEURO
Treatment of Hypernatremia low-salt diet
Acute hypernatremia treated with hypotonic intravenous fluids or diuretics
Hyponatremia Sodium level below 135 mEq/L
Caused by excessive dilution of plasma hyponatremia
Hyponatremia is caused by Excessive antidiuretic hormone (ADH) secretion, Excess administration of hypotonic intravenous solution Vomiting, diarrhea, gastrointestinal suctioning, diuretic use
Hyponatremia Early Symptoms Nausea, vomiting, anorexia, abdominal cramping
Later signs of hyponatremia Altered neurologic function such as confusion, lethargy, convulsions, coma, muscle twitching, tremors
Treatment of Hyponatremia caused by excessive dilution Treat with loop diuretics to cause an isotonic dieresis; (balance the concentration out)
Treatment of Hyponatremia caused by sodium loss Treat with oral sodium chloride or intravenous fluids containing salt. (Normal saline, Lactated Ringers, Not hypertonic saline – not tolerated well
Sodium Supplements Prototype drug: sodium chloride
Action of sodium supplements :
Sodium supplements are Used: to treat hyponatremia when serum levels fall below 130 mEq/L
Adverse effects of sodium chloride hypernatremia and pulmonary edema
Potassium Balance Essential for Proper nerve and muscle function,Maintaining acid-base balance
Major electrolyte of intracellular fluid K
Influenced by aldosterone k
For each sodium ion reabsorbed, one potassium ion secreted into renal tubules
Hyperkalemia level Potassium level above 5 mEq/L
Hyperkalemia Caused by high consumption of potassium-rich food, dietary supplements
Risk with client taking potassium-sparing diuretics Hyperkalemia
K Accumulates when renal disease causes decreased excretion – pvc – beats out of turn, vtach (problem)
Hyperkalemia Symptoms Most serious are dysrhythmias TWAVE UP
Hyperkalemia symptoms Muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea
Treatment of Hyperkalemia Restrict dietary sources; hidden sources , Decrease dose of potassium-sparing diuretics, Administer glucose and insulin, Administer calcium to counteract potassium toxicity on heart, Administer polystyrene sulfonate (Kayexalate)& sorbitol to dec k levels
Administer glucose and insulin for Hyperkalemia
If there is a k tox on the heart admin calcium to counteract it
To decrease k levels admin polystyrene sulfonate and sorbitol
Lifethreatening side of Hyperkalemia run them on insuline soultion & D5 solution: take potassium inside of cell where its not harmful, and doenst cause problems
Hypokalemia level Potassium level below 3.5 mEq/L
Hypokalemia Caused by High doses of loop diuretics, Strenuous muscle activity, Severe vomiting or diarrhea
Strenuous muscle activity hypokalemia
Hypokalemia Symptoms , Neurons and muscle fibers most sensitive to potassium loss,Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest,
If you have someone with Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest what will you do give k supplements
Treatment of Hypokalemia Mild— increase dietary intake
Severe hypokalemia treatment —give oral or parenteral potassium supplements
Low T wave! In what electrolyte disturbance hypokalemia
Potassium Supplements Prototype Drug-potassium chloride (KDur)
Action of k supplements maintain intracellular tonicity, maintain balance with Na, transmit nerve impulses, & maintain cellular metabolism
K supplements are used to : prevent and tx hypokalemia
Contraindications in giving k supplements : renal impairment, Addison’s disease
SEs of k supplements parasthesia, restlessness, weakness, hypotension, EKG changes, N/V/D, hyperkalemia, cardiac arrest ( look like hyperkalemia) make sure that you arent over correcting it
Potassium Supplements --- Nursing Implications take with full glass of water with meals, monitor k levels, don’t crush chew or suck, not IVP
Acidosis is excess acid (pH below 7.35)
Alkalosis is excess base (pH above 7.45)
If pateint is vomiting – give them an atemetic (know atemetics)
Resp. acidosis = we want to speed up the breathing, copd patients will have this
Resp. alklosis = we want to slow them down, give antianxiety, adivan.
Acidosis May be respiratory, caused by hypoventilation
Acidosis May be metabolic Causes: diarrhea, kidney failure, diabetes, excess alcohol, starvation
Pharmacotherapy of Acidosis Administration of sodium bicarbonate is appropriate pharmacotherapy
Bicarb Symptoms affect central nervous system by Lethargy, confusion, coma Deep, rapid respirations in attempt to blow off excess acid
Lethargy, confusion, coma Deep, rapid respirations in attempt to blow off excess acid acidosis
Sodium Bicarbonate Therapy Action: to raise pH of body fluids
Sodium Bicarbonate Use: to correct metabolic acidosis
Adverse effects of Sodium Bicarbonate : metabolic alkalosis caused by receiving too much bicarbonate ion & hypokalemia
Nursing Implications when giving sodium bicarb Usually given IV either bolus or in IVF, Monitor ABGs
Sodium Bicarbonate Use cautiously in clients with cardiac disease or renal impairment, Clients should use alternative OTC antacids
Alkalosis May be respiratory Cause: hyperventilation due to asthma, anxiety, high altitude
Alkalosis May be metabolic Causes Prolonged constipation, excess sodium bicarbonate, diuretics that cause potassium depletion, severe vomiting
Prolonged constipation, excess sodium bicarbonate, diuretics that cause potassium depletion, severe vomiting –
hyperventilation due to asthma, anxiety, high altitude resp alk
Symptoms of ammonium chloride are due to central-nervous-system stimulation such as Nervousness, hyperactive reflexes, convulsions, Slow, shallow respirations in attempt to retain acid
Treatment of alk administer Administration of ammonium chloride (severe cases) ; Administration of sodium chloride with potassium chloride (mild cases)
AmMonium Chloride Therapy Action: to decrease pH of body fluids
Ammonium chloride Used: to reverse severe metabolic alkalosis
Adverse effect of ammon. Chloride : acidosis
Nursing Implications when giving ammon. Chloride IV, ABGS,
Ammonium chloride is Contraindicated in presence of liver disease
When Infusing ammonium chloride slowly to avoid ammonium toxicity and decrease irritation to veins
Created by: ameliarae