Renal Flashcards
The nurse’s HIGHEST PRIORITY when caring for a patient with ESRD is the measurement of
I&O
Lactated Ringer’s solution is contraindicated for patients with ESRD because it
May disturb electrolyte imbalance
What dietary element is restricted in ESRD?
Protein
Which food should the patient with ESRD avoid?
Bananas
Which antacid is NOT appropriate for a patient with ESRD?
Antacids that contain magnesium
When would antacids be administered to a patient with ESRD?
Within one hour after meals
Which side effect is MOST COMMONLY associated with the antacids given to patients with ESRD?
Constipation
Why are antacids given to patients with ESRD?
Antacids regulate the calcium level in the blood
When should an insulin-dependent dialysis patient receive his insulin?
At the regularly prescribed time
Which medications should be held before dialysis?
Antihypertensives Nitro Digoxin Aminoglycosides PCN Cephalosporins WATER SOLUABLE or DIALYZABLE DRUGS (analgesics Tylenol, ASA, GI drugs -dine)
Which drugs can be administered during hemodialysis?
Protein-bound drugs
(analgesics codeine, methadone, morphine)
(antimicrobials doxy, erythromycin, Naf, Rif, Vanco)
Nitro
Corticosteroids
GI- Carafate
INSULIN
1 kg of fluid equals how many mL?
1000 mL
After dialysis, the nurse observes the patient’s gums bleeding. She expects the PCP to:
Lower the heparin dosage for the next dialysis treatment
Which of the following is administered immediately after hemodialysis to stimulate RBC production?
Epogen
The patient with a left arm access site should have a sign over the bed that reads?
No IVs or BP in the left arm
When the nurse observes blood oozing from the access site, the most appropriate action is to
Apply direct pressure to the site
When a fistula used for hemodialysis does not have a thrill, the nurse should?
Notify the PCP immediately
Which activity order is most appropriate for a patient following dialysis?
Rest for several hours
Dialyzable drugs are
water-soluable
What hormone lowers blood calcium and phosphate levels?
Calcitonin (stores IN)
Which hormone regulates serum calcium?
parathyroid hormone (pulls OUT of bone, muscle)
Which hormone is overproduced in Cushing’s Syndrome?
Excess ACTH, which stimulates the adrenal cortex to overproduce glucocorticoids and androgens
Signs of Cushing’s
Moon face
Buffalo hump
Truncal obesity
Osteoporosis (increase in fractures)
Hirsutism in females in a sign of?
Cushing’s Syndrome
Intervention: Increase calcium, vitamin D, and protein in the diet. Syndrome?
Cushing’s
Reassure pt that physical changes are a result of the increased hormone levels and will most likely resolve when levels return to normal is an intervention for?
Disturbed body image r/t abnormal fat distribution, muscle wasting, striae
Cushings’ and Thyroid
What interventions can be done for a pt with dx of disturbed body image?
- promote coping methods to help pt deal with changes in appearance, clothing, and grooming.
- Assist pt in locating a support group.
What interventions can be done for a dx of risk for infx/altered protein metabolism and inflammatory response?
Assess patient frequency for signs of infx such as increase in temperature (100.4)
Adrenal insufficiency is the cause of what disease?
Addison’s
Addison’s Disease
Inadequate production of the steroid hormones cortisol and aldosterone by the adrenal cortex
S&S of Addison’s
- dehydration!
- poor skin turgor
- electrolyte imbalances - hyponatremia, hyperkalemia, hypoglycemia
- fatigue
- weight loss, anorexia
- Peaked T waves on EKG (hyperK)
- postural hypotension
- diarrhea, GI cramping
- muscle weakness
IV glucose with parenteral hydrocortisone should be administered when?
Addison Crises - Medical Emergency
What assessments will be seen in a pt with Addison’s Disease?
Lethargy, fatigue, muscle weakness GI disturbances Weight loss hypoglycemia, hyponatremia Hyperkalemia, hypercalcemia Hypotension hyperpigmentation of the skin
What assessments will be seen in a pt with Cushing’s Disease?
Generalized muscle wasting and weakness moon face, buffalo hump truncal obesity with thin extremities hirsutism Hyperglycemia, hypernatremia Hypokalemia, hypocalcemia HTN Fragile skin that bruises easily reddish purple striae
Addison Crisis precipitated by
stress, infection, trauma, surgery, or abrupt withdrawal of steroid use. Can cause shock.
Intervention for Addison’s dx of Risk for Deficient Fluid Volume r/t increase in Na and H2O excretion with K+ retention?
- Encourage oral fluids as tolerated
- Instruct pt to ingest salt additives in conditions of excess heat or humidity
- Administer parenteral fluids as ordered
- Administer Kayexalate
- Administer oral cortisone, hydrocortisone, prednisone
Addison’s interventions for dx risk for imbalanced nutrition?
- monitor weight trends
- access foods pt can tolerate
- monitor SERUM GLUCOSE
- Assess for salt cravings
