Week 9 THURS Flashcards
Adult Elimination
What is Nocturia
getting up at night to urinate
What foods are high in potassium?
- citric fruits
What is a good way to measure fluid gain ?
daily weights
A pt gaining 3lbs in one day may be a sign of…
excess fluid volume
oliguria
low urine output
A patient complains of numbness/ tingling after a renal arteriogram what should the nurse do?
assess peripheral pulses in the legs and feet
A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working
with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the
risks of complications. The client’s diet should include which of the following modifications?
Select all that apply
a) Decreased protein intake
b) Vitamin D supplementation
c) Increased potassium intake
d) Fluid restriction
e) Decreased sodium intake
A, D, E
atient education regarding a fistulae or graft includes which of the following? Select all that
apply.
a) Check daily for thrill and bruit.
b) No IV or blood pressure taken on extremity with dialysis access.
c) Cleanse site b.i.d.
d) Avoid compression of the site.
e) No tight clothing
A, B, D, E
A patient with chronic kidney disease (CKD) has a low erythropoietin (EPO) level. The patient is
at risk for?
a) Hypercalcemia
b) Blood Clots
c) Anemia
d) Hyperkalemia
C
rapid reduction in renal function resulting in a failure to maintain fluid, electrolyte, and acid-base hemostasis
Acute Kidney Injury
Risk factors for AKI
- pre-existing CKD or renal problems
- post surgical, trauma(hypotensive episode)
- use of contrast dyes
- overuse of medications
- sepsis/ septic shock
- older age
- hx of heart disease and or diabetes
3 types of AKI
- prerenal
- post renal
- intrarenal
Post renal AKI
obstruction in urinary tract
- after the kidneys
Pre renal AKI
- inadequate bloodflow to the kidney(before)
- low cardiac output> blood shunted from kidneys
Intrarenal AKI
- direct kidney tissue injury
- nephrotoxic agents
- acute tubular necrosis
Assessment- initial findings of AKI
- decreasing urine output; <30ml/hr is minimum
- increasing azotemia(BUN)
- electrolyte imbalnce
- get hx, physical assessment and labs to diagnose
diagnostic test
- BUN - osmolality-serum and urine
- Cr - electrolytes(hyperkalemia)
- ABG’s> r/o metabolic acidosis
Potential complications and treatments
- fluid overload; fluid restriction, diuretics, renal replacement therapies
- metabolic imbalance
- electrolyte imbalance/ acid base imbalnce
- infection; renal replacement therapies, antibiotics
Fluid restriction nursing management
- monitor pts weight
- measure I and O
- diuretics
- dialysis; if needed
Metabolic imbalance management
- diet; limit protein, sodium, and potassium Increase carbs!
- daily wts
- monitor serum protein and albumin levels
- monitor mental status changes
- monitor stools
Hyperkalemia management
cardiac dysrhythmias
- cardiac monitoring, kayexalate, ca gluconate, insulin and glucose combo, dialysis
ABGs> metabolic acidosis
- dialysis
Hypo/ hypernatremia management
-neuro changes> neuro assessment frequently
- hypernatremia is more common; use hypotonic IV solution
Nursing priorities AKI
- prerenal pt dx w/ AKI secondary to sepsis
- assess labs in urine; protein, cr, uric acid, glucose
- place pt on continuous cardiac monitoring
- assess vs
- assess labs in blood; BMP,HGB,Cr, GFR, BUN, Albumin
- normal saline bolus
- initate/ monitor I and O
- start an IV
- administer antibiotics
Renal replacement therapy purpose
- ultrafiltration
- removal of excess fluid
- removal of waste
Types of renal replacement therapy
- hemodialysis
- continuous renal replacement therapy
- peritoneal dialysis
Hemodialysis; nursing considerations
- diet; increase carbintake, limit protein and fluids
- monitor wt before and after therapy
- labs, access site, monitor vs
- complication; hypokalemia and dehydration
Arteriovenous Fistula nursing consideration
- no BP on affected arm
- no blood draws on affected arm
- no tight clothing
- assess for thrill and bruit daily
Peritoneal dialysis
- dialysis fluid is introduced through peritoneum
- done at home vs dialysis center; may be done overnight making it less restrictive of daily activities
- risk of peritonitis; practice aseptic technique
chronic kidney disease; complex pt characteristics
occurs when the kidneys cannot remove wastes or perform regulatory functions
- progressive, irreversible deterioration of renal function
- results from many different causes
reduction in kidney function or kidney damage that has been present for at least 3 months
- gradual loss of renal function from primary renal conditions or diseases produces long-term renal insult
- ongoing process of renal injury> irreversible
chronic kidney disease
CKD clinical manifestations
- anemia
- metabolic acidosis
- calcium and phoshorus imbalnce
- uremia> no urine output
primary issues of CKD
- anemia
- cardiovascular disease
- bone disorders
- fluid and electrolyte imbalnce
Nursing implications for CKD
- dialysis will be required
- HTN is likely
- fluid restriction and dietary restrictions
- hypoxia associated w/ anemia
- increased risk of infection
- GI disturbances impact nutritional status
Hyperkalemia can cause
- cardiac dysrhythmias
- need continuous cardiac monitoring
