Nursing Care & Tx

• What type of treatment is involved in polycystic kidney disease?

  • Tx is supportive = control BP, pain, & constipation management 
  • ​As PKD progresses will need same Tx plan as CKD [pt will eventually develop renal failure and need dialysis] 
• What are some teaching nurses can provide the patient who is diagnosed with PKD?

  Patient Education:​

  • Protect Kidneys from further injury​
  • UTI prevention & Management ==> Notify HCP if Sx develop​
  • Hypertension = low Na diet ​
  • Pain management ​
  • Avoid NSAIDs and aminoglycosides ​
  • Genetic Counseling​
• What are the primary nursing goals of treatment for acute glomerulonephritis?

  Primary Goals:​

  • Treat Sx​
  • Preserve kidney function​
  • Manage fluid overload ​
  • Na & fluid restriction, daily wts, I&O​
  • Rest = most important means of restoration & relief!!​
  • Prevent complications (failure)​
  • Protein restriction 
• What type of medications could be prescribed for a patient experiencing acute glomerulonephritis?

  Meds: abx (likely penicillin to treat strep)​

  • Diuretics or anti-hypertensives for inc BP​
  • Sometimes corticosteroids to decrease inflammatory response 
• What are the goals of treatment in AKI?

  Eliminate cause, prevent complications, assist in pt recovery 
• What type of supportive care is considered when managing AKI?


  Supportive Care:​

  • Ensure adequate circulating volume ​
  • Correcting fluid overload ​
  • Meds: Tx of hyperkalemia = Loop diuretics (lasix/bumex), K wasting; avoid nephrotoxic drugs (dyes)​
  • Nutrition
  • Dialysis
• What should the nurse be monitoring in the medical management of AKI?


  • Monitor VS = BP, HR, SPO2, RR​
  • Hypotension & tachycardia initially d/t hypovolemia THEN HTN d/t fluid overload​
  • Respiratory d/t pulmonary edema 
  • Monitor vol status ​
  • Urine output, daily wts, breath sounds, edema, diuretics ​
  • Increased U/O indicates improvement​
  • Monitor labs​
  • K lowering Tx – prevent lethal arrhythmias​
• What type of teaching should be provided to a patient diagnosed w/ AKI?

  • Cause, Tx, Anxiety, preventing complications 
• What are the collaborative care goals for a patient experiencing renal trauma?

  Goals: control hemorrhage, pain, prevent infection, preserve & restore renal function ​
• What are some nursing action to take for a patient at risk for hemorrhage d/t renal trauma?

  • Monitor VS for shock [hypotension, tachycardia, pallor]​
  • Monitor urine output & color​
  • Observe for hematuria = bleeding; oliguria = obstruction​
  • Notify MD if < 0.5ml/kg/hr ​
  • Maintain bedrest until hematuria clears w/ labs^​
  • Ongoing assessment of abd/flank area for pain or swelling ​
  • Monitor labs [serial H&H, baseline renal function]^
• What are nursing action for a patient at risk for infection d/t renal trauma?


  • Administer abx as ordered to prevent infection from intra-renal hematoma ​
  • Blood in the peritoneum commonly causes low-temp​
  • If vascular injury = pt GOES to OR!! (w/ signs of shock)
• What type of nutrition is recommended for acute kidney injury?

  • Adequate carbs, protein, fat to prevent catabolism​
  • Restrict Na [prevent edema/HTN/CHF]​
  • Restrict K [prevent cardiac complications]​
  • Restrict Phosphorus
  • Fluid Restriction​
• What are some treatments/management of chronic kidney disease?

  • Renal Replacement Therapies​
  • Renal Transplant​
  • Support the remaining function​
  • Prevent Complications​​

  Once developed... measures to remove waste products should be implemented IMMEDIATELY!!
• What are the complications of chronic kidney disease?

  • Hyperkalemia​
  • HTN​
  • Hypocalcemia​
  • Anemia​
  • Osteodystrophy​
  • Dyslipidemia
• How do you treat hyperkalemia in chronic kidney disease?

  • Dialysis, Med Management, Diet Restriction​
  • Meds: P: Stabilize myocardial membrane!​
  • IV Calcium gluconate + IV glucose & insulin OR albuterol OR bicarb​
  • Sodium polystyrene (kaexalate) = Total elimination of K through stool ​
  • OR IV lasix for elimination ​
  • OR Emergent hemodialysis ​
  • Diet Restriction​ = K+ limited to 2 – 4g/day 
• How do you manage hypertension in chronic kidney disease?

  • Wt loss, lifestyle changes, avoid alcohol, smoking cessation, meds​
  • Goal BP: 130/80s ​
  • Diet & Exercise modifications ​
  • Na limited 2 – 4g/day​
  • Fluid restriction (previous day's urine + 600 mL for insensible losses)​
  • Wt gain no more than 1 – 3kg btwn treatments ​
  • Meds: diuretics, beta-blockers, Ca Channel Blockers, ACE inhibitors, angiotensin receptor blockers
• How does the nurse treat a patient with CKD experiencing hypocalcemia?

  Supplements of Vitamin C and D
• What are some treatment options for the complication of anemia in CKD?

  • IV or SQ erythropoietin​
  • Iron supplements (monitor for constipation)​
  • Blood Transfusions (only if actively bleeding or Sx w/ dyspnea, tachycardia, chest pain)
• How does the nurse manage the potential complication of dyslipidemia for CKD?

  • Goal: LDL < 100; Tri < 200​
  • Statin for decrease LDL​
  • Fibrates to decrease triglycerides
• What are some nursing actions to help manage osteodystrophies in the patient with CKD?

  • Limit dietary phosphorus​ = 1000mg/day​
  • Phosphate binders bind to phosphate in GI and excrete in stool​
  • Vitamin D supplementation​
  • Control hyperparathyroidism
• What is a nursing dx to consider during post care of a renal biopsy patient?

  Risk for hemorrhage​

  • Monitor for VS for shock​
  • Monitor pressure dressing for bleeding​
  • Monitor for signs of internal bleeding = flank or abd pain (usually colicky), abd distention, change in VS​
  • Maintain bedrest for up to 24H​
  • Observe for hematuria
• During post care for renal biopsy, the patient experiences pain at the biopsy site that spreads to flank and abdomen. What can the nurse deter or consider that is happening?

  internal bleed or hematoma
• During post care of renal biopsy the nurse must observe for hematuria. What are some things to consider during the observation of hematuria in post care for renal biopsy?

  This is a common complication and is usually microscopic

  • should NOT see clots
  • Usually resolves without treatment in < 72 hours but could go up to 3 weeks
• If a post renal biopsy patient experiences no bleeding, when can they resume activity?

  Can resume after 24H but NO heavy lifting, strenuous activity for 2 weeks
• What are some priority problems that may appear post op of radical nephrectomy?

  • Hemorrhage
  • Fluid Imbalance
  • Atelectasis
  • Infection
• What is the treatment of choice for renal cancer?

  Surgery; renal cancer is resistant to chemo (used for metastisis)
• What are some nursing assessments needed for post-op nephrectomy?

  Assess for hemorrhage,

  • adrenal insufficiency may take days or weeks for 2nd kidney assume job = monitor s/s for fluid overload
• How can the nurse manage the risk for fluid imbalance post-op nephrectomy?

  • Monitor VS for fluid overload, shock​
  • Monitor urine output​
  • Initially pink​
  • Bright red = bleeding = BAD!​
  • Cloudy = infection
• How can the nurse manage the risk for atelectasis post-nephrectomy?

  • Use Incentive Spirometry
  • Early Mobility ​
  • Pain meds
• How does the nurse manage the risk of infection in post-op nephrectomy care?

  • Incision site care​
  • Possible drain ​
  • Decreased drainage = possible obstruction
• If a patient presents with any sudden change in their condition what does this suggest in the case for renal trauma?

  hemorrhage & requires rapid surgical intervention!
• During the event of renal trauma, what are the priority nursing problems to consider during surgical management?

  • Risk for Fluid Imbalance & Hemorrhage
  • Risk for Impaired Gas Exchange
• During surgical management of renal trauma, how does the nurse manage the risk for fluid imbalance and hemorrhage?


  • Monitor VS​
  • Monitor drains and urine output ~ if irrigation = aseptic technique​
  • Monitor flank area for swelling ~ significant risk of re-bleeding in post-op period ​
  • Restricted activity for 1 mo post-surgery to limit risk of re-bleed 
• How does the nurse manage risk for impaired gas exchange in the surgical management of renal trauma?

  • Incentive Spirometry ​
  • Early Ambulation ​
  • Pain management to allow for repositioning and deep breathing 
• What other nursing considerations should be placed in the management of post-op renal trauma?

  • Pain d/t position on table as well as incision​
  • Risk for infection d/t abscess formation or leakage or urine​
  • Dysfunctional GI mobility d/t manipulation of colon, ileus [lack of movement that can lead to blockage]​
  • Common for pt to have N/V/Constipation 
• What are the preoperative management goals of kidney transplant?

  bring pt's metabolic state to normal lvls, prevent infection & prep for surgery & post-op expectations
• What type of medication should be initiated preoperatively for kidney transplant?

  immunosuppressant medications
• What are post-op goals for a kidney transplant?

  • maintain homeostasis until transplanted kidney is fully functioning
  • Prevent Rejection
• How does the nurse prevent rejection post-op kidney transplant?

  Medications suppress the immune system
• How does the nurse prevent infection postoperatively in the patient undergoing renal transplant?

  Pay attention to drains and surgical sites