Renal

• Kidney Disease


  Results when the kidneys cannot remove wastes or perform regulatory functions. A systemic disorder that results from many different causes.
• Assessment of Patients

  • Acute Kidney Injury
  • Chronic Kidney Disease

  
• Acute Kidney Injury (AKI)


  A reversible syndrome that results in rapid decreased glomerular filtration rate and oliguria
• Chronic Kidney Disease

  Decrease in GFR lasting longer than 3 months (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia - too much nitrogen, creatinine, and other types of waste in the blood
• Assessment of Patients

  1. Assess fluid and electrolyte imbalances

  2. Assess weight as most accurate indicator of fluid loss or gain in acutely ill patients

  3. Assess potassium levels and monitor for elevated T waves in clients with kidney disease

  4. Assess urine output, edema, JVD, tachycardia, and wet cough for signs of fluid overload
• Nursing Interventions for Acute Kidney Injury (AKI)

  1. Keep patient safe

  2. Surgery is always the last option

  3. Provide long-term monitoring after treatment for neurological, vision, and thyroid function changes

  4. Monitor for total removal of adrenal or pituitary gland

  5. Taper medication dosage, never stop abruptly

  6. Monitor fluid and electrolyte imbalances, weight, and urine output
• Acute Kidney Injury (AKI)


  • Oliguria Phase: Decreased urine output, fluid volume overload, metabolic acidosis, electrolyte imbalances
  • Diuresis Phase: Increased urine output, fluid volume deficit, electrolyte imbalances

  
• Nursing Care for Acute Kidney Injury (AKI)


  1. Monitor daily weights

  2. Strict intake and output monitoring

  3. Daily lab tests: BUN, creatinine, total protein, albumin, GFR

  
• Patient Teaching for Acute Kidney Injury (AKI)


  Signs and symptoms of complications<|>Symptom management<|>Nutritional needs<|>Prevention<|>Use of urine dipsticks
• Electrolyte Imbalances in Chronic Kidney Disease

  • Elevated Potassium - Hyperkalemia
  • Elevated Phosphorus - Hyperphosphatemia
  • Hypocalcemia and risk for bone fracture
• Lab Values Indicating Chronic Kidney Disease

  • Elevated Potassium
  • Decreased GFR
  • Increased BUN
  • Increased Creatinine
• Medication Management for Chronic Kidney Disease

  • Correction of electrolytes
  • Erythropoietin
  • Anti-hypertensive and cardiac medications
  • Anticonvulsants
• Patient Teaching for Chronic Kidney Disease

  1. Assess for signs of fluid volume excess

  2. Keep accurate intake and output

  3. Perform daily weights

  4. Limit fluid to prescribed amounts

  5. Identify sources of fluid

  6. Explain fluid restrictions to patient and family

  7. Assist patient to cope with fluid restrictions

  8. Provide or encourage frequent oral hygiene
• Pharmacological interventions for Chronic Kidney Disease
• Manifestations of Chronic Kidney Disease

  • Uremia
  • Anemia
  • Oliguria
• Nutrition for Chronic Kidney Disease

  1. Assess nutritional status, weight changes, lab data

  2. Assess nutritional patterns, history, preferences

  3. Provide food preferences within restrictions

  4. Encourage high-quality nutritional foods while maintaining restrictions

  5. Modify intake related to factors that contribute to alterations like stomatitis or anorexia

  6. Adjust medication times related to meals
• Risk for Situational Low Self Esteem in Chronic Kidney Disease

  Assess patient and family responses to illness and treatment<|>Assess relationships and coping patterns<|>Encourage open discussion about changes and concerns<|>Explore alternate ways of sexual expression<|>Discuss role of giving and receiving love, warmth, and affection
• Lab Values Indicating Chronic Kidney Disease

  • Elevated BUN and creatinine
  • Electrolyte imbalances - potassium, sodium, magnesium, calcium, phosphorus
  • Low glomerular filtration rate (GFR) <60 mL/min for longer than 3 months
• End-Stage Renal Disease (Stage Four)


  Elevated blood pressure<|>Uremia<|>Generalized edema/anasarca<|>Elevated BUN
• Peritoneal Dialysis


  A cleansing fluid (dialysate) is circulated through a tube inside the abdominal cavity. The dialysate absorbs waste products from blood vessels in the abdominal lining (peritoneum) and is then drawn out and discarded.
• Nursing Assessment for Peritoneal Dialysis

  1. Monitor site for leakage/bleeding

  2. Monitor for peritonitis - redness, inflammation
• Nursing Interventions for Hemodialysis


  • Monitor all medications and dosages carefully
  • Address pain and discomfort
  • Implement stringent infection control measures
  • Provide dietary considerations: sodium, potassium, protein, fluid, individual needs
  • Provide skin care: pruritus, keep skin clean and moisturized, trim nails, avoid scratching
  • Monitor for complications: hypotension, muscle cramps, blood loss, hepatitis
• Nursing Care for Hemodialysis

  1. Protect vascular access: assess site, signs of infection, do not use for BP or blood draws

  2. Use arm alert wristband - no needle sticks or blood draws on that arm

  3. Check for bruits and thrills in dialysis fistula

  4. Carefully monitor fluid balance: IV therapy, accurate I&O, IV pump

  5. Monitor for signs of uremia and electrolyte imbalance, check lab data, obtain weight

  6. Monitor cardiac and respiratory status
• AV Fistula


  An artery and vein are surgically joined together to create a larger blood vessel with higher flow for dialysis
• Nursing Care for AV Fistula


  1. Assess for normal bruits and thrills

  2. Report redness or warmth as it can indicate occlusion and infection
• Complications of Dialysis

  • Anemia
  • Hypotension
  • Nausea/vomiting
  • Decreased absorption
  • Vascular complications
  • Vascular infections
• Preoperative Assessment for Kidney Transplant

  • Fluid and electrolyte status
  • Dialysis status
  • Renal function

  
• Postoperative Assessment for Kidney Transplant

  • Potential hemorrhage and shock
  • Potential abdominal distention and paralytic ileus
  • Potential infection
  • Potential thromboembolism

  
• Postoperative Assessment for Kidney Transplant

  Include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system

  
• Medication Teaching for Kidney Transplant

  Immunosuppressants for life: Prednisone, Tacrolimus (Prograf), Cyclosporine (Neoral) - take with chocolate milk and drink immediately
• A kidney transplant patient can be on 5-15 medications a day
• Nursing Care for Kidney Transplant

  Monitor for internal bleeding, clots, and improved taste of medications