Flashcards in Quiz Unit 7 & 8 Deck (26)
What should you teach a client who has had a vascular access device installed for hemodialysis?
How to assess for a bruit/thrill, assess these often, how to assess for s/s of infection, how to find distal pulses, why not to have BP taken in that arm
What is the difference between pre-renal causes of kidney failure, intra-renal, and post-renal?
Pre-renal are caused before the kidney, like stenosis, high BP, atherosclerosis, diabetes. Intra-renal are caused by things within the kidney, like PKD. In post-renal something is blocking the renal pelvis/ureters, like stones, infection, cancer
What drugs did she mention that are very hard on the renal system?
NSAIDS and Myacind (Gentamyacin)
Is ESRD acute or chronic?
It isn't cute, so it must be chronic!
What is considered the second stage of chronic kidney disease and what is done for it?
Renal insufficiency. Low protein diet, manage sodium and fluid intake, non-potassium sparing diuretics (Lasix/Aldactone/HCZ, diamox)
What is the first stage of chronic kidney disease?
Diminished renal reserve. GFR is still within normal range
What is the last stage of chronic kidney disease called?
What happens to sodium levels during chronic kidney disease?
At first, hyponatremia may occur due to damaged nephrons being unable to reabsorb enough sodium and from polyuria. As the disease progresses sodium excretion diminishes as excretion slows, but sodium levels may appear normal, or even low, due to fluid retention and dilution.
What labs are elevated in ESRD?
Creatinine/BUN/Urea (from protein breakdown), sodium, K+, phosphorous, lipids
What labs decrease with ESRD?
Creatinine clearance, erythropoietin secretion (anemia), calcium, Hct, Hgb, HCO3
What does ESRD do to the acid-base balance?
Becomes acidotic as kidneys fail to excrete hydrogen ions, Kussmaul respirations begin
What do high phosphorous levels cause?
Calcium is released from the bones. May cause osteodystrophy
What happens to the heart during ESRD?
Dysrhythmias, cardiomegally, cardiomyopathy, tamponade
What supplements may need to be given to a pt with ESRD?
Folic acid, ferrous sulfate, Epigen, calcium
What are the physical symptoms of ESRD?
Tachypnea, hyperventilation, bad breath, sighing, yellow skin, lesions, itching, ecchymosis, purpura, uremic frost, lethargy, slurred speech, anorexia, N/V, oliguria, bone pain, fractures, osteodystrophy, weakness, cramping
Name some major nursing diagnosis for ESRD?
Fluid volume excess, imbalanced nutrition, decreased cardiac output
What happens to protein restrictions when dialysis is started?
They need lots of protein when on dialysis, but sodium is still limited
What is monitored during dialysis?
N/V (stop if during hemodialysis), fever chills (s/s of infection with peritoneal)
If dialysate effluent is brown (peritoneal), what is indicated? Cloudy?
Perforated bowel (stool). Infection
What is the disequilibrium syndrome? S/S? What is the proper response?
Rapid loss of volume during dialysis. N/V, decrease in LOC, cramps. Stop dialysis
What is used for critically ill pts who cannot tolerate the fluid shifts associated with dialysis?
CRRT. Continuous Renal Replacement Therapy. It is a slow dialysis. Can last 12-24 hrs and is often done daily
Where is a transplanted kidney placed? Why?
It is placed within the bony structures of the hips for protection
What is Azotemia?
It is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely r/t insufficient filtering of blood by the kidneys. Pre-renal azotemia is caused by DM and HTN (anything that decreases blood flow to the kidneys), while post-renal is caused by blockage of urine flow in the renal pelvis/ureters/bladder
What are the s/s of digoxin toxicity?
N/V, visual changes, restlessness/confusion, H/A, fatigue, tachycardia
What is isosthernuria?
The excretion of urine that is of the same specific gravity of protein free plasma (1.008-1.012), usually indicating renal tubular damage and loss of renal medullary function