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NUR 321 - problems with excretion - renal system part 2
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NUR 321 - problems with excretion - renal system part 2
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NUR 321 - problems with excretion - renalsystem part 2
How can we educate/monitor nutrition in chronic kidney disease patients? - ANS-1. Eat
potassium foods if on a loop diuretics
2. Have a low protein diet to help not raise urea/BUN
3. Limit phosphorus intake and magnesium so don't drink soda
How can we help patients properly manage an AV fistula? - ANS-1. Assess circulation
distal to the graft
2. Assess for a bruit and feel a thrill (vibration) q4hr
3. No BP, IVs, don't sleep on that side, venipuncture to the fistula or graft - this fistula is
ONLY used for dialysis
4. Instruct the patient to avoid carrying heavy objects of lying on the fistula
5. Device is ONLY for dialysis
6. Encourage ROM - we want to keep the graft mature
How can we increase CO in chronic kidney disease patients? - ANS-1. Give
medications like digoxin - helps make the heart pump more efficiently
- Watch for digoxin toxicity because they can't excrete medications as well
- Antidote for digoxin toxicity = Digibind
2. Diuretics - give them loop diuretics because their potassium will be high so we want
to decrease it
- They should still be eating potassium rich foods like bananas, potatoes, tomatoes,
avocados, and some citrus fruits
How can we manage our patient's fluid volume and electrolyte status? - ANS-1.
measure intake
2. Patient may be on a fluid restriction diet
3. Monitor labs especially potassium
How can we monitor for anemia in chronic kidney disease patients? - ANS-May give
them erythropoietin alfa (Epogen) - watch for high BP
- This medication takes 2-6 weeks to become effective
May have flu-like symptoms that should subside as they get more doses of this
- May need to adjust their antihypertensives a little bit because their BP may increase
, - Don't give this to someone who already has a high BP
- May also have long bone and vertebral pain because their bone marrow is being
stimulated to produce RBCs
How can we prevent pulmonary edema in chronic kidney disease patients? - ANS-make
sure they don't have fluid overload in the lungs (sit them up, listen for crackles, etc)
How many mL are in an ounce? - ANS-30 mL = 1 oz
How might skeletal muscles be affected by chronic kidney disease? - ANS-1. cramping
2. osteodystrophy (phosphorous will be high and calcium will be low in the blood which
stimulates parathyroid to release parathyroid hormone which makes calcium go out of
the bone and into the bloodstream so bones will be brittle)
How might the cardiovascular system be affected by chronic kidney disease? - ANS-1.
edema,
2. HTN,
3. JVD, and
4. increased potassium
How might the GI system be affected by chronic kidney disease? - ANS-1. bad breath
due to increased waste products in the body
2. bloody stools due to low platelets
How might the hematologic system be affected by chronic kidney disease? - ANS-1. no
erythropoietin production so we may see anemia
2. platelet problems (platelets are fragile and so if they have a ton of excess fluid it can
harm platelets and they may have thrombocytopenia), and bruising
How might the neurological system be affected by chronic kidney disease? - ANS-1.
weakness,
2. fatigue,
3. confusion,
4. tremors, and
5. seizures
How might the reproductive system be affected by chronic kidney disease? - ANS-ED
for men, bruit over renal arteries, and they may have renal artery stenosis
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