Care of the Patient with Chronic Kidney Disease PDF

Care of the Patient with Chronic Kidney Disease J. Yang MSN RN  Learning Outcomes 1 2 3 4 Apply the knowledge of Utilize nursing process and Review common drugs and Discuss the m...

Care of the Patient with Chronic Kidney Disease J. Yang MSN RN  Learning Outcomes 1 2 3 4 Apply the knowledge of Utilize nursing process and Review common drugs and Discuss the mechanisms and anatomy and evidence-based findings to other management nursing interventions of pathophysiology to assess provide care to patients with strategies to treat patients peritoneal dialysis (PD) and patients with impaired chronic kidney disease with chronic kidney disease hemodialysis (HD) as renal kidney function caused by replacement therapies chronic kidney disease  Chronic Kidney Disease (CKD) Progressive, irreversible kidney injury; kidney function does not recover 5 stages are based on glomerular filtration rate (GFR). Leads to end-stage kidney disease Chronic Kidney Disease Azotemia: build-up of nitrogen-based wastes in the blood Uremia: azotemia with clinical manifestations Uremic syndrome  Causes of Chronic Kidney Disease Most common causes of Chronic Kidney Disease Diabetes Mellitus Hypertension Glomerulonephritis Autoimmune disorders (SLE) Polycystic kidney disease Recurrent infection or urinary obstruction AKI  Kidney Changes (not seen until System ¾ of kidney function is lost) Greatly reduced GFR causes Changes abnormal urine production Fluid and electrolytes with CKD imbalances BUN Increases urine output decreases Fluid volume overload Edema Crackles and SOB Pleural or pericardial effusions  Metabolic Changes System Urea & creatinine increased d/t decreased function Changes Sodium: first low with polyuria; Later high causing HTN & edema with CKD Potassium: hyperkalemia with later stages Acid-base imbalance: metabolic acidosis later d/t decreased nephron function, decreased ammonia production, & decreased reabsorption of HCO3; hyperkalemia Calcium & phosphorus: HypoCa & HyperPh; Renal Osteodystrophy= Bone mineral are lost decreasing bone density.  Cardiac changes Hypertension Hyperlipidemia Heart failure System Pericarditis Hematologic & Immunologic Changes changes anemia d/t decreased erythropoietin level  decreased RBC with CKD Uremia decreases RBC survival, disrupts WBC function GI changes Uremia causes halitosis, stomatitis, anorexia, n/v, hiccups. Peptic ulcer disease common with uremia Uremic colitis watery stools or constipation.  History Height/Weight Chronic conditions CKD- Current/Past Meds (ex: NSAIDS) Diet change Assessme Energy level nt Urinary elimination Psychosocial Labs: increased Cr/BUN, electrolytes, GFR CKD- Assessment CKD causes changes in all body systems see key features on page 1470 (Box 60.7). Most symptoms are related to Fluid and electrolyte balance Acid Base balance Build up of Nitrogenous waste  Fluid overload Potential for pulmonary edema Decreased cardiac function Analysis: Weight loss Potential for infection interpretin Potential for injury g Fatigue Potential for depression Prevention Modify Risk Factors Control diseases that lead to of CKD- CKD (HTN, DM) Dietary adjustments Limitation of alcohol Weight maintenance Exercise Smoking cessation  Managing Fluid Volume Maintain fluid balance and prevent complications CKD- Diuretics Fluid restriction Nursing Monitor I+O Pulmonary Edema secondary to fluid Interventio volume overload Early indicators- restlessness, anxiety, ns increased HR, SOB, and crackles. Treatment- Loop Diuretics, Morphine Managing electrolytes and A/B imbalance Na+ and K+ dietary restriction Sodium polystyrene sulfonate (Kayexalate) - > reduce serum K+ level Replacement of bicarb to treat acidosis Phosphate-binding agents (calcium carbonate)  Preventing Injury and infection Pathologic fracture (low serum CKD- Ca++) Decreased immunity Nursing Enhancing Nutrition Interventio Vitamin and mineral supplements; iron supplement ns Restrictions are important and vary Cardiac Function Control blood pressure (diuretics, ACEIs, CCBs) Anemia-epoetin alfa injection Kidney Replacement Therapies: Hemodialysis Removes excess fluid/waste products —performing filtering and excretion of the kidneys Osmosis and Diffusion Dialysate Dialyzer Anticoagulation 3-4 hour treatment, 3 times a week Vascular Access: AV Fistula & Graft AV Fistula: thrill, bruit, sign at HOB for NO BP AV Graft: pulse check, sign at HOB for No BP Both require months for healing and “maturation” 15 Central Venous Catheters Care: Sterile technique Dedicated line No meds or blood draws preferred Heparinized lines Occlusive dressing Risk for infection 16  Dialyzing Drugs Hemodialy Given after dialysis Preventing complications sis: Thrombosis or Nursing Post-dialysis stenosis assessment Care Hypotension Infection Aneurysm Headache formation N/V Ischemia Dizziness Dialysis Muscle cramps disequilibrium syndrome Heart failure (rare) Peritoneal Dialysis Allows exchange of wastes, fluids & electrolytes in the peritoneal cavity Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate Types Continuous ambulatory (CAPD) Automated Intermittent  Peritonitis Before treatment: Complicatio Evaluate baseline vital ns & Nursing Pain signs, weight, laboratory tests Care Exit site/tunnel Continually monitor infections patient for respiratory distress, pain, Poor dialysate flow discomfort Dialysate leakage Monitor prescribed dwell time, initiate Other complications outflow Observe outflow amount and pattern of fluid Complications of PD: ESIs and Tunnel Infections NCLEX Question The nurse is preparing a client with stage 3 CKD for discharge. Which client statement indicated the need for further teaching? A. I will be sure to attend f/u appointments. B. I will increase my protein intake so my body can heal. C. I will weigh myself daily. D. I will take my BP each day. NCLEX Question A client with newly created vascular access for hemodialysis is being discharged. What discharge teaching will the nurse include: A. Do not allow BP to be taken in the affected arm B. Elevate the arm to allow the total rest of the affected arm C. Assess for bruit daily to ensure patency D. Sleep on the affected arm to protect the access device