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Med surg week 9 , 10 , 11 , 12 wk 13 is exam

Functions of Kidney; -produce urine - eliminated excess waste and toxicity - Uremia (urine goes into bloodstream) -water volume or hydration status - fluid volume excess -Blood Pressure regulation - U... NCONTROLLED HYPERTENSION -electrolyte balance / regulation - prone to develop cardiac dysrhythmia -Acid Base Balance - Metabolic acidosis -Erthyropoietin - stimulate bone marrow to produce RBC - issue with Anemia -Vitamin D production - calcium absorption - renal osteodystrophy - fracture and falls UREMIA: hemodialysis 3x a week or kidney transplant 1. 2. 3. 4. 5. 6. 7. Can go to brain - uremic encephalopathy - delirium , acute confusional state Can go to heart - uremic pericarditis - positional chest pain Can go to lungs - uremic lungs / uremic pneumonitis - DOB / SOB Can go to GI tract - uremic gastritis - GI bleeding give proton pump inhibitors - prone to develop constipation taking iron, phosphate binders given , fluid restriction , activity restriction Can go to Skin - uremic frost - super dry skin and itchy Can go to oral cavity - uremic breath or uremic fetor - breath smells like shit - oral hygiene Can go to nerves - uremic neuropathy - pins and needles - restless leg syndrome - give GABAPENTIN and PREGABALIN What can lead to body weakness ; anemia , metabolic acidosis , nutritional imbalance , depression , dialysis , lack of movement Pt can develop: - sexual dysfunction - Risk for infection - Risk for bleeding - Depression - Slow death for all vital organs - slowly damaging vital organs one by one Downloaded by Morris Muthii ([email protected]) Complications of Renal Failure; a. Fluid overload = pulmonary edema - HOB elevated , diuretics , O2, bronchodilators , fluid restriction b. Electrolyte Imbalances; hyperkalemia - cocktail - calcium gluconate c. Hypermagnesemia - avoid antacids - milk of magnesium d. Hyperphosphatemia - calcium will drop - give them calcium acetate - SEVELAMER - can lead to cardiovascular complications and constipation - 3x a day phosphate binder phosphorus is found in sodas e. Hypocalcemia - vitamin D - CALCITRIOL f. Hyponatremia - dilutional effect - fluid and sodium restriction g. Metabolic acidosis - sodium bicarbonate - weakness , abdominal pain , decreased LOC / lethargy h. Renal Osteodystrophy - weak and soft bones - low calcium level - brain will tell parathyroid to attack and produce more PTH - the parathyroid will work overtime trying to produce calcium and will lead to SECONDARY HYPERPARATHYROIDISM give CINACALCET parathyroid releasing PTH = releasing calcium from the bones i. j. Calciphylaxis Wound- if phosphate and calcium not balanced - can lead to sepsis Anemia of CKD - Iron (oral) Iron (IV - anaphylaxis) - Epoetin Injection (do not give if hgb over 10) Blood transfusion k. Uncontrolled Hypertension - hypertensive crisis - beta blockers , CCB, ACE / ARBS , Vasodilator ; HYDRALAZINE l. Stroke : 81 mg of aspirin every day give them antihypertensives every day Downloaded by Morris Muthii ([email protected]) m. Myocardial Infarction - 81 mg of aspirin combined with clopidogrel ; give STATINS ; low sodium and low saturated fats IMMEDIATE CAUSE OF DEATH: 1. dead kidney = increased water volume = fluid overload = pulmonary edema = death (resp failure) Pulmonary edema classic sign - pink frothy sputum , DOB/SOB, crackles , hypoxemia - elevate the HOB followed by oxygen and then IV push diuretics (furosemide) 2. Electrolyte Imbalance - develop CARDIAC DYSRHYTHMIA- (K , Ca, Mg) muscle weakness or muscle cramps : Electrolyte Imbalances- hyperkalemia, hypermagnesemia, hyperphosphatemia , hypocalcemia , hyponatremia (dilutional effect) LONG TERM CAUSE OF DEATH: why you die on dialysis / renal failure 1. 2. Brain - stroke Heart - myocardial infarction - heart attack *these causes of death are the same for DM* Nursing Management 1. 2. 3. 4. 5. 6. 7. 8. 9. Vital signs Fluid restriction 1L fluid restriction Daily weights Strict I&O Fall precautions and safety precaution Bleeding precautions Monitor skin integrity Monitor lab results Patient teaching - meds side effect 10. Patient teaching - complications of illness 11. Patient teaching - self management 12. 5 year rule they die from MI , stroke - should have advance directives 13. Collaborate with other members of healthcare team 14. Renal diet dietician — low potassium , phosphorus , sodium , calculated protein , increase calcium , fluid restricted 15. Activity and exercise 16. Anemia - frequent rest periods - avoid strenuous activity 17. Infection prevention 18. Dialysis care - dialysis access care - fistula vs graft Downloaded by Morris Muthii ([email protected]) 19. Regular follow up with provider 20. Emotion support and psychosocial support - depression 21. Healthy lifestyle - no smoking , no drinking 22. Prepare patient for any diagnostic tests - check for allergy metphormine for contrast dye 23. Always review their list of medication for interactions - avoid herbal and OTC meds without telling your Dr. [Show More]

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