Renal
Retinopathy
Complications of DM
Visual impairment and blindness
Diabetic retinopathy, cataracts, and glaucoma
Retinal damage
Signs and symptoms of Addison Disease
Depletion of sodium and hyperkalemia
Generalized malaise, muscle weakness, muscle pain, orthostatic hypotension, cardiac dysrhythmias
Hypoglycemia
Anorexia, N & V, anxiety, depression, loss of mental acuity
S/Sx of Cushing Syndrome
Painful fatty swellings in the intrascapular area (Buffalo Hump)
Moon face
Enlarged abdomen, thin extremities, easily bruising, impotence, amenorrhea, hypertension, weakness, and loss of muscle mass
Unusual body hair growth
Streaked purple marking on the abdomen area
Familial predisposition to DM
Chronic Renal Failure
Early - high elevation of creatine
Early-asymptomatic
Stage 3 uremia or uremic syndrome
Headache, nausea, weight loss, fatigue
Fluid Restrictions Example=
1,200 FR= 700mls dayshift, 400mls evening shift and 100mls for nightshift
Peritoneal dialysis
Alternative for HD
Solution is instilled into the peritoneal cavity for a specific dwell time to equalize
Pt can move around during the dwell time
Drainage should be colorless or straw colored
Patients can do at home overnight
UAP reportables for DM
Skin alterations- skin tears, excessive urination, change in VS- rapid respirations
Treatment of Addison Disease
Replace missing hormones- lifelong replacement
Prednisone or glucocorticosteroids
Teaching to Avoid Addisonian Crisis
Avoid stress, medication compliance, and learn coping mechanisms
Diagnostics for Cushing
Free plasma cortisol
24 hour urine level
If cortisol is elevated= dexamethasone suppression test
ESRD Patient teaching
Daily weights
I & O
Fluid restriction- it is the nurses job to make sure each shift is giving the right amount of fluids ****
Complications of PD
Perotonitis
Leakage
Obstruction
Respiratory problems
Fluid overload
Hypertriglycemia
Insulin Teaching
Advise patients to avoid injecting insulin into an area that is going to get a lot of exercise (leg)
The abdomen is the best place because absorption is steady, rapid, and not affected by surgeon
Rotate the site- DO NOT MASSAGE INSULIN SITE
Example of peak insulin times and exercise:
Pt takes his 70/30 insulin at 0700- he should not exercise until 1300 - Why?
Addisonian Crisis
Low BP
Produce typical signs and symptoms of shock
Severe abdominal pain, flank or leg pain
Tachycardia, nausea, LOC
Treatment of Cushing
Microsurgery on the pituitary gland
Adrenal tumor= adrenalectomy
Uremic Frost
Late sign of ESRD
Appears as evaporated sweat leaves urea crystals on the eyebrows, face, axilla and groin
Teaching- Pt should take brief, warm, not hot showers and PAT DRY
Post hemodialysis treatment nursing
PRIORITY NURSING
Monitor access site for bleeding for 1 hour after treatment
Signs of confusion, hypotension, vomiting, headache, dizziness, muscle cramps
Invasive procedures are postponed 4-6 hour due to increased clotting time due to heparin
Regular Insulin
Regular drawn up first if mixing with longer acting insulin
Clear to cloudy
2 nurses verify
Treatment of Addisonian Crisis
VS
Blood glucose
Sodium and Potassium levels
Immediate fluid replacement
IV Hydrocortisone, Sodium, Fluids, pressors, and dextrose
Hyperkalemia - regular insulin or calcium gluconate
Q one hour blood glucose
Adrenalectomy post op nursing
Maintaining hemodynamic stability
Pain
Prevention of infection or DVT
* Adrenal glands maintain BP and stress response
Drugs that are held prior to HD
Antihypertensives are held before dialysis because of risk of severe hypotension
Nitroglycerin patches, digitalis, anticoagulants
Proteins
High biologic protein= animal, eggs, milk and fish- ALL AMINO ACIDS
Low biologic protein= SOME AMINO ACIDS- breads, crackers, cereal, corn rice
Decreased function of the adrenal cortex and deficiency of the cortisol, aldosterone, and testosterone
Addison Disease
Excessive levels of cortisol
Cushing syndrome
Chronic Renal Failure
Caused by the destruction of the nephrons
Diabetes and hypertension
AV Fistula Care
Never take blood pressure on the arm with the AV fistula
Never do lab draws on the arm with the AV fistula
Palpate/feel the thrill
Listen for the bruit
Bladder Cancer- Illeal conduit
Urinary ileostomy
A portion of the ileum is used as a tube through which the urine flows to the outside
Post op- Urine should always be flowing
Link pink ok
Bright red or clots- report immediately
Dusky stoma= bad. Should be red and beefy.