AKI/CKD
Describe the nursing management for acute glomerulonephritis.
Assess weights, low Na/low K/fluid-restricted diet, antibiotics, rest.
Identify signs of hyperkalemia.
Peaked T waves, muscle weakness, paresthesia
Identify 3 nursing measures post-TURP.
Assess for bleeding. Monitor strict I/O. Medicate for bladder spasms. If no UOP, check for kinks, increase rate of irrigant, and flush the foley.
Identify 3 nursing measures to prevent a CAUTI.
Ensure there are no kinks or twists in the tubing. Use aseptic technique with specimen collection. Remove it asap.
Identify nutritional recommendations for uro- and nephrolithiasis.
Uric acid - low purine diet (mushrooms, asparagus, shellfish, organ meats)
Oxalate - low oxalate diet (nuts, green vegetables)
Increase fluid intake (3L/day), low protein, high fiber
HD - disequilibrium syndrome, hypotension, infection, bleeding
PD - bleeding, infection, peritonitis
Describe findings of fluid volume deficit and fluid overload.
Deficit - hypotension, poor skin turgor, tachycardia, hypernatremia
Fluid overload - weight gain, crackles, edema, HTN
What can you do as the nurse to PREVENT incontinence?
Recommend kegel exercises, bladder training, toilet q2hr, medicate for UTI or spasms, use BSC or urinal.
What diagnosis causes symptoms similar to cystitis but is not associated with a positive urine culture?
Interstitial cystitis
What foods would you teach a client to avoid on a low-potassium diet?
Oranges, bananas, tomatoes, green vegetables
Oliguric - decreased UOP, elevated BUN/Cr, fluid retention, metabolic acidosis, abnormal electrolytes, signs of uremia
Diuretic - 1-3 + L per day UOP, fluid depletion, watch for hypotension and dehydration
Recovery - tubules healing, BUN/Cr/GFR coming back down to normal
What type of IVF should be administered for hypotension?
Isotonic
Identify prerenal, intrarenal, and postrenal causes of AKI.
Prerenal - shock, hypotension, CHF
Intrarenal - nephrotoxic meds, contrast dye
Postrenal - stricture, BPH, tumor
What education should be provided to patients to prevent UTIs?
Drink fluids, wipe front to back, avoid perfumed soaps, shower rather than bathe, pee when you have the urge and empty your bladder completely.
Describe the type of diet recommended for CKD.
Low sodium (canned soups, cured meats, processed foods), low potassium (avoid salt substitutes), low phos (dairy products), low protein, fluid restriction (yesterday's output + 600cc)
Identify clinical manifestations of CKD:
Early - polyuria, nocturia
Late - uremia, yellowish hue to skin, uremic frost, HTN, lethargy, fluid overload, malnutrition, N/V, anemia, osteodystrophy, hyperkalemia
Identify the normal ranges for the following lab values: Na, K, BUN, Cr
Na 135-145
K 3.5-5.0
BUN 8-20
Cr 0.4-1.2
Describe the nursing management of a client with renal calculi.
Pain management, medicate for spasms and nausea, increase fluid, strain urine
Identify 4 reasons why a foley catheter is necessary?
Urinary retention, perineal wound, end of life comfort, urology surgery/recommendation, critically care requiring strict hourly I/O
Describe the cascade which results in bone damage in CKD.
Phosphorous builds up in the blood due to kidney damage and inability to filter it out, Ca levels drop since Phos and Ca are inversely related. PTH pulls Ca from the bones into the blood. This leads to osteodystrophy/osteoporosis.
Which of the following ABG results would be expected in a client with CKD?
A: pH 7.37, CO2 44, HCO3 24
B: pH 7.47, CO2 29, HCO3 29
C: pH 7.32, CO2 47, HCO3 26
D: pH 7.33, CO2 35, HCO3 20
Describe the pharmacological management of hyperkalemia and how each med works.
IV calcium gluconate - stabilizes cardiac membrane potential
Insulin/glucose - insulin pulls K into the cell, glucose prevents hypoglycemia
IV sodium bicarb - treats acidosis
Kaexylate - excretes K in the stool
The SDR of amoxicillin is 20-40mg/kg/day. The provider ordered 200mg QID for a child weighing 75 pounds. Is this order safe and therapeutic?
Yes
Describe the post-op care of a client with a new ileal conduit.
Monitor stoma - should be beefy red and moist, monitor for signs of infection or bleeding, monitor skin for breakdown around the appliance, empty the bag with 2/3 full.
Describe how nutrition affects the signs and symptoms of CKD.
Most symptoms come from the build-up of urea which is a byproduct of protein metabolism. Signs of fluid overload come from a high Na intake. Signs of hyperkalemia come from a high K intake. Hypocalcemia results from a high intake of Phos.