Renal Disorders

RENAL DISORDERS Objective # 82 ---- Prioritize nursing intervention for the client with renal disorders. Acute Renal Failure: • Measure and record intake and output • Weigh the patient daily • Assess hemoglobin level and hematocrit and replace blood components as ordered ○ Use packed red blood cells (RBCs) instead of whole blood if the patient is prone to heart failure and can’t tolerate the additional fluid volume • Monitor the patient’s vital signs; report signs of pericarditis (pleuritic chest pain, tachycardia, pericardial friction rub), inadequate renal perfusion (hypotension), and acidosis • Maintain proper electrolyte balance; watch for symptoms of hyperkalemia (malaise, anorexia, paresthesia, or muscle weakness) and ECG changes (tall, peaked T waves; widening ORS segment; and disappearing P waves) and report them immediately • Monitor potassium and glucose levels in a patient receiving hypertonic glucose and insulin infusions • When giving sodium polystyrene sulfonate rectally, make sure that the patient doesn’t retain it and become constipated (to prevent bowel perforation) • Maintain nutritional status ○ Provide a high-calorie, low-protein, low-sodium, and low-potassium diet with vitamin supplements ○ Give the anorexic patient small, frequent meals • Use sterile technique because the patient with acute renal failure is highly susceptible to infection • Perform passive range-of-motion (ROM) exercise and help the patient walk as soon as possible • Provide good skin care, add lubrication lotion to the bath water to combat skin dryness • Provide frequent oral hygiene, if stomatitis occurs and an antibiotic solution is ordered, have the patient swish the solution around in his mouth before swallowing • Monitor for GI bleeding by guaiac-testing stools for blood ○ Give aluminum hydroxide-based antacids, as needed; magnesium-based antacids can cause serum magnesium levels to rise to critical levels • Use appropriate safety measures; a patient with central nervous system (CNS) involvement may be dizzy or confused • Provide emotional support to the patient and his family, and clearly explain all procedures • During peritoneal dialysis ○ Elevate the HOB to reduce pressure on the diaphragm and aid respiration ○ Watch for S/S of infection (cloudy drainage, elevated temp) and bleeding ○ If pain occurs, rduce the amout of dialysate ○ Monitor the diabetic patient’s blood glucose and administer insulin as ordered ○ Watch for complications, such as peritonitis, atelectasis, hypokalemia, pneumonia, and shock • If patient requires hemodialysis

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○ Weigh the patient before beginning dialysis ○ Check the blood access site(arteriovenous fistula, subclavian or femoral catheter) every 2 hours for patency and signs of clotting ○ Don’t use the arm with the shunt or fistula for taking blood pressures or drawing blood ○ During dialysis, monitor the patient’s vital signs, clotting times, blood flow, function of the vascular access site, and arterial and venous pressures  Watch for complication, such as septicemia, embolism, hepatitis, and rapid fluid and electrolyte loss  After dialysis, monitor the patient’s vital signs and the vascular access site; weigh the patient; and watch for signs of fluid and electrolyte imbalances Use standard precautions when handling blood and other body fluids

KEY NURSING INTERVENTIONS: Measure and record I & O Daily Wts Monitor V/S Maintain proper electrolyte balance Dialysis: • • • • •

Watch for complications—such as peritonitis and infection Weigh before and after hemodialysis Watch for complications of septicemia Check blood access site every 2 hours for patency and signs of clotting Do not use the arm with the shunt or fistula for taking BP or drawing blood

CHRONIC RENAL FAILURE: • • •

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Bathe the patient daily using superfatted soaps, oatmeal baths, and skin lotion without alcohol to ease pruritus, provide good perineal care using mild soap and water; and turn the patient often and use a convoluted foam mattress to prevent skin breakdown Provide good oral hygiene by encouraging or performing frequent brushing with a soft brush or sponge tip to reduce breath odor and providing sugarless hard candy and mouth wash to minimize the metallic taste in the mouth and alleviate thirst Offer small, nutritious, and palatable meals • Encourage intake of high-calorie foods and instruct the outpatient to avoid highsodium and high-potassium foods • Encourage adherence to fluid and protein restrictions • To prevent constipation, stress the need for exercise and sufficient dietary bulk Monitor for signs of hyperkalemia (cramping of the legs and abdomen and diarrhea); as potassium levels rise, watch for muscle irritability and a weak pulse rate • Monitor the EcG for tall, peaked T waves, widening QRS segment; prolonged PR interval; and disappearance of P wave

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Carefully assess the patient’s hydration status, check for jugular vein distention, auscultate the lungs for crackles, carefully measure daily intake and output, record daily weight, and document peripheral edema Monitor for bone or joint complications • Prevent pathologic fractures by turning the patient carefully and ensuring his safety • Provide passive ROM execersies for a bedridden patient Encourage deep breating and coughing to prevent pulmonary congestion, auscultate the lungs often, stay alert for clinical effects of pulmonary edema (dyspnea, restlessness, crackles), and administer diurectics and other medications as ordered Maintain strict sterile technique; use a micropore filter during I.V. therapy • Watch for signs of infection (listlessness, high fever, leukocytosis) during hospitalization and urge the outpatient to avoid contact with infected people during the cold and flu season Carefully observe and document seizure activity; infuse sodium bicarbonate for acidosis and sedatives or anticonvulsants for seizures as ordered • Pad the side rails and keep an oral airway and suction setup at the bedside • Assess the patient’s neurologic status periodically and check for Chvostek’s and Trousseau’s signs (indicators of low serum calcium levels) Observe for signs of bleeding (prolonged bleeding at puncture sites and at the vascular access site used for hemodialysis), monitor hemoglovin level and hematocrit, and check stool, urine, and vomitus for blood Report signs of pericarditis such as a pericardial friction rub and chest pain If the patient requires dialysis\ • Explain the procedure, and make sure that he understands how to protect and care for the vascular access site • Check the vascular access site every 2 hours for patency, and check the extremity for adequate blood supply and intact nervous function (temperature, pulse rate capillary refill and sensation) • If a fistula is present, feel for a thrill and listen for a bruit; use a gentle touch to avoid occluding the fistula • Report signs of possible clotting • Do not use the arm with the vascular access site to take blood pressure readings, draw blood, or give injections because these procedures may rupture the fistula or occlude blood flow • Withhold the 6 a.m. (or morning) dose of antihypertensive medication on the morning of dialysis, and instruct the discharged patient to do the same • Use standard precautions when handling body fluids and needles • Monitor hemoglobin level and hematocrit • After dialysis  Check for disequilibrium syndrome, result of sudden correction of blood chemistry abnormalities (symptoms range from headache to seizures)  Check for excessive bleeding from the dialysis site; apply a pressure dressing or absorbable gelatin sponge, as indicated  Monitor blood pressure carefully • Refer the patient to appropriate counseling agencies for assistance in coping with chronic renal failure

KEY NURSING INTERVENTION: • • • • •

Carefully observe and document seizure activity Provide good skin care and oral hygiene Monitor for signs of hyperkalemia Assess hydration status Observe for signs of bleeding

RENAL TRANSPLANTATION:

KEY TERMS: PRURITUS- Itch; a tingling or faintly burning skin sensation that prompts a person t rub or scratch. PYELONEPHRITIS- Inflammation of the kidney and renal pelvis, usually as a result of a bacterial pelcis usually as a result of a bacterial infection that has ascended from the urinary bladder. RENAL OSTEODYSTROPHY- Uremic bone disease develops from the complex changes in calcium, phosphate, and parathormone balance. RENAL RESERVE- Measure of the capacity of the kidney to increase the glomeruluar filtration in response to the stimulus of protein meal or amino acid infusion. RENAL TRANSPLANTATION- The organ transplant of a kidney in a person with end-stage renal disease STENT-Any material of device used to hold tissue in place to provide a support for a graft or anastomosis while healing is taking place