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N370-03: Renal
Interventions, Medications & Treatment pt. 1
| Intervention | Problem |
|---|---|
| Normal values for them are going to be far from the usual normal -> consult with med team for the PATIENT'S NORMALS. | What kind of lab value range would you anticipate if pt has CHRONIC renal failure managed on dialysis? How would you intervene? |
| Low sodium and low protein | What types of diet restrictions are required during the oliguric phase of AKI? |
| NS hydration (priority - bolus IV saline), Mucomyst, and Bicarbonate drip | Contrast dye is one of the most common causes of hospitalization d/t AKI. What are the three main parts of pre-contrast prophylaxis? |
| Restrict; decrease; reduce; increase | With renal failure, we aim to: (restrict/give) fluids, (increase/decrease) Na, K, Phosphorus; (reduce/add) PPPS = Potassium, Phosphorus, Protein, Sodium; (increase/decrease) calories. |
| Anti-HTN; diuretics & potassium-wasting diuretics; folic acid & ferrous sulfate (iron); phosphate binders; calcium supplements; stool softeners & laxatives | We give ____ for HTN, _____ + ____ for volume overload, ____ for anemia, _____ to lower phosphate and inc calcium, _____ supplements, ____ & _____ b/c iron med causes constipation. |
| Protein (can't breakdown protein), Potassium (hyperkalemia bc kidneys can't waste), Phosphorus (dec calcium), Sodium (inc BP) | We limit the 3 P'S. What are they? |
| True | T or F: Avoid salt substitutes b/c they contain potassium |
| "Dwell" & drain; more than or equal to | During peritoneal dialysis, monitor the "____" & ____ in cycles (gravity). The amount drained should be ____ or ____ the amount administered. |
| Reposition the patient | If the amount drained from peritoneal dialysis is less than what's administered, what should the nurse do FIRST? (Hint: tip cath may have dislodged against the bowel) |
| Weight loss and decreasing BUN + Cr | How do we know if the peritoneal dialysis worked? / What should we monitor? |
| Document findings. Protein in fluid is expected because we want to get rid of protein. | What do you do if dialysate is yellow during peritoneal dialysis? |
| WBC >11,000 d/t presence of bacteria in peritoneum caused by insertion/contamination of PD cath | The nurse notes cloudy dialysate during peritoneal dialysis and checks the lab result. What would WBC level would they expect and why? |
| Bowel perforation; STOP PD & clamp tubing -> THEN call physician STAT b/c it's a medical emergency | A patient's peritoneal assessment shows brown or green dialysate return. What would the nurse suspect and what are priority actions? |
| Hemodialysis | ______ is a procedure wherein a dialysis machine and a dialyzer (takes blood from fistula - filters - warms to avoid clots - back to body) are used to clean the pt's blood OUTSIDE the body. The most efficient and effective clearance. |
| AV fistula (access) | Hemodialysis requires placement of an _______ which is done through the arm with minor surgery b/c access is needed into the blood vessels. |
| True | T or F: hemodialysis works through diffusion and osmosis -> blood flows through semipermeable membrane. |
| Chest catheters/ports | Hemodialysis patients can have AV fistulas or ______ which is more discreet and can be an option for pts who are worried about body image. |
| 3 temporary ports (1 for take out blood, 2 for returning blood, 3 for draw) | Hemodialysis requires _______ ports while AV is growing. |
| Hypotension | Hemodialysis puts patients at risk for _____ b/c body shifts fluid from intravascular space to intracellular space (back and forth to body). This is a priority! |
| After hemodialysis | Since certain medications can be dialyzed, when do we give them to our hemodialysis patients during pre-tx readiness? |
| Medications, food, fluids, vital signs not trending toward hypo/hypervolemia | What other pre-treatment readiness do we assess for hemodialysis patients? |
| Post-treatment | Current VS, K+ reduction, BG if diabetic, weights before and after = total fluid removed, daily weights, lab follow up for "shifts" esp K, Na, BUN, Cr, and access site observations are part of the _____ needs/assessment. |
| Start low, go slow; short | To prevent disequilibrium syndrome during hemodialysis, nurses have to _____ _____, _____ ____ with (short/prolonged) intervals. |
| Side lying/rescue | Always utilize seizure precautions during disequilibrium syndrome and put patient in a ______ position when seizing. |
| True | T or F: No lab routine use of 2 dialysis ports and use only 3rd if present. + Heparin/calcium citrate can be added to prevent clotting but always PULL heparin and waste it first. |
| PAP - Palpate the thrill (low vibrating sensation); Auscultate the bruit (stenosis bruit is more high pitched and normal for fistulas ONLY); Perfusion (CRT, CSM, assess distal pulses) | How do you assess AV fistula? |
| Pre-op | Determination of need, recipient evaluation, organ-specific screening & labs, VS, informed consent with psychological testing, PT EDUCATION regarding self-managements and adherence to lifelong anti-rejection meds happen during _____ care. |
| Post-op | Monitori complications (thrombosis, bleeding, anastomosis leak), graft rejection, organ dysfunction, infection, kidney and liver dysfunction dt immunosuppressive rx/steroid-induced, anxiety about adhering to meds, and insurance are _____ care. |
| Organ removal | During hyperacute kidney transplant rejection, we anticipate and prepare the pt for ______ as the tx. |
| False; look for s/sx of kidneys not working | T or F: During kidney transplant rejection, we are looking for manifestations that the kidney is still working somehow. |
Created by:
yortiz
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