Med surg week 9 , 10 , 11 , 12 wk 13
is exam
Medical Surgical (Long Island University)
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,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 - UNCONTROLLED 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. Can go to brain - uremic encephalopathy - delirium , acute confusional state
2. Can go to heart - uremic pericarditis - positional chest pain
3. Can go to lungs - uremic lungs / uremic pneumonitis - DOB / SOB
4. 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
5. Can go to Skin - uremic frost - super dry skin and itchy
6. Can go to oral cavity - uremic breath or uremic fetor - breath smells like shit - oral
hygiene
7. 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
()
, 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. Calciphylaxis Wound- if phosphate and calcium not balanced - can lead to sepsis
j. 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
()
, 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. Brain - stroke
2. Heart - myocardial infarction - heart attack
*these causes of death are the same for DM*
Nursing Management
1. Vital signs
2. Fluid restriction 1L fluid restriction
3. Daily weights
4. Strict I&O
5. Fall precautions and safety precaution
6. Bleeding precautions
7. Monitor skin integrity
8. Monitor lab results
9. 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
()
is exam
Medical Surgical (Long Island University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Morris Muthii
,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 - UNCONTROLLED 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. Can go to brain - uremic encephalopathy - delirium , acute confusional state
2. Can go to heart - uremic pericarditis - positional chest pain
3. Can go to lungs - uremic lungs / uremic pneumonitis - DOB / SOB
4. 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
5. Can go to Skin - uremic frost - super dry skin and itchy
6. Can go to oral cavity - uremic breath or uremic fetor - breath smells like shit - oral
hygiene
7. 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
()
, 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. Calciphylaxis Wound- if phosphate and calcium not balanced - can lead to sepsis
j. 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
()
, 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. Brain - stroke
2. Heart - myocardial infarction - heart attack
*these causes of death are the same for DM*
Nursing Management
1. Vital signs
2. Fluid restriction 1L fluid restriction
3. Daily weights
4. Strict I&O
5. Fall precautions and safety precaution
6. Bleeding precautions
7. Monitor skin integrity
8. Monitor lab results
9. 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
()
