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Individuals2Exam3Matrix.docx

Individuals2Exam3Matrix.docx - Individuals 2 Exam 3 Matrix...

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Individuals 2 Exam 3 Matrix Chronic Renal Disease Acute Interventions: Both pt and caregiver need to understand the whole body’s function can be disrupted by kidney failure Prevention and early recognition of AKI are most important components of care Prevention- Identify and monitor high risk populations Control exposure to nephrotoxic drugs and industrial chemicals Prevent prolonged episodes of hypotension and hypovolemia Careful monitoring of I&O and fluid and electrolyte imbalances Monitor losses from vomit, diarrhea, or hemorrhage Prompt replacement of significant fluid losses help prevent ischemic tubular damage associated with trauma, burns, and extensive surgery I&O records provide indicators of fluid status Daily weights- same scale and same time each day to detect gains or loss Assess for common signs and symptoms of hypervolemia (diuretic phase) hypovolemia (oliguric phase), potassium and sodium disturbances Bc infection is leading cause of death for AKI- aseptic technique is critical Protect pt from other people with infections Alert to S&S of infection (redness, swelling, pain, fever malaise, leukocytosis) Monitor type, frequency, and dosage of antibiotics to ensure safe for the kidney Skin care to prevent ulcers bc pt usually has edema and dec. muscle tone Mouth care is important- prevent stomatitis (developed from ammonia from bacteria breakdown of urea) Chronic Interventions: CKD is more common than AKI Primary goal is to preserve kidney function, reduce risks of CV disease, prevent complications, and provide comfort to pt. Treat potentially reversible causes of kidney failure- especially CV disease Control HTN, hyperparathyroid disease, Anemia, hyperglycemia, and dyslipidemia Drug Therapy Managing hyperkalemia- evacuated in the bowel (expect diarrhea) Restrictions on high-potassium foods (40mEq/day) IV glucose and insulin IV 10% calcium gluconate Calcium Cabonate- Kayexalate Managing HTN Target BP 130/80 for CKD pts. 125/75 for pts with proteinuria Weight loss, lifestyle changes (exercise, avoid alcohol), Diet recommendations, antihypertensives (most pts on 2 or more) Most common Antihypertensives Diuretics, CCB, ACE inhibitors, ARB agents Ace and ARBs used with pts with diabetes bc dec, proteinuria Managing CKD-Mineral and Bone Disorder (MBD) Limit phosphorus
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Administer phosphate binders Supplement Vitamin D Manage Anemia Exogenous erythropoietin- lowest possible dose to avoid CV events epoetin alpha- admin IV od SQ 2-3x/week Darbepoetin alpha- longer acting, admin weekly or bi-weekly Manage Dyslipidemia Statins used to lower cholesterol Atrovastatin (Lipitor) Nutritional Therapy- see diet section Protein restriction Water restriction Sodium restriction Potassium Restriction Phosphate restriction Nursing management: -S/S:
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