CRF notes.docx - Problem Intervention Water Balance...

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Unformatted text preview: Problem Intervention Water Balance Hypervolemia I/O Diuretics CRF/CKD/ESKD Edema AKI Pulmonary edema Daily Key facts Slow/progressive 50%weight increase of Creatinine level CHF Resp assess Irreversible loss in kidney fxn Pre/intra/postrenal ElectrolyteGFR less than/equal Increase K, Mg & xPhosphorus to 60mL/min 3 months + Replacement/removal s/s similar to CRF Decrease Ca Kayexalate [fix K] 5 stages cause is reversible Lasix [fix K] Affects all major body systems interventions similar to CRF IV insulin/dextrose [fix K] RF Diabetes Renagel [fix phosphorus give w/meals] HTN EKG Chronic Urinary Obstruction Ca acetate Recurrent Infections Supplements Renal artery Occlusion Diuretics Autoimmune Disorder Dialysis Meds Dx Serum Creatinine [**only affected by Kidney Dz] Diet HTN Anti-HTN BUN Diet Urinalysis Beta blocker Urine specific gravity Anemia Urine culture/sensitivity Fatigue Monitor HbG/Hct SOB test Epoetin alfa/epogen Creatinine clearance Angina Rest KUB Fe Bladder scan Transfusion U/S, CT, MRI Bone Demineralization Monitor labs Blood chem Supplements Electrocardiogram acid Decreased protein Renal diet Increased Increase: Carbs &Mental Fiber changes Agitation Decrease: Protein, K, Na, Phosphorus, Mg, & FluidsIncrease safety measure Pruitus Skin care/hygiene RN management Meds Pericarditis Cardiac assess/EKG/labs Infection control Metabolic acidosis Admin Na Bicarb Ed VS Position change Labs Ambulatory care Ed Resources Home health: nutrition, dialysis site care, s/s, med management Tx Meds Cause Dialysis Sim to CRF Transplant Fxn Type Bedside RN Complications RN management Times/week Pt Ed Hemodialysis Cleanses blood of accumulated waste products Corrects electrolyte levels Central Line: Immediate access Short term Complications: infection, hematoma, & pneumothorax AVF: Connects vein to artery 2-3 months to mature Reduces risk of infection & clotting Long term Complications: aneurysm, infiltration, & hematomas AV graft: Synthetic connector from vein to artery Pt. vessels are comprised 2-3 weeks to mature More prone to infection & clotting 2-3 yr use Complications: clotting, aneurysm, & infection VS Labs Infection Support Meds Diet Assess Air embolus HypoTN Muscle cramps Itching fatigue Palpate pulse below fistula/graft Monitor edema/ischemia Monitor for clotting/infection Patency V/S Labs Support Meds Diet ***Notify MD immediately if thrill not present*** Up to 3 x week Extremity not used for BP, venipuncture, IVs, or Peritoneal dialysis Peritoneum acts the dialyzing membrane Uses osmosis Continual Acute intermittent Con. Ambulatory [CAPD] Con. Cycling [CCPD] Fluid gen. clear-yellow **cloudy indicate infection** Aseptic tech Fluids @ rm temp **Peritonitis** Insufficient outflow: - Full colon - Catheter migration - Tube kinks - Tube clots - Pt needs position change Pain Leaks bleeding Assess Ed Cath site check Monitor dwell time Position pt Monitor outflow Intermittent - Continuous High fiber diet injection Deff. Post-OP Complications Interventions Kidney Surgery Removal of obstruction Insert tube Kidney Removal Urine out -put Diuretics Meds Monitor daily weights Monitor daily labs [Hct, BUN, Crt, UA] Urine color/characteristics Hemorrhage Shock Infection Ed Infection prevention Lifestyle changes PRN Ambulate Transplant New kidney to take over fxn of damaged kidney [not removed] Rejection: - In 24h [hyper acute] - 3-14days [acute] - Yrs later [chronic] - Assess for rejection/kidney failure Hemorrhage Shock Infection Rejection Ed. s/s of rejection & need for med compliance ...
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