CHRONIC KIDNEY DISEASE

Stage 1 (60-SmLAnin) (30-SmLAnin) Stage 5

(>90 mL/min) (15-MmLAnin) (<15 mL/min)

T BUN and Î serum

creatinine (Azotemia) Uremic Frost Hyperpigmentation

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NSG. DIAGNOSIS
Risk for infection r/t high Accumulation of
uremia secondary to Renal urates in the skin
Dysfuntion
NSG. DIAGNOSIS

Pruritus

Impaired comfort r/t

irritation secondary to
NSG. MANAGEMENT elevated level of urea
/ Monitor VS / Evaluate the
patient’s fluid intake and output. NSG. MANAGEMENT
/ Monitor for signs of infection.
/ Encourage the patient to increase fluid intake. / Apply soaks with washcloths wrung out
/ Modify the patient’s diet as needed to limit in cool water or ice water as needed / Keep
protein client's fingernails short; / necessary. /
/ Monitor the patient’s BUN levels,
creatinine levels,
Leave pruritic area open to the air if
and other lab values as ordered to evaluate possible. / Use a super fatted soap
the
effectiveness of
Elevated serum levels of
interventions and urochrome
detect any changes in renal function.
I =
Accumulation of sallow
color skin
l -

Hyperpigmentation
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NSG. DIAGNOSIS NSG. MANAGEMENT promote relaxation and stress reduction. /
Disturbed body image Referral to counseling may be necessary to
/ Encourage positive self-talk / Encourage the address body image concerns
r/t changes in skin patient to engage in self care activities that
color and appearance
 PHARMACOLOGIC
DIAGNOSTIC EXAM / Provide safety
MANAGEMENT / Monitor adverse
/ CBC / effects such as
Urinalysis
z Furosemide CDiuretics) drowsiness /
Provide safety

/ Discuss available
NURSING PHARMACOLOGIC treatment options and
CONSIDERATION MANAGEMENT provide information
about skincare
Furosemide (Diuretics) / Cimetidine routines that may
z Follow 14 rights help reduce the
z Monitor VS esp. (BP) appearance of
z Provide safety hyperpigmentation
z Monitor urine output NURSING
z Weight the patient CONSIDERATION
DIAGNOSTIC EXAM
Cimetidine / Follow 14 / Physical
rights / Monitor VS / Examination
Monitor the patient for
possible
adverse effects
such as dizziness, rash
and diarrhea / Advise the
patient to take the
medication after meal
/ Check for potential
drug interactions /
Provide safety

/ Use a humidifier or a
container of water
on heat source to
increase humidity
in the environment.

MEDICAL
MANAGEMENT

/ Diphenhydramine

NURSING
CONSIDERATION

Diphenhydramine /
Follow 14 rights
/ Monitor VS
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Hyperkalemia Hypermagnesemia Hypo/Hypematremia I
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NSG. DIAGNOSIS NSG. DIAGNOSIS NSG. DIAGNOSIS I
Risk for Electrolyte
imbalance r/t renal disease
Risk for Electrolyte
imbalance r/t renal
Risk for Electrolyte
imbalance r/t renal
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1 1 1 I
DIAGNOSTIC DIAGNOSTIC DIAGNOSTIC I
Test
EXAM / Blood EXAM
/ Blood Test
EXAM /
Blood Test
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NSG. MANAGEMENT
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T
MANAGEMEN
z Monitor VS NSG. MANAGEMENT
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MANAGEMEN MANAGEMEN Hyponatremia / z Establish rapport I
T T Monitor VS / z Provide supplemental z Monitor VS I
Establish rapport / z oxygen therapy as needed
z Maintain good respiratory
/ Monitor VS / / Monitor VS / Encourage patient z Educate energy-
conservation techniques.
function I
Establish rapport /
Educate the client
Establish rapport /
Monitor I & O /
to take sodium rich
food diet / z Assist the client in z Protect the client from
injury
I
on low potassium Check patellar Safety
precautions
developing a schedule for
daily activity and rest. z Restore electrolyte balance I
diet / Monitor I & reflex
regularly / / Check weight z Monitor iron level
z
especially K.
Promote energy I
O / Follow ECG
closely to look for
Encourage bed every day to
monitor fluid
z Advise diet to eat rich in
iron food and supplements
conservation I
peaked T waves
rest / Monitor fluid z Monitor 02 level
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anf electrolyte volume status / z (green leafy veggies
z Monitor patioent’s blood
andred meat)
/ Check blood
glucose when
balance
/ Provide
Monitor for any
sign of seizure / z Provide emotional support
gas level
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z Provide safety
administering emmotional Monitor patient z Provide safety
z Provide comfort I
insulin support to laboratory results z Provide blood products as
z Provide emotional support
I
alliviate fears Hypernatremia / prescribed
z Administer medication as
Monitor VS /
Restrict Na
prescribed I
diet I
/ Monitor I & O
/ Promote safety
 PHARMACOLOGIC
PHARMACOLOGIC PHARMACOLOGIC
NSG. MANAGEMENT
MANAGEMENT I
MANAGEMENT
/ Glucose 10% with PHARMACOLOGIC MANAGEMENT / Monitor VS / Establish
/ Sodium Bicarbonate
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regular insulin per MANAGEMENT Hyponatremia
/ Administer NaCl
rapport / Assess the patient’s
I&O and fiiid balance /
I
IV
/ Exchange resin
/ Calcium 0.9% IV, plasma Encourage the patient to rest and I
kayexalate /
Hemodialysis
Gluconate IV /
Hemodialysis
expander
Hypernatremia /
use comfort measures / Assess
using OLDCART /Provide safety NURSING I
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Furosemide (Diuretics) NURSING /
/
Provide safety
Monitor weight
CONSIDERATION I
CONSIDERATION
/ Monitor patient for sign of Sodium Bicarbonate / Follow I
Hyponatremia / Follow 14
rights / Monitor VS esp. /
infection or obstruction
such as fever, chills and
14 rights / Monitor VS / Check
for medication allergy (Skin test)
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NURSING
CONSIDERATION
Monitor laboratory results / pain, such as heat and cold / Check for possible adverse I
NURSING
Monitor for possible
adverse effects / Provide
therapy, positioning and
relaxation techniques /
reaction
/ Monitor electrolytes
I
Glucose 10% with
regular insulin per IV
CONSIDERATION
safety / Provide rest and comfort Administer pain medication as
prescribed
/ Monitor laboratory results I
NURSING Hyponatremia / Follow
/
/
Provide comfort
Provide rest I
14 rights / Monitor VS
/
/
Follow 14 rights
Monitor VS
CONSIDERATION
esp. / Monitor the PHARMACOLOGIC /
/
Provide safety
Provide emotional support
I
/ Provide safety Calcium glucunate / patient for possible MANAGEMENT
Corticosteroid I
Follow 14 rights /
/ Monitor
adverse reaction
for
Monitor VS esp. /
adverse effects such as
fluid overload. / Monitor
/ Ceftriaxone (Antibiotic) /
/ Follow 14 rights / Monitor VS /
Advise client to take medication
I
such as Monitor electrolyte imbalances /
Ibuprofen (NSAIDS)
after meal /Monitor for possible I
/
hypotension
Monitor for drug
laboratory result /
Monitor patient for
Provide emotional
support NURSING
adverse effects /
Provide comfort I
tocixity possible adverse effecr CONSIDERATION /
/
Provide rest
Provide safety
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(hypoglycemia) / hypotension and
bradycardia / Check for
Hypernatremia
Furosemide (Diuretics) Ceftriaxone (Antibiotic) / NSG. MANAGEMENT I
Monitor laboratory
result / Provide emotional potential drug toxicity / Follow 14 rights / Follow 14 rights / Monitor VS /
Check for medication allergy
I
support Magnesium sulfate at bed Monitor VS esp.
(BP) / Provide
(Skin test)
Establish rapport
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side / Provide safety z Monitor VS, renal stones,
calcium and phosphate levels I
Kayexalate / Follow / Educate the patient on the
safety / Monitor urine
14 rights importance of completing
/ Monitor VS
output
the full course of z Monitor I&0
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/ Provide safety / Weight the patient antibiotics and the potential z Low calcium Diet
/ Monitor side effects. z Monitor the patient’s
mobility, strength, and
I
laboratory result Ibuprofen (NSAIDS) / Follow
14 rights / Monitor VS /
balance to prevent falls or I
result from hypercalcemia- I
other injuries that could
Provicde safety
Furosemide (Diuretics) /
Follow 14 rights / Monitor VS
related muscle weakness. I
esp. (BP) / Provide safety / z Consult a nutritionist for I
proper diet
z Monitor for complication I
Monitor urine output / Weight
the patient such as thyroid storm
z Provide comfort I
PHARMACOLOGIC z Provide rest I
z Provide safety
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 NSG. NSG. CONSIDERATIONS PHARMACOLOGIC
CONSIDERATIONS MANAGEMENT
Electrolyte replacement
Phospahate binder / Follow 14 rights Diuretics (Furosemide)
/ Follow 14 rights / Monitor VS Calcitonin hormone
/ Monitor VS / Assess for allergy (Calcitonin)
/ Monitor serum / Monitor for serum
phosphorus level Calcium level ---------------1---------------
/ Monitor serum calcium / Promote rest
NSG. CONSIDERATIONS
levels / Promote safety
/ Provide safety / Provide emotional Diuretics
/ Promote rest support
/ Provide emotional
z Follow 14 rights

support z Monitor VS
z Monitor I/O
z Monitor serum K
z Monitor weight
z Provide comfort
z Provide rest
z Provide safety
z Provide emotional support
Calcitonin Hormone
✓ Follow 14 rights
NSG. ✓ Monitor VS
MANAGE ✓ Assess for allergy
Pre- MENT ✓ Promote safety
OperaEstablish rapport ✓ Monitor calcium level
tive Monitor VS prior to OR ✓ Monitor for tetany
care Provide psychological support
z Assess patients level of
zZ understanding about the
SURGICAL MANAGEMENT
zZ procedure
Bowel preparation
zZ Skin preparation / Parathyroidectomy
Z Monitor lab results prior to
surgery
Advise client for diet
modification before surgery
Post- (NPO)
Oper Monitor VSmedication
Administer ql5 for lhr then
for pain
ative q4 until VS is
as ordered
Z
care
Z Monitorl&O
Educate patient for wound
Z care
Z Advise patient to limit
Z physical activity
NPO to DAT
Administer post-operative
antibiotic for prophylaxis
Administer pain reliever
(NSAIDS &
Analgesics) as ordered
 NSG. CONSIDERATIONS

ACE Inhibitor
/ Follow 14 rights / Monintor VS / Monitor
serum K / Provide safety
Amiodarone (Antiarrhythmics) /
Follow 14 rights
/ Monintor VS
/ Assess ECG before gising
 medication I
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/ Monitor for pussible adverse I
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effects such as hypotension and I
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bradycardia I
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/ Monitor for drug interaction / NSG. CONSIDERATIONS I
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Monitor liver test I
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/ Provide comfort Aldactone (Diuretics) I
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/ Provide rest z Follow 14 rights I
/ Provide safety z Monintor VS I
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Captopril (ACE inhibitors) / Follow 14 z Monitor lab results I
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rights / Monintor VS / Monitor for possible z Monitor for drug interaction I
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adverse effects such as hypotension, cough, z Monitor renal function I
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hyperkalemia, renal dysfunction / Monitor z Provide comfort I
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for drug interactions / Monitor renal z Provide rest I
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function z Provide safety I
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/ Provide comfort I
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/ Provide rest I
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/ Provide safety 1 I
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SURGICAL MANAGEMENT I
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• LeVeen peritoneo I
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P -Operative care
NSG.
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rZ Establish rapport
MANAGEMENT
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z Monitor VS prior to OR I
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z Provide psychological support I
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z Assess patients level of understanding about the I
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z Bowel preparation I
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z Skin preparation I
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z Marek the insertion site I
z Monitor lab results prior to surgery I
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z Advise client for diet modification before surgery (NPO) I
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z Administer medication for pain as ordered I
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Post-Operative care I
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/ Monitor VS ql5 for lhr then q4 until VS is stable I
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/ Monitor I & O I
/ Educate patient for wound care I
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/ Advise patient to limit physical activity / NPO to DAT I
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/ Administer post-operative antibiotic for prophylaxis I
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/ Administer pain reliever (NSAIDS & Analgesics) as I
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ordered / Assess surgical site for any signs of bleeding / I
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Maintain electrolyte balance I
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/ Ensure proper documentation I
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/ Encourage ambulation I
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NSG. INTERVENTION
Maintain fluid and electrolyte
DIAGNOSTIC EXAM
balance.
• Blood Test
/ Weigh the client daily. To assess
edema.
• ABG test
/ Measure and record I and O
• MRI accurately.
• CT Scan / Assess presence and extent of edema.
/ Auscultate breath sounds.
Rales/crackles indicate pulmonary
edema. / Restrict fluids as indicated.
/ Monitor cardiac rhythm for
dysrhythmias; BP for
hypertension
/ Avoid over - the counter medications
MEDICAL (e.g., Milk of Magnesia may
cause magnesium toxicity).
MANAGEMENT Provide adequate nutrition. / High
carbohydrates, low protein, low sodium
/ Hemodialysis / Renal and low potassium.
/ High carbohydrate diet provides
transplantation caloric requirements of the body.
/ Low protein diet reduces urea and
nitrogenous waste products.
/ Low sodium diet prevents further
water retention and edema.
/ Low potassium diet to help resolve
hyperkalemia.
Prevent infection and injury. Maintain
asepsis during treatments and
procedures. / Avoid aspirin products. To
prevent bleeding / Encourage the
client to use
bristle toothbrush
Promote comfort
/ Relieve pain
/ Relieve pruritus due to uremic
frost
Care of the client undergiong Dialysis / / Renal transplantation may be indicated
Hemodialysis requires vascular access. The different vascular in ESRD
accesses are as follows: arteriovenous fistula, arteriovenous The medications administered to prevent Graft-
graft, external arteriovenous shunt, femoral vein Versus-Host-Disease (GVHD) or rejection
catheterization. reaction are as follows:
■ Arm precaution should be observed when a client has ■ Imuran (Azathioprine)
AV fistula or AV shunt. No BP taking or puncturing of ■ Sandimmune, Neoral (Cyclosporin)
the affected arm ■ Prograf (Tacrolimus)
■ Assess for patency of AV fistula by auscultating for ■ Rapamune (Sirolimus)
bruit and by palpating for thrill. ■ CellCept (Mycophenolate mofetil)
■ During hemodialysis, blood transfusion should be ■ Deltasone (Prednisone)
administered. To prevent hypovolemia and shock. Protect the client from infection because these
■ Usually, antihypertensive medication doses are omitted medications areimmunosuppressants.
during hemodialysis. To prevent hypotension. BP
should be monitored
■ Promote comfort. Hemodialysis may take 3 to 4 hours
per session.
■ Maintain activity and nutrition.
■ Prevent disequilibrium syndrome.
■ The signs and symptoms of disequilibrium syndrome are as follows: restlessness, headache, dizziness, nausea and
vomiting, hypertension.
/ Peritoneal dialysis requires peritoneal catheter. The caleteria Inserted below the umbilicus This area is avasala therefore,
there is very minimal bleeding during insertion of he catheter.
■ The dialysate folloreashould be warned at bod temperature. To increase capillary permeability and enhance removal of
waste products from the blood.
■ The cycle of peritoneal dialysis is as follows: infusion time is 10 minutes; dwell time or equilibration time is 20 minufes;
drainage time is 30 minutes.
■ The first few bottles of drainage will normally be pink, tinged. This is due to trauma during insertion of the peritoneal
catheter.
■ If the drainage stops, turn the client to sides. The lumen of the catheter may he occluded hy a loop of colon.
■ The client should be placed in semi - Fowler's position. To prevent dyspnea due to compression of the diaphragm by the
fluids in the abdominal cavity.
■ Cloudy dialysate indicates peritonitis. Notify the
■ physician. Collect specimen for culture.
■ Monitor urine and blood glucose levels. The dialysate solution contains glucose. Small doses of insulin may be required,
if hyperglycemia occurs.
■ Continuous ambulatory peritoneal dialysis (CAPD) is done by the client at home. Teach the client on asepsis to prevent
infection.
■ Dialysis may improve the following problems in a dient
■ with renal failure:
-Edema
-Elevated BUN, serum creatinine
-Elevated electrolyte levels
-Elevated blood pressure