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00 Renal Fabs
00 Renal Fabs
LO
- Movement of fluids from low to high concentration of ② HYPERTONIC
solute - Water loss is greater than electrolyte loss
- Example: cellular dehydration - Condition is cellular dehydration
- Give HYPOTONIC IV fluids
② DIFFUSION
- Movement of solute from high to low concentration ③HYPOTONIC
- Example: gas exchange - Water loss is less than electrolyte loss
- Condition is cellular edema
IV FLUIDS - Give HYPERTONIC IV fluids.
IL
① ISOTONIC
-
-
-
-
Equal concentration, osmolality or osmolarity to blood.
Stays in the intravascular space.
Usually used when refilling intravascular space
Always RAPID infusion
FLUID VOLUME EXCESS
① ISOTONIC (HYPERVOLEMIA)
-
-
Excess fluid in intravascular
Do not give IV fluids
② HYPERTONIC
R
Examples
- Increase concentration in sodium ⇒ hypernatremia
● 0.9 NaCl
- Give HYPOTONIC IV fluids
● Lactated Ringers – usually given to burn patients
● D5W (in the bag)
③ HYPOTONIC
- Decrease concentration of blood due to water
② HYPERTONIC (>.9 NaCL, D5W, D5W with other solution)
AR
ELECTROLYTES IMBALANCES
LOC Altered
Vital signs High BP, HR, and Low BP, High HR POTASSIUM
RR and RR
HyperTachyTachy HypoTachyTachy - Always PRIORITY; POTA ARTE
- Any increase or decrease in K:
Serum ○ Damages the heart, thereby decreasing its
osmolality function.
(275-300 ○ Decreases BP or HR
mOsm/kg; ○ May lead to cardiac arrhythmias or
concentration of
dysrhythmias
solute)
LO
- Normal value: 3.5-5 mEq/L (same with serum
Hematocrit albumin)
(M:42-52%; F: - Major intracellular cation
35-45%) Low High - Increases musculoskeletal contraction
○ Hyperkalemia ⇒ diarrhea
BUN (10-20 ○ Hypokalemia ⇒ constipation
mg/dlL) - Abnormality can cause cardiovascular irregularity
(decreased).
Creatinine
(0.6-1.2 mg/dL)
Cause Hypokalemia Hyperkalemia
IL
Serum sodium
(135-145 mEq/L)
Urinary output
Urine specific
gravity
High
Low
Low
High
Loop diuretics (K,
Na, Mg wasting)
Addison’s disease
(decrease K
excretion)
✓
✓
R
(1.010-1.025;
retention) Diarrhea ✓
(increase K
Central venous High Low excretion)
pressure (8-12
mmHg)
AR
Chronic Renal ✓
Failure (increase
Urine output is inversely proportional to urine specific K retention)
gravity.
Metabolic ✓
Central venous pressure is directly proportional to water. acidosis
(decrease ph →
Intravascular
Intervention FVE FVD shift)
LO
intake)
IL ●
●
IV
NEVER
KCl =
BOLUS AND
RAPID
Potassium
sparing
diuretics
Problem Subside
● Diuretics →
Loop
(furosemide)
● Insulin with
dextrose
● Salbutamol
Assessment
CNS
Hyponatremia
Cerebral edema,
decreased LOC,
Hypernatremia
Cerebral shrink,
decreased LOC,
R
increase ICP, seizure,
(spironolacto (adrenergic seizure polydipsia (thirst)
ne) agonist)
● Calcium Renal Polyuria Oliguria
gluconate for
cardiac
Skin FVD FVD → dry
arrhythmia
AR
FVE → edema
● Sodium
Polystyrene
Sulfonate
(Kayexalate) Intervention Hyponatremia Hypernatremia
○ Directly proportional
spasm)
■ High Ca = High BP, HR ● Chvostek’s
■ Low Ca = Low BP, HR (cheeks)
- Abnormality can cause dysrhythmia ● Spasm
- Excess in the kidneys can cause supersaturation (larynx and
(solid) and osmotic diuresis (attracts water) bronchus)
○ High Ca in the kidneys ● Seizure
■ Renal calculi
GIT Diarrhea Constipation
■ Polyuria → FVD → thirst
Renal Renal calculi
Cause Hypocalcemia Hypercalcemia Polyuria → FVD
LO
→ Thirst
Lactose ✓
intolerance (low ECG changes Hypolonged ST ShorT
Ca absorption) QT ● Short ST
● Prolonged ST ● Wide T
Diarrhea ✓ ● Prolonged
(increase Ca QT
excretion)
IL
reabsorption)
Vitamin D
deficiency (low Ca
absorption)
Hyperparathyroidi
✓
Diet
Medication ●
●
High Ca (milk,
dairy)
Vitamin D
Calcium
gluconate
Calcium
●
Low Ca
Calcitonin
(Ca
blood
from
—>
R
✓
sm (high PTH = carbonate bones)
Ca [bones) → ● IV
blood phosphorus
(calcium
Immobility (Ca ✓ binder ––
[bones] → blood) Always
AR
PABABA)
Chronic renal ✓
failure (low MAGNESIUM (MAG-ISA; MAGNUM)
Calcitriol → low
Ca absorption) - Normal value: 1.5-2.5 mEq/L
- Vasodilator
Dehydration (low ✓ ○ Increased blood flow → warm, flushed
fluids → increase appearance
Ca concentration) ○ Decreased BP, HR
- Neuromuscular effects are similar to those of calcium
Acute pancreatitis ✓
C
(Ca [blood] →
pancreas) Cause Hypo Hyper
magnesemia magnesemia
Magnesium ✓ Respiratory ✓
sulfate alkalosis (High pH
→ Intracellular
Chronic renal ✓ shift)
failure (Mg
retention) Tumor lysis ✓
LO
syndrome (P
Insulin (Mg ✓ inside tumor →
intracellular shift) blood)
IL
Neuromuscular
ECG Changes
Hypocalcemia
HyPRolong and
wide QRS
● Prolonged
PR
Intervention
Diet
Medication
Hypo
phosphatemia
High P (protein)
IV phosphorus
Hyper
phosphatemia
Low P
Al OH (Amphogel)
R
● Wide QRS
ABG ANALYSIS
magnesemia magnesemia
② Oliguric Phase
- 8-15 days
- Urine output:
○ < 30 ml/hr
○ < 400 ml/day
LO
○ Decreased removal of waste products (
increased BUN and creatinine) → uremia
and azotemia → renal encephalopathy
○ Decreased removal of water → decreased
urine → oliguria and FVE
○ Decreased removal electrolytes → increased
potassium
- Decreased production of calcitriol → decreased
calcium absorption → decreased Ca = increased P
- Decreased reabsorption of HCO3 → decreased
💡
IL PRACTICE HERE 💡
-
HCO3 → metabolic acidosis
③ Diuretic Phase
- 4-5 L/day
Increased GFR → increased removal:
○ Waste products → Decreased BUN and
R
creatinine (ABN)
https://survivenursing.com/abg/ ○ Water → Decreased H20 → increased urine
→ polyuria and FVD
○ Electrolytes → Decreased electrolytes →
RENAL DISORDERS decreased Na and K
AR
● Heart failure
● Burns STAGES ESTIMATED GFR (mL/min)
🟨
Early CKD
🟩
If one of the kidneys is not functional, the other Hyperphosphatemia
🟩
kidney will compensate → increased GFR → Diet: low P (protein)
Polyuria Medication: Al OH
🟨 🟩
Oliguric Hypocalcemia
🟩
Decreased GFR Diet: high Ca
○ Increased BUN and creatinine Supplement: Vitamin D
○ Oliguria and FVE
🟨 🟩
○ Increased K, Na, and Mg Metabolic Acidosis
LO
Decreased calcitriol Medication: sodium bicarbonate
○ Decreased Ca = increased P → bone
🟨 🟩
disorders Anemia
🟨 🟩
Metabolic acidosis Laboratory: low Hct and Hgb
🟩
Low erythropoietin → decreased stimulation of bone Medication: epoetin alfa
🟩
marrow → decreased RBC → anemia; decreased Supplement: iron and folic acid
O2 and nutrients delivery → both leads to weakness Procedure: blood transfusion if the level of Hgb is 7
and fatigue ○ Hgb 7 will go to heaven
🟩
MANAGEMENT Uremia and Azotemia
FVE
IL
🟩
🟩
🟩
🟩
🟩
🟩
Body weight: monitor daily
I & O: monitor every shift
V/S: monitor every 4 hours
Lung sounds: crackles
Fluid intake: limit or restrict to 800-1L/day
🟩
🟩
🟩
Monitor: BUN and creatinine; LOC
Avoid sedatives
Diet: low protein, high carbs
Activity: bed rest
TREATMENT
R
🟩
Diet: low Na
Medications: diuretics
HEMODIALYSIS
- Functions:
🟩
FVD
○ Removal of excess fluid and wats products
🟩
Body weight: monitor daily
○ Correction of electrolyte and acid-base
AR
🟩
I & O: monitor every shift
balance.
🟩
V/S: monitor every 4 hours
- Dialyzer –– an artificial kidney that has a filter and is
🟩
Lung sounds: crackles
semi permeable (cellophane).
🟩
Skin: dry and poor turgor
Fluid intake: increase ○ Warms the blood
- Dialysate –– nonsterile
○ Content: water, electrolytes, bicarbonate
🟩
Hyperkalemia
(depends on what the clients need)
🟩
V/S: monitor HR
🟩
Diet: low K
🟩
Medication MANAGEMENT
○ Diuretics (loop) Body temperature:
C
🟩
○ Salbutamol b. Fever → Infection → REPORT
🟩
○ Calcium gluconate Laboratory: BUN, creatinine, CBC
○ Sodium polystyrene sulfonate (Kayexalate) Body weight:
for Na and K exchange in GIT a. Before: FVE
🟩
b. During and after: FVD
🟩
Monitor signs of bleeding
🟩
Hypermagnesemia
🟩
Meals are ALLOWED during dialysis
🟩
V/S: monitor HR and BP
Withhold water soluble supplements ––
🟩
Monitor neuromuscular
🟩
antihypertensive medications
🟩
Diet: low Mg (fiber)
Medications: Complications: STOP, SLOW, REPORT!
○ Calcium gluconate
○ Avoid magnesium based meds
REFRESHER: RENAL FABS
LECTURER: PROFESSOR KEITH KAINNE D. GARINO
🟩
○ Infection disappear after few exchanges
○ Bleeding Drainage appearance:
○ Clotting ○ Pink/clear/yellow – normal
○ Skin erosion ○ Cloudy – peritonitis
○ Red – bleeding
LO
② Internal ○ Brown – perforated bowel
🟩
- Gold standard; very fragile ○ Urine/amber – perforated bladder
- Takes several weeks to mature Position: semi-fowler to relieve pressure in the
🟩
- Patients are encouraged to perform arm exercises diaphragm.
through the use of a stress ball. If the drainage stops, there is an obstruction:
- Long term use ○ Check patency
🟩
- AV fistula –– most common ○ Turn side to side → increases drainage
- AV graft Post monitoring:
- WOF: ○ Check glucose in the urine and blood.
○ Arterial steal syndrome
🟩
obstruction → REPORT Avoid prolonged contact to ill person
🟩
Avoid pressure and puncture ○ Sitting
Cannula clamp for external AV shunt to prevent risk ○ Contact sports
🟩
for bleeding ○ Infection
Occlusive dressing for external access
PERITONEAL DIALYSIS
- Semipermeable membrane → peritoneum
- Dialysate
○ Content: water and sugar (hypertonic)
C
○ Sterile
- Insertion site: below the umbilicus (avascular––
pinkish)
- Dwell time: 30 minutes
- Complications:
○ Peritonitis –– board-like rigid abdomen;
blumberg (rebound) tenderness
○ Hyperglycemia –– due to over dwell time;
reverse absorption happens.
○ Hypertriglyceridemia
🟩
MANAGEMENT
Pre-insertion instruction:
○ Empty bladder and bowel
REFRESHER: RENAL FABS
LECTURER: PROFESSOR KEITH KAINNE D. GARINO
ANAPHY
TFN
HA
FNP
HE ❓ RANDOM QUESTION ❓
MCN
NUTRI
CHN
PHARMA
BIOETHICS
NI
LO
MEDSURG
GERON
NURSING RESEARCH
PSYCH
NLM
DWET
DISASTER NURSING
INP
ACPS
SPAT
IL
①②③④⑤⑥⑦⑧⑨⑩ ❶❷❸❹❺❻❼❽❾ →←↑↓ ≤ ≥
💡
✅
🟩
Remember / Important notes
Purpose
R
🔏
Nursing action | Intervention
🖋
Must to know
🚨
Nice to know
🟨
Emergency
🟥
Signs and symptoms
AR
📝
Contraindication
🌟
Diagnosis
💊
Rationale
Medications
❗ ❗
C