Nursing Aspects in Caring of Patients with Kidney Disease

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1 Nursing Aspects in Caring of Patients with Kidney Disease Noyemi Kasbarian, MSN, RN Medical Surgical Clinical Educator American University of Beirut Medical Center

2 OBJECTIVES Understand the pathophysiology in acute and chronic kidney disease Identify signs and symptoms of acute and chronic kidney disease Describe nursing implications of acute and chronic kidney disease

3 Overview of the Functions of the Kidney Regulation of Extracellular Fluid Volume Regulation of Water and Electrolyte Balance Excretion of Metabolic Waste and Foreign Substances Regulation of Plasma Osmolality Regulation of Red Blood Cell Production Regulation of Vascular Resistance Regulation of Acid-base Balance Regulation of Vitamin D Production Gluconeogenesis

4

5 Acute Kidney Injury Pre Renal Failure: Decreased Renal Blood Flow Examples: Dehydration, hemorrhage, sepsis, renal artery stenosis Intra Renal (Intrinsic) Failure: Direct Damage to the kidneys Examples: Nephrotoxins, endothelial injury from ischemia, glomerulonephritis Post Renal Failure: Obstruction in the Urinary Tract Examples: Renal Calculi, Tumor

6 The Characteristics of Acute Kidney Injury do NOT include: Rapidly increasing Scr Hypocalcemia Short Duration Has different stages

7 Acute Kidney Injury Classification

8 Fluid Management Metabolic Acidosis Management Electrolyte Management Immune System Management Nutritional Management Patient Education Nursing Care in AKI: Important Role in preventing and identifying early signs of AKI Risk Factors for AKI and for AKI progression Signs and Symptoms of AKI Strict Accurate Intake/Output, daily weights and calorie counts Monitor routine lab and imaging studies Recognize and alert for any decline in UO, urinary symptoms, hypotension or changes in SCr

9 Chronic Kidney Disease

10 The common sign or symptom first seen with Chronic Kidney Disease is: Anemia Nocturia Uremia Hyperkalemia

11 From: Part 13. Disorders of the Kidney and Urinary Tract Harrison's Principles of Internal Medicine, 18e, 2012 Left: Schema of the normal glomerular architecture. Right: Secondary glomerular changes associated with a reduction in nephron number, including enlargement of capillary lumens and focal adhesions, which are thought to occur consequent to compensatory hyperfiltration and hypertrophy in the remaining nephrons. (Modified from JR Ingelfinger: N Engl J Med 348:99, 2003.) Copyright 2015 McGraw-Hill Education. All rights reserved.

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14 With patients who have CKD, levels must be monitored closely for cardiac health Omega 3 fatty acid Blood Hematocrit Serum Potassium Iron levels

15 The most accurate measure of kidney function is the: Serum electrolyte level Glomerular filtration rate Blood urea nitrogen Amount of protein in the urine

16 Nursing Management in CKD: Cardiovascular NURSING ASSESSMENT: -- Peripheral Edema and Weight loss/gain -- Circulatory Overload evidenced by CHF pulmonary edema -- Cardiac Dysrhythmias -- Blood Pressure Electrolyte Levels Expected Outcomes: -- Maintain cardiac output as evidenced by BP and heart rate within patient s normal range; peripheral pulses strong and equal with prompt capillary refill time. -- Electrolyte Balance -- Patient Compliance in prescribed medications and diet

17 Nursing Management in CKD: Respiratory NURSING ASSESSMENT: -- Increased Resp Rate due to fluid overload, compensatory for metabolic acidosis, or decreased PaO2 -- Assess breath sounds and pattern -- ABG results Expected Outcomes: Normal Breathing Pattern Acid-Base Balance

18 Nursing Management in CKD: Gastrointestinal NURSING ASSESSMENT: Inspection of oral mucous membranes Monitor Weight and symptoms of nausea/vomiting Check for Stool Occult Blood & coagulation studies Breath odor (from breaking down urea & ammonia) Expected Outcomes: Maintaining normal weight Compliance with the prescribed diet No signs of malnutrition/ GI bleeding No Hyperkalemia Controlled Blood Glucose

19 Nursing Management in CKD: Neurological NURSING ASSESSMENT: Mental Status (signs of uremic encephalopathy) Motor and Sensory Function (atrophy and demeylination of nerves from uremic toxins & electrolyte imbalances Expected Outcomes: Regain/maintain optimal level of mental status & motor/ sensory function. Identify ways to compensate for cognitive impairment/memory deficits

20 Nursing Management in CKD: Integumentary NURSING ASSESSMENT: Pruritis (from excretion of waste products & phosphate through the skin) Dry Skin (decreased activity from sweat/oil glands) Yellow-brown/gray skin color due to urinary pigment Bruises Edema Expected Outcomes: Intact Skin Integrity Demonstrate behaviors/techniques to prevent skin breakdown/injury

21 Nursing Management in CKD: Musculoskeletal NURSING ASSESSMENT: Monitor Calcium/Phosphorus/Vitamin D/PTH levels Signs/Symptoms of Hypocalcemia (ex paresthesia, muscle cramps) Pain/stiffness in joints Muscle Weakness Expected Outcomes: Compliance with the prescribed diet (restricted phosphate) Normal Lab values Follow weight bearing exercises and fall precaution

22 Nursing Management in CKD: Hematological NURSING ASSESSMENT: Monitor Lab values of Hemoglobin/Hematocrit/Iron Monitor signs and symptoms of anemia Expected Outcomes: Compliance with the Medications (Erythropoietin preparations) Maintain normal Lab values

23 Nursing Management in CKD: Immunological NURSING ASSESSMENT: Signs and symptoms of impaired inflammatory and infectious responses (as a result of elevated uremic toxins) Expected Outcomes: Prevention of Infection

24 Renal Diet Patient Education Healthy Lifestyle: Physical Exercise, quitting smoking Compliance in prescribed medications, diet, monitoring of lab tests/blood Glucose/Blood Pressure and renal replacement therapy Psychological aspects of coping with a chronic illness Treatment modalities (hemodialysis, peritoneal dialysis, transplantation)

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26 References Murphy, F. and Byrne G. (2009). Chronic Kidney Disease Stages 4-5: Patient Management. British Journal of Cardiac Nursing, 4(2), Broscious S. and Castagnola J. (2006). Chronic Kidney Disease: Acute Manifestations and Role of Critical Care Nurses. Critical Care Nurse, 26(4), Murphy F. & Byre G. (2010). The Role of the Nurse in the Management of Acute Kidney Injury. British Journal of Nursing, 19(3), Guthrie-Chu, C. (2012). Acute Renal Failure. Retrieved from

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