->how to deal with the kidney stone/ pain managment
->how to prevent reoccurrence:
-low sodium diet is recommended
-teach the dosing schedule and potential side effects of drugs used to reduce the risk of stone
formation
-some pt will be taught to self monitor their urinary pH, or they may be asked to monitor their urinary
output
-we need to ensure that any spontaneously passed stones are retrieved, so we'll be straining all urine
using a urine strainer
-encourage ambulation to promote movement of the stone from the upper to lower urinary tract so
that is passes - ✔✔What do we want to teach a pt w/ kidney stones?
-Periorbital and dependent edema
-Crackles in bases of lungs
-Hyperkalemia
-Heart failure develops
-Hematuria-varying degrees
-Elevated BUN, Creatinine
-Fatigue - ✔✔Chronic glomerulonephritis:Clinical manifestations and diagnostic findings include:
-pregnancy
-having a foley catheter in place
-any urinary dysfunction like reflux urine or BPH
-renal calculi or stones. - ✔✔Risk factors for Pyelonephritis includes:
-relative
-non-relative
-alshuwistic (anomynous) - ✔✔A live transplant donor can be:
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-the size of the stone
-if the stone is associated with infection or bacteruria
-if its causing impaired renal function, like elevated BUN or creatinine
-if the patient is having persistent pain, N/V
-if medical treatment is not working, and or if the patient only has one kidney - ✔✔A few reasons
surgical intervention may be necessary for kidney stones includes:
-weight to see how much the patient lost
-recheck VS
*Anticipate client fatigue, orthostatic hypotension, possible muscle cramps - ✔✔Hemodialysis Client:
Nursing management after dialysis
"A WET BED"
Acid-base balance
Water removal
Erythropoesis
Toxin removal
Blood pressure control
%
Electrolyte balance
D vit. activation - ✔✔Functions of the Kidneys:
*also know as manual
provides ongoing dialysis every few hours during the day as the patient goes about his or her daily
activities
usually happening about 4 times daily - ✔✔Continuous ambulatory peritoneal dialysis (CAPD)
*CKD diet complex, adherence difficult
*Rules highly different from standard dietary instructions
•Low sodium
•Low potassium
•Low protein
•Fluid restriction
•Low phosphorus
•High-quality protein: lean meat, fish, egg whites - ✔✔CKD/ESRD: Dietary management
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*Patients won't always go through all these symptoms, but tend to have quite a few of them -
✔✔Clinical Manifestations of CKD
*recent sore throat infection
•Cardinal symptom is hematuria
-HTN
•Urine -> dark colored/smoky color due to presence of blood
•Edema, most noticeably around eyes and ankles
•Decreased urinary output due to renal insufficiency
•Fever
•Fatigue
•Hypertension
•Proteinuria
•lethargic
-Abdominal/flank/joint pain - ✔✔Symptoms of glomerulonephritis include:
*we need to assess their fluid volume status, so we need to be checking:
-weight
-BP
-for any peripheral edema
%
-evaluating lung and heart sounds, and their vascular access.
-check for bruit and thrill
-assess their HD site
-check their temp, and VS
-assess for any signs of infection - ✔✔Hemodialysis Client: Nursing management before dialysis
*we start off by treating the symptoms
•Bring down their BP using ACEs/ARBs
•Treat pain using narcotics
•As the disease progresses, it may lead to ESRD. If it does, the pt may need to be on HD or PD
•If the kidney grows too large, the pt may need a nephrectomy, which means the kidney is removed -
✔✔Treatment for PKD:
•Accurate intake and output measurements
•Daily weights: 1 Kg = 1 liter of fluid
•Assessment for signs of hypervolemia or hypovolemia
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