Signs and Symptoms of Uremia
Fatigue, SOB, unexplained weight loss, N/V, muscle cramps. change in mental status,
metallic taste in mouth, pruritus.
Pathophysiology of End Stage Renal Disease (ESRD)
Renal function declines and end products of protein metabolism accumulate in the
blood. Uremia develops and adversely affects every system in the body. Usually
associated with a low GFR. The more waste products in the system the more severe
the symptoms.
Uremic Pericarditis
Inflammation and irritation of the visceral and parietal layers of the pericardium by
metabolic toxins that accumulate due to renal failure.
Uremic Treatment
Diuretics and Hemodialysis and if the patient is already on hemodialysis we need to
intensify it.
Clinical manifestations of fluid overload in ESRD
Pericarditis, pericardial effusions/tamponade, pulmonary infiltrates, JVD, edema, HF,
hypertension, hyperkalemia, metabolic acidosis
BUN normal range
10-20
Creatinine normal range
0.5-1.2
Sodium normal range
135-145
Potassium Normal range
3.5-5
Magnesium normal range
1.5-2.5 (high in ESRD pt)
Normal urine output range
30mL/hr
Dietary restrictions for patients with ESRD
Low protein, low potassium, no potatoes or oranges or citrus fruits, no salt substitute,
fluid restrictions
How much protein is allowed in a patient with ESRD?
1.2-1.5 mg/kg/day
What medications are used to treat ESRD?
Calcium acetate/carbonate, Phosphate-binding agents (Phoslo, Renagel),
Erythropoeitin, Antihypertensive and cardiac medication, Ionotropes, Anticonvulsants
What are important topics for patient education in ESRD?
Dietary education, S/S of hyperkalemia (muscle cramps, urine abnormalities, respiratory
distress, decrease cardiac contractility, EGK changes, decrease reflexes, tingling in
hands and feet, paralysis), worsening S/S of kidney disease (anemia, difficulty
breathing, nocturia, swelling and puffiness of feet and ankles, high BP, changes in
mental status, poor digestion
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