Nursing 212

Health Differences Across the Lifespan 2 Study Guide Signs and symptoms include oliguria (urine output less than 400 ml/day for 1-2 weeks, which may be followed by diuresis of 3-5 L/day for 2-3 weeks), tingling extremities, epistaxis, irritability, restlessness, lethargy, pallor, stomatitis, muscle weakness, nausea, vomiting, diarrhea, anemia, confusion, agitation, disorientation and seizures. Diagnostics: hyperphosphatemia; hyperkalemia; hypocalcemia; metabolic acidosis; elevated BUN and creatinine; proteinuria; positive renal biopsy findings; azotemia (retention of excess nitrogenous waste in blood); urine analysis shows specific gravity equal to specific gravity of plasma; presence of casts, RBC, WBC, and renal tubular cells Interventions: provide fluid and electrolyte management; supportive therapy with dialysis; monitor I&O; observe for oliguria followed by polyuria (excess urine output from diuresis); check weight daily and observe for edema; once diuresis phase begins, evaluate slow return of BUN, creatinine, phosphorous, and potassium to normal; have patient follow a diet low in protein with increased carbohydrates and moderate fat and calorie intake; restrict potassium and sodium Medications: avoid nephrotoxic drugs; use volume expanders as prescribed to restore renal perfusion in hypotensive clients and dopamine (intropin) IV to increase renal blood flow; use loop diuretics to reduce toxic concentrations in nephrons and establish urine flow; use ACE inhibitors to control hypertension; use antacids and histamine H2 receptor antagonists to prevent gastric ulcers; use sodium polystyrene sulfate (Kayexalate) to reduce serum potassium levels and sodium bicarbonate to treat acidosis Teaching: informpatient of dietary and fluid restrictions after discharge; teach signs of complications, such as fluid volume excess, CHD, and hyperkalemia; recovery of renal function requires up to one year and during this period, nephrons are vulnerable to damage fromnephrotoxins Chronic Renal Failure Chronic renal failure is a slow, progressive loss of kidney function and glomerular filtration; it ends fatally with uremia (excess urea and other nitrogenous waste products in blood). The most common cause is diabetes mellitus, hypertension, glomerulonephritis, and polycystic kidney disease. Progressive loss of renal function occurs in four stages; the fourth stage ends with ESRD (Uremia). As 90% or more of nephrons are destroyed, BUN and creatinine clearance rise and urine specific gravity is fixed at 1.10 (normal is up to 1.025). The loss of erythropoietin leads to chronic anemia and subsequent fatigue. There is fluid and electrolyte retention (sodium, potassium, magnesium, phosphate and calcium). Early signs and symptoms include nausea, apathy, weakness, fatigue, and declining urine output. Late signs are frequent vomiting, increasing lethargy, weakness, and confusion. Patients may report restless leg syndrome, paresthesia, and sensory loss. Personality changes, such as anxiety, hallucinations, seizures, and coma are also present. Respirations may change to Kussmaul’s pattern with a deep coma to follow. The skin becomes pale and dry with a yellowish hue; metabolic wastes cause itching and uremic frost (crystallized deposits of urea on skin).

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