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Chronic Kidney Disease
Priority Assessments: Health Hx, Current…
Chronic Kidney Disease
Priority Assessments: Health Hx, Current Medications, Dietary Habits, BP, dry weight
Hypertension
r/t failure of kidney to maintain BP homeostasis # #
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Acid-Base Imbalance & Hyperkalemia 2° to Metabolic Acidosis
r/t decreased renal function and decreased GFR
Clinical Manifestations:
- Muscle weakness
- ECG abnormalities (slow, weak irregular HR)
- N&V
- Kussmaul breathing
- drowsiness, confusion
Assessments + Interventions
- Perform ECG, Monitor for dysrhythmia
- ↓ K+ diet
- Monitor LOC + signs of resp. distress
- Administer sodium bicarbonate, insulin, kayexalate
- Monitor K+ level
Body Homeostasis: secretion of aldosterone + release of CO2 by controlling the depth and speed of breathing
Excess Fluid Volume
r/t decreased GFR #
-
Clinical Manifestations:
- JVD
- bounding Pulse
- ↑ BP + HR
- swelling of extremities
- crackles
- SOB
- restlessness
- headache
Assessments & Interventions
- Monitor VS (especially BP)
- Monitor I&O + daily weight
- monitor for periorbital, sacral, peripheral edema
- monitor electrolyte levels
- monitor for signs of HF + pulmonary deem (esp. blood tinged sputum)
- Fluid and Na+ restriction diet
- Administer diuretics & antihypertensive medications as prescribed
- Monitor for pressure ulcers (due to swelling + ↓circulation)
- Chest x-ray
- Smoking Cessation
- weight reduction
- control hyperlipidemia
Activity Intolerance
due to impaired erythropoietin production
(hormone produced in renal cortex to promote erythropoiesis)
-
-
-
due to increased workload of heart #
Assessments & Intereventions
- Monitor HgB & HCT level
- Administer epoietin alfa
- Administer Folic acid + iron as prescribed (stoolsoftenerforconstipationeffectofiron)
- Blood transfusion if prescribed
- Provide adequate rest period
- Educate pt. to plan activities to avoid fatigue
- CNS depressant PRN to promote rest
- Maintain good nutrition (moderately restricted protein diet for non-dialysis patient, caution with pt. with malnutrition)
- Administer supplemental calcium (e.g. calcium based phosphate binder)