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Renal - Coggle Diagram

- - - - • Health promotion -
        • Monitoring of intake and output of fluids -
        • Monitor kidney function of individuals who are taking potentially nephrotoxic medications (antibiotics, opioids, NSAIDS, heavy metals)
        • Holistic approach to physical and emotional needs due to concurrent comorbidities
        • Standard precautions against infection, alert to signs of inflammation (local and systemic). May have blunted febrile response due to an infection like pneumonia. Why? Caution the use of antibiotics as it is nephrotoxic.
        • Skin care to prevent PU due to development of oedema and decreased muscle tone
        • Mouth care - develop stomatitis due to accumulation of ammonia in saliva
        -contrast media and metformin and contraindicated together, as it may cause lactic acidosis
    - - • diuretic therapy e.g. loop (frusemide) osmotic (mannitol).
        • Anti-hyperklaemia - insulin and sodium bicarbonate temporarily shifts K+ back into cells. Calcium gluconate raises threshold at which arrhythmias occur. Sodium polystyrene sulfonate and dialysis remove K+ from body
        • kidney replacement therapy, intermittent haemodialysis
        • nutritional therapy - additional energy to prevent catabolism 125-150kj/kg and 1.5g protein/kg. Carbohydrate and fats can prevent ketosis from lioplysis and muscle breakdown from gluconeogenesis. Restriction of sodium to prevent oedema, fat intake is increased to 30-40%. Enteral nutrition is preferred route if can’t oral.
- - - - Implemention - health promotion (dietary and fluid restrictions, alternative ways of reducing thirst like sucking on ice cubes)
    - - Medication therapy -
        • sodium polystyrene sultanate treat hyperkalaemia
        • ACE inhibitors to lower hypertension (ARB)
        • EPO therapy and iron to treat anemia
        • Statins to treat dyslipidaemia
        -avoid NSAIDS
        Nutritional therapy
        • Avoid high protein intake to avoid overburdening kidneys
        • Fluid restriction as GFR decreases
        • Restrict sodium intake to avoid fluid retention. Restrict phosphate
        -DASH diet - dietary approaches to stop HTN=veges, low salt, moderate meat and grains
        
        -psychological support
- - - - PD=peritoneal membrane acts as the semipermeable membrane. Potential problems: peritonitis, hyperglycaemia, exit site and tunnel infections, completion of education program
    - - HD=artificial membrane is used. Potential problems: heparinisation necessary, dietary and fluid restrictions, hypotension during dialysis, added blood loss contributing to anaemia, education program to train self-care
    - - -done over 24 hours and much slower rate than haemodialysis
    - - -high success rate, provides hope