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The Kidney's Role in Homeostasis , Assess LOC and note progressive…
The Kidney's Role in Homeostasis
Regulates H2O balance
COMPROMISED REGULATORY MECHANISM LEADS TO: EXCESS FLUID VOLUME
Signs & Symptoms:
Nursing Dx: Edema and SOB related to fluid volume overload
Intervention:
Desired outcome:
Regulate concentration and volume of body fluids through RAAS
Hypothalamus of brain directs pituitary gland of endocrine system
Dehydration, sodium deficiency or decreases blood volume. This signals the kidneys to release renin, which releases Angiotensin I. Angiotensin I with ACE makes angiotensin II & this signals the adrenal cortex to release aldosterone and the posterior pituitary to release ADH.
Electrolyte Balance
The kidneys help maintain electrolyte concentrations by filtering electrolytes and water from blood , returning some to the blood, and excreting any excess into the urine. Thus, the kidneys help maintain a balance between daily consumption and excretion of electrolytes and water.
LOSE OF THIS FUNCTION LEADS TO: ELECTROLYTE IMBALANCE
Phosphate &Calcium:
Causes weakened bones eventually
Hyperphosphatemia
symptoms:
Diagnosis:
Interventions:
Hypocalcemia:
Signs and symptoms:
Nursing Dx:
Nursing Interventions:
Potassium:
Nursing Dx:
Signs and Symptoms:
Decreased cardiac output
Interventions:
Regulate Bone Marrow Production
COMPROMISED REGULATORY MECHANISMS LEADS TO: ANEMIA
Signs and symptoms: Weakness, fatigue, headaches, problems with concentration, paleness, SOB, chest pain, dizziness.
Heart problems: irregular heartbeat, tachycardia.
Nursing Dx: Fatigue related to decreased Hgb and diminished oxygen-carrying capacity of the blood.
Desired Outcome: Client will verbalize reduction of fatigue, as evidenced by reports of increased energy and ability to perform desired activities.
Intervention:.
Nursing Dx: At risk for a decrease in blood volume that may compromise health.
Desired outcome: Client will have a reduced risk for bleeding, as evidenced by normal or adequate platelet levels and absence of bruises and petechiae.
Intervention:
Regulate Blood PH
Lose of this function which lead to: METABOLIC ACIDOSIS
An excess of Acid(H+) & defect of base (HCO3) resulting from acid overproduction, loss of intestinal bicarbonate, inadequate conservation of bicarbonate, execration of acid.
Nursing Dx:
Dyspnea on exertion related to increased of PCO2, manifested with Kussmaul's respiration and hyperventilation.
Interventions:
Desired Outcome: Display serum bicarbonate WNL and be free of symptoms of imbalance, i.e. absence of neurological impairment/irritability, regular respiration rate.
Regulate Blood Pressure
Regulated through RAAS
LOSS OF BLOOD PRESSURE CONTROL MAY LEAD TO: RENAL HYPERTENTION
.
Treatment:
ACE inhibitors and ARBs lower intraglomerular pressure by decreasing efferent arteriolar pressure.
Symptoms:
Nursing Dx:
Intervention:
Desired outcome:
Assess LOC and note progressive change in neuromusculare
Rational::Decreased mental status, weakness,confusion, seizures , flaccid paralysis can occur due to hypoxia and decrease PH of CNS fluid.
Test and monitor PH
Rational: Kidneys attempt to compensate for acidosis by excreting excess Hydrogen in the form of weak acids and ammonia. The maximum urine acidity is PH of 4.0.
Provide oral hygiene with Sodium bicarbonate, lemon, glycerin swab.
Rational: Providing protective lubrication and neutralizes mouth acids.
Notice for any respiratory excursion, rate and depth.
Rational: Deep, rapid respirations may be noted as a compensator mechanism to eliminate excess acid.
Instruct the client about medications that may stimulate RBC production in the bone marrow
Recombinant human erythropoietin, a hematological growth factor, increases hemoglobin and decreases the need for RBC transfusions
Provide supplemental oxygen therapy, as needed
SaO2 should be kept at < 90%
Client will verbalize reduction of fatigue, as evidenced by reports of increased energy and ability to perform desired activities.
Fatigue can limit the client's ability to participate in self-car and perform his or her role responsibilities in family and society, such as working outside the home.
Assist the client in planning and prioritizing ADL.
This will allow the client to maximize his/her time for accomplishing important activities.
Instruct client about bleeding precautions.
Once the client's platelet count drops to 50,000mm3, bleeding precaution should be instituted immediately to avoid risk of spontaneous bleeding.
Instruct client in dietary modification to reduce constipation.
Eating a diet in fiber and drinking a lot of fluids to avoid constipation or using a stool softener and other laxatives as prescribed if having difficulty passing stool.
Monitor stool (guaiac) an urine for occult blood.
These test help identify the site of bleeding
Assess for any frank bleeding from the nose, gums, vagina, or urinary or GI tract.
Early assessment facilitates immediate treatment. These sites are most common for spontaneous bleeding
Monitor and record intake and output
Decrease in output may indicate acute failure, especially in high-risk patients. Accurate monitoring of I&O is necessary for determining renal function and fluid replacement needs and reducing risk of fluid overload.
Assess skin, face and lower extremity for edema. Evaluate degree of edema
Edema occurs primarly in dependent tissues of the body. (hands, feet, lumbosacral area). Patient can gain up to 10lb (4.5kg) of fluid before pitting edema is detected.
Auscultate lung and heart sounds.
Fluid overload may lead to pulmonary edema and HF evidenced by development of adventitious breath sounds, extra heart sounds.
Weight daily with same type of clothing
Daily body weight is best monitor of fluid status. A weight gain of more than 0.5kg/day suggests fluid retention.
Assess skin color, mucous membranes and nail beds
Pallor may reflect vasoconstriction/anemia
Monitor BP AND JVD/CVP.
Tachycardia and hypertension can occur because of kidney failure to excrete urine.
Auscultate heart sounds
Development of S3/Ss4 is indicative of failure. Pericardial friction rub may be manifestation of uremic pericarditis, requiring prompt intervention.
*It plays important role of eliminate about 70% of uric acid
*Control serum bicarbonate concentration through execration or reabsorption of filtered serum bicarbonate, the secretion of metabolic acid and synthesis of new serum bicarbonate
Kidney control red cell mass and amount of oxygen blood can carry. Also amount of oxygen in blood which is perfusing. Epo stimulates erythropoiesis (formation of erythrocytes in red bone marrow).
When the oxygen levels decrease, kidneys release erythropoietin which stimulate the process of erythropoiesis. RBCs are formed in the bone marrow and when formed, it released into system circulation increased RBC in blood leads to increase O2 carrying capacity of the blood. Therefore, the increased levels of O2 in blood perfusing to kidney increase O2 in renal blood kidneys respond by secreting less EPO.
When kidneys damaged/decreased function: They do not make enough Epo as a result the bone marrow makes less RBC causing anemia. When less RBC it deprives the body of the oxygen needs.
Rationale:
Rationale:
First signs of impaired phosphate and calcium homeostasis arise early in renal impairment.
Phosphate retention and impaired activation of vitamin D results in reduced absorption of calcium from food in small intestine
Hypocalcemia stimulates increased release of PTH. In an attempt to normalize plasma calcium levels, calcium and phosphate from the bone is released
does not usually have apparent symptoms
If levels of phosphate in the blood become high, it may cause mineral and bone disorders and calcification
Imbalanced nutrition
Changes to diet and medication to treat hyperphosphtemia. Diet includes avoiding foods such as peas, milk, and peanut butter and processed foods which contain phosphorus as a preservative.
Phosphate binder to control amount of phosphorus the body absorbs from the food
Dialysis
Hyperkalemia:
Renal dysfunction leads to K+ retention and hyperkalemia
Decreased renal excretion of K+ due to defect of collecting tubule, decreased delivery of Na++, and direct injuries of cells that are responsible for K+ secretion.
Irritability, paresthesia of lips and extremities, muscle spasm and cramping, tetany, seizures due to irritation of nervous system tissue, cardiac arrhythmias, prolonged QT interval, Chvostek's sign
At risk for injury
Imbalanced nutrition: less that what body requires
Maintain Iv access
High calcium diet to replenish lost calcium
Administer vitamin D, helps with absorption of calcium
Monitor VS, intake & output
Monitor neurologic status for change, irritability, and disorientation
Monitor cardiovascular status
Risk for imbalanced fluid volume
abdominal distension
Weakness & dizziness due to neuromuscular changes
Administer IV insulin and glucose to move potassium from extracellular fluid to intracellular fluid
Monitor cardiac rhythm and cardiovascular status for regularity of rhythm, rate, heart sounds, and peripheral pulses
Avoid food high in potassium & salt substitutes since most are potassium-based.
Educate patient about med and diet.
Administer diuretics to remove potassium from body
In the kidneys, more sodium and water return to blood and more potassium is eliminated in the urine. This increases blood volume and therefore increases GFR.
The skin if often swollen, puffy, moist and shiny. Edema. The abdomen may look distended. The person can have a bounding pulse, feel heaviness in the body, or complain of difficulty breathing, heart palpitations, fatigue and confusion.
Display appropriate urinary output with specific gravity/laboratory studies near normal; stable weight, vital signs within patient's baseline; and absence of edema
Rationale:
When blood volume or sodium levels in the body are low, or blood potassium is high, cells in the kidney release the enzyme, renin.
With a decrease in blood pressure, the nephron increases sodium and water reabsorption, to increase ECFV and thereby increase blood pressure.
Headache, confusion, hematuria.
Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed
When the kidneys receive low blood flow, they act as if the low flow is due to dehydration. so they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up.
ACE inhibitors
ARBS
At risk for inadequate blood pumped by the heart (decreased cardiac output) to meet metabolic demands of the body.
Maintain cardiac output as evidenced by BP and HR/rhythm within patient's baseline.
Rationale:
Excess fluid resuscitation during efforts to treat hypovolemia and/or hypotension or covert oliguric phase and renal failure.
Changes in the renin-angiotensin system.