Adult-Gero Exam 3

Kidney Biopsy - Nursing Care

Removal of sample of tissue for cytological (histological) exam

Sedation and monitoring of patient

Pre-procedure

• review coag studies

• ensure client has been NPO for prescribed period (4-6-12 hrs)

Kidney Biopsy Complications

Hemorrhage

Infection

Cloudy foul-smelling urine

Urine pos for leukocyte esterase and nitrites, sediment, and/or RBCs

Chronic Kidney Disease (CKD)

Gradual onset

90-95% nephron involvement

Permanent

Prognosis: can be fatal without renal replacement therapy, either dialysis or transplantation

Inability of the kidney to filter fluid and waste

Acute Kidney Injury (AKI)

Sudden onset

~50% nephron involvement

duration of 2-4 wks, less than 3 months

goof prognosis for return of kidney function with supportive care

AKI - Recognize Cues

Perfusion

Immunity

Physical Assessment

AKI - Interventions: Take Action

Perfusion

Reduce exposure to nephrotoxic agents

Fluid and electrolyte imbalance

Acid base imbalance

Nutrition

Kidney replacement therapy

CKD Stage 1

GFR > 90 ml/min

Normal kidney function (at risk)

Possible proteinuria or hematuria

Focus on screening for risk factors

CKD Stage 2

Mild

GFR = 60-89 ml/min

Focus on reduction of risk factors

CKD Stage 3

Moderate

GFR = 30-59 ml/min

Nephron damage

Abnormal BUN, creatinine, electrolytes

Implement strategies to slow progression

CKD Stage 4

Severe

GFR = 16-29 ml/min

Abnormal BUN, creatinine, and electrolytes

Manage complications and prepare for eventual renal replacement therapy

Discuss patient preferences and values

CKD Stage 5

End Stage Renal Disease

GFR = < 15 ml/min

Implement renal replacement therapy/kidney transplantation

CKD - Recognize Cues

History

• weight and height; weight gain or loss

• med history, esp kidney or urologic origin

• drug use

• dietary habits

• GI and GU problems

Physical Assessment

• neuro changes

• cardio, resp, hematologic, skeletal, urine, skin symp

Reproductive: CKD Signs and Symptoms

• decreased fertility

• infrequent or absent menses

• decreased libido

• impotence

• sexual dysfunction

Musculoskeletal: CKD Signs and Symptoms

• muscle weakness and cramping

• bone pain

• fractures

• renal osteodystrophy

Integumentary: Severe CKD Signs and Symptoms

• decreased skin tugor

• yellow-gray pallor

• dry skin

• pruritus

• ecchymosis/purpura

• soft-tissue calcifications

• uremic frost (late, premorbid)

Lab findings in CKD

• increased BUN and creatinine

• azotemia = increased urine and creatinine

• early → hyponatremia

• late → hypernatremia

• mid-late → hyperkalemia

• late → metabolic acidosis

• mid-late → hyperphosphatemia and hypocalcemia; hypermagnesemia

Hemodialysis

• common

• used in ESRD

• removes excess fluids and toxins

• restores chemical and electrolyte baalnce

• usually 3x/week

Dialysis induced disequilibrium syndrome

Rapid decrease in fluid volume and BUN

Causes cerebral edema and results in increased intracranial pressure

Symptoms: headache, nausea, vomiting, restlessness, decreased LOC, seizures, coma, death

PD complications: Peritonitis

Caused by connection site contamination

Prevention = sterile technique

Manifestations: cloudy dialysate outflow (effluent), fever, abd pain, general malaise, nausea, vomiting

Infections at insertion site or peritonitis may occur

Uremic Syndrome

Systemic clinical and lab manifestations of severe and/or end-stage kidney disease due to accumulation of nitrogenous waste products in the blood caused by the kidney’s inability to filter out waste products (skin rash and stomatitis)