Nursing Interventions for CKD Patients

This is a part 2 to my first CKD set and focuses on interventions for various symptoms of CKD.

What is Uremic Frost / Uremia

When waste in blood increases, the patient can experience itchy spots where urea crystals begin to deposit due to the skin sweating out the urea.

What is the nurses responsibility with a patient who is experiencing confusion related to high waste levels in the blood?

• Assess neurological status

• Maintain a safe environment for the patient

• Prevent falls

What kind of diet will the client be placed on with CKD?

A low protein diet due to protein breaking down into urea

What is the nurse monitoring in a client with Metabolic Acidosis related to CKD 

• Respiratory status

• Presence of Kussmaul Breathing

• Full respiratory assessments 

How does the nurse manage Anemia in a CKD patient? 

• Iron supplements 

• Folic Acid supplements

• Vitamin B12 to compensate for low energy related to low hemoglobin. 

• Erythropoietin Shots (SubQ) 

• Blood Transfusions 

How does the nurse manage Fluid Overload in a CKD patient? 

• Strict I&O’s Monitor

• Daily Weights

• Status of swelling (abdomen, face, extremities) 

• Lung sounds (presence of crackles) 

• Blood pressure and Respiration status monitoring. 

• Fluid restrictions and low sodium diet

What foods should a CKD patient be avoiding (think potassium)

Potatoes, Avocados, Strawberries, Bananas, Spinach, Oranges

What may a physician order to take potassium out of a patient’s system? 

Kayexalate given oral or rectal 

How can we lower the phosphate levels and in turn raise the calcium levels in a CKD patient?

Phosphate binders

• Calcium Carbonate

• Calcium Acetate (AKA Phoslo)

What is a normal calcium level? 

Any level between 8.6 mg/dL to 10 mg/dL 

What is a normal phosphate level

Any level between 2.7 mg/dL to 4.5 mg/dL 

When is the best time to give a patient a phosphate binder?

Right before meals or immediately after. We want the patient to take it with food so the phosphate in the food can be excreted with the meal waste. 

What is a low phosphate diet?

A diet that restricts foods such as poultry, fish, dairy, nuts, soda and oatmeal. 

How does hypermagnesemia manifest in a CKD patient? 

• Low calcium levels as the relationship is inverse

• Diminished to absent reflexes in the tendons.

• Overall system lethargy / lethargic presentation.

How can we lower or at least avoid worsening the magnesium levels in a patient?

• Avoid magnesium based antacids

• Avoid magnesium based laxatives

• Possible order of IV calcium to raise the levels of Ca and subsequently lower those of Mg.