11. Nursing Actions for Kidney Failure

what areas are assessed in CKD and AKI?

• fluid status

• nutritional status

• patient knowledge

• activity tolerance

• self-esteem

• potential complications

what kind of dietitian might a CKD/AKI patient need?

a renal dietitian

what major complications should be monitored in CKD & AKI?

• hyperkalemia

• pericarditis

• HTN

• anemia

• pericardial effusion

• pericardial tamponade

• bone disease and metastatic calcifications

what signs can point to worsening kidney injury or kidney failure?

• HTN

• crackles

• shortness of breath

• cardiomegaly

• EKG changes

• fluid overload

• tight clothes

• skin changes

how to assess fluid status

• signs of fluid volume excess

• accurate I&O

• daily weights

how should a patient with fluid retention have fluids?

no more than 1000mL of fluids (no milk)

• spread out through the day

• use little cups

• use frequent oral hygiene to help with thirst

what kind of protein should a patient with kidney disease have?

high-biologic-value protein

• eggs, meat, fish

why are antihypertensive medications often held before dialysis?

because dialysis can lower BP, so giving antihypertensives right before dialysis can cause hypotension

why are water-soluble medications often not given right before dialysis?

because dialysis can remove them from the blood before they have time to work