Comprehensive Review for the NCLEX-RN® Exam, 9e Notes

Study Notes from Comprehensive Review for the NCLEX-RN® Exam

Hemodialysis Complications

  • Arteriovenous Fistula Complications
    • Hepatitis or infection due to inadequate infection control practices.
    • Post-treatment complications:
    • Blood loss due to needle removal after dialysis.
    • Potential post-dialysis bleeding exacerbated by heparin use.
    • Other complications:
    • Hypotension from rapid vascular volume removal.
    • Muscle cramps due to fluid shifts.

Acute Kidney Injury (AKI) Care

  • Hyperkalemia Management
    • Serum potassium level > 5.0 mEq/L (normal: 3.5–5.0 mEq/L).
    • Priorities:
    • **Cardiac Monitoring **to prevent dysrhythmias and arrest.
    • Notify primary healthcare provider (PHCP).
    • Review medications for potassium content.
  • Disequilibrium Syndrome
    • Symptoms to assess during dialysis:
    • Headaches, confusion, nausea, vomiting, twitching, seizures.

Arterial Steal Syndrome in Hemodialysis

  • Assess for:
    • Pallor, diminished pulse, pain in the hand corresponding to the fistula.
    • Warmth, redness likely indicates infection rather than steal syndrome.

Hydronephrosis and Urolithiasis Management

  • Treatment Approaches
    • Insertion of a percutaneous nephrostomy tube to drain urine.
    • Placement of ureteral stent to facilitate urine flow.
    • Renal stone analysis.
    • IV opioid analgesics for pain management.

Chronic Kidney Disease (CKD) Post-Dialysis Assessment

  • Expected Laboratory Changes:
    • Lower potassium, creatinine, and phosphorus levels expected post-dialysis.
    • Monitor RBC count for potential anemia.

Psychosocial Effects of CKD

  • Possible manifestations include:
    • Agitation, euphoria, depression, and emotional lability due to coping with chronic illness.

Dietary Recommendations for CKD

  • Aluminum Hydroxide Use
    • High risk for constipation; diet modifications needed.
  • Fluid Intake
    • Limit weight gain between dialysis to 2–3 lb to prevent hypotension.

Medication Management in CKD

  • Epoetin Alfa Use
    • Used for anemia treatment; effective if hematocrit increases.
  • Monitoring Side Effects of Medications:
    • Meperidine for pain control; monitor for constipation and respiratory depression.
  • Sulfamethoxazole
    • Report signs of blood disorders (e.g., sore throat, fever).

Risk Factors for Urinary Tract Infections and Urosepsis

  • Conditions increasing urosepsis risk:
    • Diabetes, renal disease, urinary retention, and use of indwelling catheters.

Nursing Priorities During Patient Assessment

  • Rapidly assess and monitor vital signs for signs of infection, dehydration, and metabolic changes.
  • Notify PHCP for abnormal findings quickly (e.g., low BP, high HR).

Patient Education for Clients on Dialysis

  • Importance of maintaining fluid and dietary restrictions.
  • Recognizing signs of complications requiring immediate attention, such as infection or air embolism during dialysis.

Urinary Changes and Considerations

  • Urethritis and Cystitis Symptoms
    • Urethritis: Dysuria with possible discharge.
    • Cystitis: Burning sensation during urination, increased urgency, and frequency.

Troubleshooting Renal Complications

  • Urethal Stricture Assessment
    • Symptoms: diminished urinary stream, straining with voiding, dribbling.
  • Unlocking Cystic Conditions
    • Recognize and manage hydronephrosis-related complications such as pain or changes in urine output.

Emergency Conditions in Renal Disorders

  • Initiate contact with the PHCP in cases of suspected sepsis or significantly altered client conditions.
  • Essential to intervene swiftly to prevent complications.

Laboratory Findings Related to Kidney Dysfunction

  • Common abnormalities in CKD include elevated BUN and creatinine.
  • Monitoring electrolyte levels (especially potassium) critical for patient stability in dialysis.