Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Fluids and Electrolytes (Renal) Alteration IV
Renal Diseases
RENAL FAILURE A. Definition: - A state of total / nearly total loss of the kidneys ability to excrete waste products and maintain fluid and electrolyte balance B. Causes: Pre-Renal A condition that occurs BEFORE the kidney Any situation/condition that would bring about a HYPOPERFUSION of the kidney (Hypoperfusion Any condition that brings blood flow/supply to the kidney) Examples: Pressure in the arteries 1. Bleeding 2. Hemorrhage / Stroke 3. Cardiac Output Intra-Renal A condition in which occurs WITHIN the kidney :-o Brought about by: 1. Infection of the kidney - Glomerulonephritis - Pyelonephritis 2. Malignancy - Cancer of the Kidney Post-Renal A condition in which it occurs AFTER the kidney Brought about by: = Any obstructive disease - Presence of STONE FORMATION - Stagnant urine C. Assessment of Signs and Symptoms 1. Fluid Imbalance Impairment of the normal functioning of the kidney Isotonic Excess Hypervolemia Cues: a. Urine Output Oliguria (UO: >50 mL/day but <400 mL/day) For 1 2 years Anuria (UO: < 50 mL/day) b. Edema Formation Periorbital Edema Observed during waking up at the morning Peripheral Edema Lower extremities 1 st has the edema Then eventually the stomach gets affected (Ascites) Topics Discussed Here Are: 1. Renal Failure 2. Dialysis a. Peritoneal Dialysis b. Hemodialysis LOOKY HERE
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jcmendiola_Achievers2013 c. Body Weight 1 kg = 1 L retained by the body Abdominal circumference! 2. Electrolyte Imbalance a. Hyperkalemia ( K+ [Cannot be excreted!]) b. Hyponatremia ( Na+ in relation to H 2 O) c. Kidney maintains the acid-based balance = In the last step in urine formation (Excretion / Secretion)
= The kidney is responsible for EXCRETION of metabolites - Urea, Creatinine, Uric Acid (Used to assess kidney functioning) - If in the event, the kidney cannot excrete Urea :o
3. 4. Abnormal Vital Signs O Normally TPR is NORMAL DOI! XD O There is an abnormal TEMPERATURE if infection is present O BLOOD PRESSURE is 5. Skin Changes a. Uremic Frost + Accumulation of URIC ACID on the SKIN + How to ASSESS UREMIC FROST XD - USE A MAGNIFIER (LOL) Experience ni MAM - It is really hard to see the flakes + Disadvantages: - HIGHLY IRRITATING TO THE NERVES - The patient complains of SEVERE ITCHINESS b. Ashen Gray Color + Usually occurs on the latter part of the disease process + For the laymans term it is color talong of the skin + The color depends on the melanin pigmentation of the person + The ASHEN GRAY COLOR is brought about by the CHRONICALLY LOW HEMOGLOBIN CONTENT!!!
Secretion HCO 3
(Impaired) HCO 3 Acidosis Excretion H 2
(Impaired) H 2 Acidosis Normal Renal Tubules PATIENTS WITH RENAL FAILURE ARE AT RISK FOR METABOLIC ACIDOSIS!!
jcmendiola_Achievers2013 Pathophysiology of Ashen Gray Color for Renal Failure
D. Plan of Care 1. Conservative Management a. Diet: Low Na Diet (2g Na Diet) Low K Diet Protein Content RESTRICT fluid intake b. Intake and Output For an unconscious client, use a DIAPER c. Weight and Abdominal Circumference Weigh in the MORNING, BEFORE BREAKFAST and AFTER VOIDING Use the same weighing scale Control the type of clothing Get the abdominal circumference - Get the abdominal circumference upon WAKING UP in the morning, AFTER voiding, and BEFORE breakfast - Put the tape measure at the HIGHEST POINT of the abdomen - Put a mark on the AREA! Strict REVERSED ISOLATION technique! - Isolate the clean case! (Use a mask, and people should be free from URTI) - To prevent infection 2. Dialysis a. Definition: ^ Process of SEPARATING CRYSTALLOIDS and COLLOIDS in a solution through a DIFFERENCE in the rate of DIFFUSION! b. Purpose: 1. To treat the signs and symptoms of RENAL FAILURE 2. To prepare the client for a MORE definite management (Renal Transplantation) 3. To take the place of the kidneys temporarily! c. Types: 1. Peritoneal Dialysis a. Intermittent (On and Off) Very seldom used Done at the HOSPITAL Catheter is inserted on the client, between the umbilicus and the symphysis pubis 2 3 finger breadths away Introduction to the peritoneum
jcmendiola_Achievers2013 Only a portion of the catheter is exposed on the abdomen (About 1 inch) Peritoneum = Space between the large intestine and skin Attaches a Y-Tube which is connected to the dialysate Then has a drainage tube which is connected to a drainage bag
3 Steps in Peritoneal and Hemodialysis 1. Introduction of Dialysate + Open the regulator for the infusion tube, but make sure that the regulator is OFF + Occurs for about 10 15 minutes + Close the regulator + Fluid is inside the peritoneum 2. Retain the Fluid / Dialysate + Dialysate is in the peritoneum for about 20 30 minutes + Dwell Time The amount of time the dialysate remains in the peritoneum Also known as: Retention Time, Equilibrium Time and Perfusion Time + This is done so that we will allow diffusion to take place + Then regulator is opened up 3. Drain the Dialysate + Drain then change the dialysate
The WHOLE PROCESS is called ONE EXCHANGE One type of intermittent dialysis will account for 30 32 or 35 exchanges o Duration is about 2 3 days XD Drawback: o Done in the HOSPITAL o Patient may acquire Nosocomial infection! o IT IS VERY EXPENSIVE
b. Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient wears a mask Patient performs it himself / herself Steps are almost the same, differs only on DWELL TIME
3 Steps in Peritoneal and Hemodialysis 1. Introduction of Dialysate + Hang the dialysate on an IV stand + Open the regulator + Close it then fold the tube neatly 2. Retain the Fluid / Dialysate + Dialysate is in the peritoneum for about 4 5 or 6 hours + Dwell Time is 5 6 hours (ANG GULO XD) 3. Drain the Dialysate + Drain the fluid in the comfort room and then change the dialysate~
2. Hemodialysis Blood of the client is propelled out which will pass out to a dialysis machine This is done to remove bad ELEMENTS and return the blood
jcmendiola_Achievers2013
PICTURE A PICTURE B (Not the actual pic na meron si mam)
Mga Sinabi ni Mam sa Pic na to (PICTURE A) Vascular Access This is in between the client and the machine Catheter (Has to wait 2 3 weeks before the patient can be attached) o AV Shunt / Canula Arteriovenous Shunt Makes an artificial connection between the artery and the vein Uses the RADIAL ARTERY Uses the median cephalic vein Done on the arm not commonly used MINOR type of surgery o AV Graft Catheter
Hooking Up Process o Process of connecting the client! Hook Up Attach Hook Down Detach The NURSE puts the machine ON THE CLIENT The TECHNICIAN SETS UP the machine
MGA IBA PANG SINABI NI MAM (PICTURE B) - Arterial shunt FIRST is connected o There is a BLOOD PRESSURE DETECTOR on the machine - Blood passes through a BLOOD PUMP (Spinning) o To assist the clients heart on the pumping - The machine is made up of membranes / cellophane-like (semi permeable) membrane o Cleanses the blood o Blood comes out to the venous blood line o Before returning, the blood passes a device that removes clotted blood o Then the blood is returned to the venous shunt o This process has a duration of 2 4 hours and is done 3 times in a week
Nursing Responsibilities: - Get a baseline vital sign - Get the ABGs of the client - Get the Creatinine and urea results - Check the CBC and blood sugar levels and the hemoglobin level