lOMoARcPSD|17808653
Adult Health 3 Exam 1
▪ S/S of uremia
o AFFECTS EVERY SYSTEM HF,d HiN.
risk for edema, aldosterone axis + the
o s/s of fluid overload > increases of renin-angiotensin
-
-
activation
HTN results from aldosterone secretion
.
o confusion concomitant increased
is1)
o weakness
o uremic fetor (urinary)
pg o thin hair and nails
o ulcer formation
o hiccups
o hyperkalemia (EKG CHANGES)
▪ patho of ESRD
o buildup of toxins (uremia)
nonfunctioning glomeruli
o decreased renal function
▪ low GFR (<15), low filtration - > due to
bp
o uncontrolled diabetes is usually the cause - >
high sugar high,
▪ clinical manifestations of fluid overload in ESRD
o pericarditis, pericardial effusion, and tamponade
▪ tx: hemodialysis to remove fluid
o JVD
o Pulmonary infiltrates
o Crackles
▪ ESRD fluid overload complications (pg. 1583) -1570 angi n
a
o Anemia -substance produced by Kidneys ~
results in
fatigue,
▪ Due to decreased erythropoietin production, decreased RBC lifespan, GI
bleeds from toxin/ulcer formation, and blood loss from hemodialysis
o Bone disease & metastatic and vascular calcifications
▪ Due to retention of phosphorus, low serum calcium, abnormal vit D
metabolism and high aluminum levels
o Hyperkalemia -issuereakdown
▪ Due to decreased excretion, metabolic acidosis, catabolism, and excessive
intake (nutrition, fluid, and meds)
o Hypertension of renin-
malfunction are
▪ Sodium and water retention (angiotensin) : help with heart health a aldoster
o Pericarditis, pericardial effusion, and tamponade due to retention
of angiotensin-
uremic waste products.
▪ BUN - Inadequate
dialysis
o 10-20
▪ Cr
o 0.5-1.2
▪ K
o 3.5-5
▪ Mag
o 1.2-2.5 (DON’T NEED TO KNOW VALUE JUST THAT IT IS HIGH IN ESRD
PATIENTS)
▪ Urine output
o 30 mL/hr
, lOMoARcPSD|17808653
dains
pudding,
phosphors Ngunt milk
,
.
a foods
CanProcessedment
low
~
▪ Diet restrictions for ESRD patients (pg. 1584) No Sodium
leafy o Low protein
No no > -
o Low potassium are
veggies > Apples
,
aomatoes ▪ Foods high in potassium include potatoes, oranges, citrus, salt substitutes
avocado
-
the best choice
o Fluid restriction
▪ ESRD medications (pg. 1583) carbonate
o Calcium binders or calcium > treats -
hyperphosphatemiahypocalcemia
▪ Calcium acetate (PhosLo)
o Phosphate binder
> sevelamer carbonate
▪ Renagel -
o Erythropoietin (for anemia)
▪ Epoetin alfa
o Anticonvulsants
▪ Benzodiazepine – diazepam
▪ Hydantoin - phenytoin
o Inotropes
▪ Digoxin – cardiac glycosides
▪ Beta receptor agonist - dobutamine
o Diuretics
▪ ESRD patient education
o Nutrition
o Worsening s/s
▪ Imbalanced nutrition nursing interventions in ESRD patients (care plan pg. 1585)
o Promote high biologic value protein like eggs, dairy, and meat
o High calory, low protein, low sodium, and low potassium diet
o Assess weight changes
o Labs: electrolytes, BUN, creatinine, protein, transferrin, and iron levels
o Assess patients diet history, food preferences, and calorie counts
o Assess for factors that can contribute to altered intake
▪ Anorexia, n/v, depression, diet unpalpable to patient, lack of
understanding of restrictions, and stomatitis
o Provide patients food preferences within the restrictions for phosphate
binders
o Schedule medications so that they are not given right before meals-Except are first bite
which given we
▪ Possible complications after hemodialysis pg 1580 -
of food.
o Bleeding
o Infection
o Hypotension (COMMON BUT NOT NORMAL)
o Complications on pg. 1591
▪ Heart failure, coronary artery disease, stroke, and peripheral vascular
disease
▪ Anemia
▪ Gastric ulcers
▪ Metallic taste in mouth and n/v
▪ Renal osteodystrophy can cause bone pain and fractures
▪ Phosphorus deposits in skin cause itching
▪ Shortness of breath
Adult Health 3 Exam 1
▪ S/S of uremia
o AFFECTS EVERY SYSTEM HF,d HiN.
risk for edema, aldosterone axis + the
o s/s of fluid overload > increases of renin-angiotensin
-
-
activation
HTN results from aldosterone secretion
.
o confusion concomitant increased
is1)
o weakness
o uremic fetor (urinary)
pg o thin hair and nails
o ulcer formation
o hiccups
o hyperkalemia (EKG CHANGES)
▪ patho of ESRD
o buildup of toxins (uremia)
nonfunctioning glomeruli
o decreased renal function
▪ low GFR (<15), low filtration - > due to
bp
o uncontrolled diabetes is usually the cause - >
high sugar high,
▪ clinical manifestations of fluid overload in ESRD
o pericarditis, pericardial effusion, and tamponade
▪ tx: hemodialysis to remove fluid
o JVD
o Pulmonary infiltrates
o Crackles
▪ ESRD fluid overload complications (pg. 1583) -1570 angi n
a
o Anemia -substance produced by Kidneys ~
results in
fatigue,
▪ Due to decreased erythropoietin production, decreased RBC lifespan, GI
bleeds from toxin/ulcer formation, and blood loss from hemodialysis
o Bone disease & metastatic and vascular calcifications
▪ Due to retention of phosphorus, low serum calcium, abnormal vit D
metabolism and high aluminum levels
o Hyperkalemia -issuereakdown
▪ Due to decreased excretion, metabolic acidosis, catabolism, and excessive
intake (nutrition, fluid, and meds)
o Hypertension of renin-
malfunction are
▪ Sodium and water retention (angiotensin) : help with heart health a aldoster
o Pericarditis, pericardial effusion, and tamponade due to retention
of angiotensin-
uremic waste products.
▪ BUN - Inadequate
dialysis
o 10-20
▪ Cr
o 0.5-1.2
▪ K
o 3.5-5
▪ Mag
o 1.2-2.5 (DON’T NEED TO KNOW VALUE JUST THAT IT IS HIGH IN ESRD
PATIENTS)
▪ Urine output
o 30 mL/hr
, lOMoARcPSD|17808653
dains
pudding,
phosphors Ngunt milk
,
.
a foods
CanProcessedment
low
~
▪ Diet restrictions for ESRD patients (pg. 1584) No Sodium
leafy o Low protein
No no > -
o Low potassium are
veggies > Apples
,
aomatoes ▪ Foods high in potassium include potatoes, oranges, citrus, salt substitutes
avocado
-
the best choice
o Fluid restriction
▪ ESRD medications (pg. 1583) carbonate
o Calcium binders or calcium > treats -
hyperphosphatemiahypocalcemia
▪ Calcium acetate (PhosLo)
o Phosphate binder
> sevelamer carbonate
▪ Renagel -
o Erythropoietin (for anemia)
▪ Epoetin alfa
o Anticonvulsants
▪ Benzodiazepine – diazepam
▪ Hydantoin - phenytoin
o Inotropes
▪ Digoxin – cardiac glycosides
▪ Beta receptor agonist - dobutamine
o Diuretics
▪ ESRD patient education
o Nutrition
o Worsening s/s
▪ Imbalanced nutrition nursing interventions in ESRD patients (care plan pg. 1585)
o Promote high biologic value protein like eggs, dairy, and meat
o High calory, low protein, low sodium, and low potassium diet
o Assess weight changes
o Labs: electrolytes, BUN, creatinine, protein, transferrin, and iron levels
o Assess patients diet history, food preferences, and calorie counts
o Assess for factors that can contribute to altered intake
▪ Anorexia, n/v, depression, diet unpalpable to patient, lack of
understanding of restrictions, and stomatitis
o Provide patients food preferences within the restrictions for phosphate
binders
o Schedule medications so that they are not given right before meals-Except are first bite
which given we
▪ Possible complications after hemodialysis pg 1580 -
of food.
o Bleeding
o Infection
o Hypotension (COMMON BUT NOT NORMAL)
o Complications on pg. 1591
▪ Heart failure, coronary artery disease, stroke, and peripheral vascular
disease
▪ Anemia
▪ Gastric ulcers
▪ Metallic taste in mouth and n/v
▪ Renal osteodystrophy can cause bone pain and fractures
▪ Phosphorus deposits in skin cause itching
▪ Shortness of breath
