Chapter 44 Management of Patient with Renal Dsorder

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|Chapter 44 | | | |Management of Patient with Renal Disorders | | | | | | | |Submitted by: | |Inac, Sarah Gaile T. | |BSN III | | | |Submitted to: | |Prof. Frederick Calara PTRP, RN,RM,MAN |

FLUID AND ELECTROLYTE IMBALANCES IN RENAL DISORDERS
▪if fluid intake is inadequate, the pt is said to be volume depleted and may show s/sx of fluid volume deficit. ▪the fluid intake and output (I&O) record, a key monitoring tool, is used to document important fluid parameters, including:

-fluid taken (orally and parenterally)
-volume of urine
-other fluid losses (diarrhea, vomiting, diaphoresis)
▪pt weight is also important and documenting trends in weight is key assessment strategy essential for determining the daily fluid allowance and indicating signs of fluid overload or deficit. Nursing Alert: the most accurate indicator of fluid loss or gain in an acutely ill pt is WEIGHT. An accurate daily weight must be obtained and recorded. A 1-kg wt gain is equal to 1000ml of retained fluid.

GERONTOLOGIC CONSIDERATIONS
▪with aging, kidney is less able to respond to acute fluid and electrolyte changes. ▪elderly pt may develop atypical and non-specific s/sx of disturbed renal function and fluid and electrolyte imbalances. ▪fluid balance deficit in elderly:

-constipation
-falls
-medications toxicity
-urinary tract and respiratory tract infection
-delirium
-seizures
-electrolyte imbalances
-hyperthermia
-delayed wound healing

RENAL DISORDERS

CHRONIC KIDNEY DISEASE
▪umbrella term that describes kidney damage or a ↓ in the GFR for 3 or more months. ▪can result in end stage renal dse and necessitate renal replacement therapy (dialysis or kidney transplant).

RISK FACTORS:
▪Cardiovascular Dse
▪Diabetes, primary source of CKD.
▪Hpn, 2nd leading cause
▪Obesity

PATHOPHYSIOLOGY
▪early stages of CKD, there can be significant damage to the kidneys w/o s/sx. ▪damage to the kidney is thought to be caused by prolonged acute inflammation that is not organ specific and thus has subtle systemic manifestations.

STAGES OF CKD
▪based on the GFR.
Normal GFR: 125 ml/min/1.73m²
STAGE 1
▪GFR ≥ 90ml/min/1.73m²
▪kidney damage with normal or ↑GFR
STAGE 2
▪GFR = 60-89ml/min/1.73m²
▪mild ↓ in GFR
STAGE 3
▪GFR = 30-59ml/min/1.73m²
▪moderate ↓ in GFR
STAGE 4
▪GFR = 15-29ml/min/1.73m²
▪severe ↓ in GFR
STAGE 5
▪GFR < 15ml/min/1.73m²
▪kidney failure (End stage renal dse)

▪pt with CKD are at risk for cardiovascular dse – leading cause of morbidity and mortality.

CLINICAL MANIFESTATIONS
▪Elevated Serum Creatinine –indicate underlying kidney dse. ▪Anemia – due to ↓ erythropoietin production by the kidney and metabolic acidosis; abnormalities in calcium and phosphorus. ▪Fluid Retention – evidenced by edema and CHF, develops. ▪Abnormalities in electrolytes

▪Heart failure worsens
▪Hpn becomes more difficult to control.

ASSESSMENT AND DIAGNOSTIC FINDINGS
▪GFR- amount of plasma filtered through the glomeruli per unit of time. ▪Creatinine Clearance- measure of the amount of creatinine the kidneys are able to clear in a 24hr period. ▪calculation of GFR, important assessment perimeter in CKD.

MEDICAL MANAGEMENT
▪Regular clinical and laboratory assessment is important to keep the BP below 130/80mmHg. ▪It also includes early referral for initiation of renal replacement therapies as indicated by the pt’s renal status. ▪Prevention of complications is accomplished...
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