ADULT HEALTH HESI STUDY GUIDE
Respiratory system
Pathophysiology Nursing Assessment Analysis Plans Hints
Pneumonia:
Inflammation of lower
... [Show More] respiratory tract Caused by infectious agents
Organisms reach the lungs in 3 methods:
1. Aspiration
2. Inhalation
3. Hematogenous spread Pneumonia is classified according to causitive agent
1. Bacterial (gram pos and neg)
2. Viral
3. Fungal
4. Chemical
Pneumonia may be community acquired or nosomcomial
High risk groups include
1. Debilitated by lung secretions
2. Cigarette smokers
3. Immoblie
4. Imunosuppressed
5. Expereincing a depressed gag reflex
6. Sedated
7. Experiencing neuromusclar disorders A. Tachypnea: shallow respirations with use of accessory muscles.
B. Abrupt onset of fever with shaking and chills (not reliable in O/A)
C. Productive cough with pleuritic pain
D. Rapid bounding pulse
E. In older adults sx include:
1. Confusion
2. Lethargy
3. Anorexia
4. Rapid respiratory rate
F. Pain and dullness to percussion over the affected lung area
G. Bronchial breaht sounds/crackles
H. Chest radiography indication of inflitrates with consolidation or pleural effusions
I. Elevated white blood cell coung
J. ABG of hypoxemia
K. On pulse oximetry a drop in O2 satruation (> 90 and ideally 95) A. Impaired gas exchange related to…
B. Ineffective airway celarance related to…
C. Activity intolerance related to…
D. Risk for deficient fluid volume related to….
E. Ineffective breathing pattern related to… A. Assess suptum for volume, color, consistency and clarity.
B. Assist client to cough productively by:
1. deep breathing care every 2 hours (many use incentive spiometer)
2. Using humidity to loosen sevretions (may be oxylgenerated)
3. Suctioning airway if necessary
C. Assess lung sounds before and after coughing
D. Assess rate, depth, and pattern of respirations regularly (normal adult rate 16 to 20 breaths/min)
E. Monitor Abg's (pO2 > 80mm2; Pco2
< 45mm hg)
F. Monitor O2 saturation with pulse oximetry (ideally > 95%)
G. Assess skin color
H. Assess mental status, restlessness, and irritability
I. Administer o2 as prescribed
J. Monitor temperature regularly
K. Provide adequate rest periods, including uniterrupted sleep.
L. Encourage at risk groups to annual pneumonia and influenza (flu) immuniziations. High risk for pneumonia
Any person who has an altered level of consciousness, has depressed or absent gag and cough reflexes or is susceptible to aspirating orophayngeal secretions, including alcoholics, anesthesized, those with a brain injury and those in a state of drug overdose and stroke victims are at high risk
When feeding-- raise the head of the bed and position the client on his or her side and not on the back.
Bronchial brath sounds are heard over areas of density or consolidation. Sound waves are easily transmitted over consolidated tissues.
Hydration
Enables liquefication of mucous trapped in the bronchioles and alveoli, facilitating expectoration Is essential for client experiencing fever
Is important because 300 to 400 mL of fluid is lost daily by the lugns through evaporation.
Irritably and restlessnes are early signs of cerebral hypoxia; the cleint's brain is not recieiing enough of O2.
Pneumonia Preventaives
Older adults: flue shots; pneumonia, immunizations; avoiding soucres of infection and indoor pollutants (dust, smoke and aerosols); no smoking.
Immunosuppressed and debilitated persons: infection avoidance, sensible nutition, adequate intake, balanced rest and activy.
Comatose and immoblie persons: elevetion of head of bed to fed and for 2 hours after/ frequently turning
Pathophysiology Nursing assessment Analysis Plans Hints
Chronic airflow limitation
Description: chonic lung disease includes chonic bronchitis; pulmonary emphysema and asthma.
Emphysema and chonic boronchitis termed as chonic obstructive pulmonary disease (COPD) are characterized bronchospasm and dyspnea. The damage to the lung is not reversity and increases in the severity. Asthma, Unlike COPD, is an intermittent disease with reversible airflow obstruction. Changes in breathing pattern (eg. An increase with rate iand depth)
Use of accessory breathing (barrel chest) Gernalized cyanosis of the lips, mucous memrbanes, face, nail beds ("blue bloaters) Cough (dry or productive)
Higher Co2 than average
Low O2 as determined by pulse oximetary
Decreased breath sound
Coarse crackles in lung fields that tend disappear after coughing, wheezing Dyspnea, orthopena
Poor ntuition
Activity intolerance
Anxiety concerneing breathing manicested by:
1. Anger
2. Fear of being alone
3. Far of not being able to catch breath Ineffective airway clearance related to Ineffective breathing pattern related to Impaired gas exchage related to Activity related to Teach client to sit upright and bend slightly forward to promote breathing
1. In bed teach client to sit with arms resting on overbed table (tripod position0
2. In chair teach client to lean forward with elbows resting on knees (tripod position)
Teach diaphragmatic and pursed lip rbeathing. Teach prolonged expiratory phase to clear trappped air Administer O2 at 1 - 2 L per nasal canula.
Pase activities to conserve energy Maintain adequate dietary intake
1. Select small, frequent mealse
2. Inscreased calories and protein Select foods that derive their calories from high fat rather than high carbohydrate level because Co2 that is a natrual end product of carbohydrate metablism and can elevate PaCo2 levels
3. Favorite
4. Dietary supplements
For people contiinuing to smoke tobacco, adiditional vatamin C may be necessary.
Magnesium and clacium, because of their role in muscle contraction and relaxation, may be important for people with COPD.
Routine monitoring of magnesium and phosphorus levels is important because of their role related to bone mineral density (osteoprorisis).
Provide an adequate fluid intake (minimum 3 L day)
Fluids should be taken between meals (rathern them) to prevent excess stomach distention and to decrease pressure on the diaphragm
Instruct the client in relaxation techniques (teach when not in distress)
Teach prevention of seconday infections
Teach about medication regimen Smoking cessation is imparative Encourage health promoting activities. Exposrue to tobacco smoke is the primary cause of COPD in the United States.
Compensation occurs over time in clients over time in clients with chonic lung disease, and ABG's are altered.
As COPD worsens the amount of O2 in the blood decreases (hypoxemia) and the amount of carbon dioxide (Co2) in the blood increases (hypercarbia), causing chonic repisratory acidosis (increased arterial carbon dioxide (paCo2), which results in metabolic a (increased arterial bicarbonate) as compensation.
Not all clients with COPD are Co2 retainers, even when hypoxemia is present, because Co2 diffuses more easliy across lung memebranes than O2.
In advanced emphysema, due to the alveoli bereing affected hypercarbia is is a problem rather than borchitis where the airway are affected.
It is imparitive that basline data be obtained for the client.
Productive cough and comfort can be facilited by semi fower or high power position, which lessens pressure on the diaphragm by abdominal organs. Gastric distention become a proity in these cliente because it elevates the idaphragm and inhibits full lung expansion.
NORMAl ABG values
Adult
pH 7.35 - 7.45
Pco2 35 - 45 mmHG
Po2 80 to 100 mmhg
Hco3- 21 to 28 mEq/L
Child
pH 7.36 - 7.44
Same as adult Same as adult Same as adult
Pink puffer: barrel chest is indicative of emphysema and is caused by the use of accessory muscles to breathe. The person works harder to breathe, but the amount of O2 taken is adequate to oxygenate the tissues.
Blue bloater-- insufficient oxygenation occurs with chonic bronchitis and leads to generalized cyanosis and often right sided heart failrue (cor pulmonale)
Cells of the body depend on O2 to carry out their functions. Inadequate arterial oxygenation is manifested by cyanosis and slow capillary refill (< 3 seconds). A chonic sign is clubbing of the fingers.
Caution must be used in administering O2 (not greater than 2L of O20 to a COPD client. The stimulus to breathe is hypoxia (hypoxic drive), not
the usualy hypercapnia, which is the stimulus to
breathe for healthy persons. Therefore, if too mcuh O2 is given they may stop breathing.
Helath promotion--
Eatin consumes energy needed for breathing. Offer mechanically soft diets, which do not require as much chewing and digestion. Assist with feeding if needed.
Prevent seconday infections: avoid corowds, contact with persons who have infectious diseases, and respriatory irritants (tobacco smoke)
Teach the client to report any change in characteristics of sputum.
Encourage client to hydrate well (3L/day) and decreases caffiene due to diuretic effect.
Obtain immunizationw when needed (flu and pneumonia)
When asked to pioritize nursing actions use the ABC rule:
Airway Breathing Circulation
Look and listen! If breath sounds are celar but the client is cyanotic and lethargic, adequate oxygenation is not occurring.
The key to respriatory status is assessment of breath sounds as well asl visualization of the client. Brath sound are better described, not named; e.g., sounds should be descrinbed as crackles, wheezes or high pitched whisteling sounds rather than rales, rhonchi, ect. Which may not mean the same thing to each clinical professional.
Whatch out for NCLEX questions that deal with O2a delivery. In adults, O2 it must bubblet hrough some water solution so it can be humidified if given at > 4L/min or delivered directly to the trachea. If given at 1 - 4/min or mask or nasal prongs the oropharynx and nasal pharynx provided adequate humidification.
Pathophysiology Nursing assessment Analysis Plans Hints
Tuberculosis:
Communicable lung disease caused by an infection by mycobacterium tuberculosis
A. Transmission is airborne
B. After initial exposrue, the bacteria encapsulate, they form a ghon lesion
C. Bacteria remain dormant until later time, when clinical sympoms appear A. Is often asymptomatic
B. Symptoms include
1. Fever with night sweats
2. Anorexia, weight loss
3. Malaise, fatigue
4. Cough, hemoptysis
5. Dsypnea, pleuritic chest pain with inspiration
6. Cavitation or calicfication as evidenced on chest radiograph
7. Positive sputum A. Knowledge deficiency (spefify) related to…
B. Risk for infection related to…
C. Imbalanced nutition less than body requirements related to…. A. Provide cleint teaching
B. Cough into tissues and dispose of immediately into special
1. Take all priescribed medication daily for 9 to 12 months
2. Wash hands using proper handwashing technique
3. Report symptoms of deteriorating condition, especially hemorrhage
C. Collect sputum cultures as needed; caliet many return to work after three negatives cultrues.
D. Place client in respriatory isolation while hospitalized
E. Administer anti-TB medications as prescribed
F. Refer client and high risk persons to local or state health department for testing and phrophylactic treatment Tuberculosis (TB) skin test
A positive TB skin test is exhibited by an inducation 10 mm orgreater in a diameter 48 hours after the skin test. Anyone who has received bacillus Calmette- Guerin (BCG) vaccine will have a positive skin test and must evaluated with chest radiograph.
Teaching is very important with the client with TB. Drug therapy is usually long term (9 months or longer). It is essnetial that the cleint take the medicatiosn as prescibed for the entire time.
Skipping doses or prematurlely terminating the drug therapy can result in a public health hazard
Teaching points:
Rifampin reduces effectiveness of oral contceptives; client should use other bierth control methods during isoniazid (INH); increased dilantin levels Ethambutol: vision check before starting therapy and monthsy therafter; may have to take for 1 to 2 years. Teach rational for combination drug therapy to increase compliance. Resistance develops slowly if several anti TB drugs given instead of just one drug at a time.
Pathophysiology Nursing assessment Analysis Plans Hints
Lung cancer
Neoplasm of the lung
A. Lung cancer is the elading cause of cancer related death in the united states
B. Cigarette smoking is responsible for 80 - 90% of all lung cancers
C. Exposure to occupational hazards such as asbestos and radioactive dust poses significant risk
D. Lung cancer tends to appear years after exposrue; it is most common sdeen in persons in the fifth or sixth decade of life
E. Lung cancer has a poor prognosis- 5 year survivial rate is 14% A. Dry hacking cough, early with cough turning productive disease progresses
B. Hoarseness
C. Dyspnea
D. Hemoptysis-- rist colored or purulent sputum
E. Pain in the chest area
F. Diminihed breath sounds, occasional wheezing
G. Abnormal chest radiograph
H. Positive sputum for cytology for plural fluid. A. Chonic pain related to…
B. Ineffective breathing pattern related to…
C. Impaired gas exchange related to….
D. Imbalanced nutition: less than body reuqirements related to…
E. Anxiety related to…. A. Nursing interventions are simlar to those implemented for clients with COPD
B. Place client in SEMI fowler position
C. Teach pursed lip breathing to imporve gas exchange
D. Teach relaxation techniques; client often becomes anxious about rbeathing difficulty]
E. Adminsister O2 as indicated by pulse oximetry of ABG's
F. Take measures to allay anxiety
1. Keep client and family informed of impending tests and procedures
2. Give client as much control as possible over personal care
3. Encourage client and family to verbalize concerns
G. Decrease pain to manageable level by administering analgesics as needed (within safety range for respiratory difficulty
Surgery
1. Toractomy for clients who have resectable tumor. (unfoturnately detection commonly occurs so late that the tumor is no longer localized and is amenable to resection)
2. Pneumoectomy (removal of the entire lung
a. Position client on operative side or back
b. Chest tubes are not usually Some tumors are so large that they fil the entire lobes of the lung. When removed, large spaces are left. Chest tubes are not ususally used with these clients because it is helpful if the mediastinal cavity, where the lung used to be, fills up with fluid. This fluid helps to prevent the shift of the remaining chest organs to fill the empty space.
Chest tubes:
If the chest tube becomes disconnected do not clamp! Immediately place the end of the tube in a container of sterile saline or water until a new drainge system can cbe connected.
if the chest tube is accidnetally removed from the client, the nruse should apply pressure immediately with an occlusive dressing and notify the HCP.
Chest tubes:
Fluctations tidaling in the fluid will occur if there is no external suction. These fluctating movments are a good indicator that the system is intact; they should move upward with each inspiration and downward with each expiration> if fluctutations cease, check for kinked tubing; accumulation of fluid in the tubing, occluaions or change the client's position because expanding lung tissue may be occluding the tube opening. Remember when external sucation is applied, the flutations cease. Most hospitals do not milk the chest tubes as a means of clearning or preventing clots. It is too easy to remove chest tubes. Mediastinal tubes may involve orders to be stripped because of their location compared to the larger thoracic cavity tubes.
used
3. Lobeectomy and segmental resection
a. Position client on his or her back
b. Check to ensure tubing is not kindked or obstructed
c. Chest tubes are usually inserted
4. Chest tubes
a. Keep all tubing coiled loosely below chest levels, with connections tight and taped
b. Keep water seal and suction control chambers at the aporopriate water levels
c. Monitor the fluid drainage and amrk the time of measument and the fluid level
d. Observe for air bubbling in the water seal chamber and fluctuations (tidaling)
e. Monitor the client's clinical status
f. Check the position of the chest drainage system.
g. Encourage the client to rbeathe deeply periodically
h. Do not empty collection chamber
i. Do not strip or milk the tubes
j. Chest tubes are not clamped routinelsy. If the drinage system breaks, place the distal end of the chest tubing connectiion in a steril water container at 2 cm level as emergency water seal
k. Maintain a dry occlusive dressing.
Chemotherapy
1. Attend to immunosuppresion factor
2. Administer antiemetics prior to administering chemotherapy
3. Take precautions in administering antineoplastics
Radiation therapy
1. Provide skin care according to hcp
2. Instruct the client not to wash off the lines drawn by the radiologist
3. Instruct client to sear soft connon garments only
4. Avoid use of powders and creams on radiationg site unless specified by radiologist Various pathophysiologic conditions can be related
to the nrusing dx ineffective breathing patterns. Inability of air sac to fill and empty propery (empysema, cystic fibrosis)
Obstruction of the air passages (carcinoma, ashma, chonic bronchitis)
Accumulation of fluid in the air sace (pneumonia) respiratory muscle fatigue (COPD) pneumonia.
Pathophysiology Assessment Analysis Plans Hints
Cancer of the larynx
Neoplasm occurring in the larynx most commonly squamous cell in origin
A. Proolonged use of alcohol and tobacco is directly related to the development
B. Other contibuting factors include
1. Vocal straining
2. Chonic laryngitis
3. Family predisposition
4. Industrial exposure to carcinogens
5. Nutitional deficiencies
C. Men are affected 8 times more often than women
D. Dx usually occurs between the age of 55 and 80
E. The earliest sign is hoarseness or a change in vocal quality
F. Medical management incldues radiation therapy, often with adjuvant chemotherapy or surgical removal of the larynx-- laryngectomy A. Magnetic resonance imaging
B. Direct laryngoscopy
C. Assessing for hoarseness of longer than 2 weeks-- early changes
D. Assessing for color changes in the mouth or tongue
E. Assessing for dysphagia, dyspnea, cough, hemotysis, weight loss, neck pain, radiating to the ear, enlarged cervical nodes, and halitosis (later changes)
F. Radiographs of the head, neck and chest
G. Computed tomography (CT scan of neck and biopsy. Nursing Diagnosis
Client undergoing laryngectomy
A. Anxiety related to….
B. Ineffective airway clearance related to
C. Impaired verbal communication related to…
D. Ineffective breathing pattern related to… A. Provide preoperative teaching.
1. allow client and fmily to observe and handle tracheostomy tubes and suctioning equipment
2. Explain how and why suctioning will take place after surgery
3. Plan for acceptable communication methods after surgery
4. Consider literacy level
5. Refer the cleint to a speech patholgist
6. Discuss the planned rehabilitation program
B. Provide postoperative care
1. Use simple communication
2. Use planned alternative communication methods
3. Keep call bell/light within reach at all times
4. Ask client yes/no questions whenever possible
C. Promote respiratory functioning
1. Assess respiratory rate and characteristics every 1 to 2 hours
2. Keep bed in semi fowler position at all times
3. Keep larygnal airway humidified at all times
4. Auscultate lung sounds every 2 - 4 horus
5. Provide tracheostomy care every 2 - 4 hours and PRN
6. Administer tube feedings as prescribed
7. Encourage ambulation as early as possible
8. Refer for sppch rehabiltiaion with artificial larynx or learn esophageal speech. with cancer of the larynx the tongue and mouth often appear white, gray, dark brown or black and may appear patchy.
Tracheostomy care involves cleaning the inner canula, suctioning and applying clean dressing.
Air entering the lungs is humidified along the nasobronchial tree. This natural humidifying pathway is gone for the client who has had a laryngectomy. If the air is not humidified before entering the lugns, secretions tend to thicken and become crusty.
A laryngectomy tube has a larger lumen and is shorter than the tracheostomy tube. Observe the cleint for any signs of bleeding or occlusion, which are the greatest immediate postoperative risks (first 24 hours)
Fear of choking is very real for lyngectomy clients. They cannot cough as they could earlier because the glottis is gone. Teach the glottal stop technique to remove secretions (take a deep breath, momentarily occlude the tracheostomy tube, cough and simultaneously remove the finger from the tube.
Renal System
Pathophysiology Assessment Analysis Plans Hints
Acute Renal failure
Abrupt deteroiration of the renal system
A. ARF occurs when metabolites accumulate in the body and urinary output changes
B. There are three major types of ARF
C. There are 3 phases of ARF
1. Oliguric phase
2. Diuretic phase
3. Recovery phase A. History of taking nephrotoxic drugs (salicylates, antibiotics, nonsteroidal antiinflammatory drugs NSAIDS)
B. Alteration in urinary output
C. Edema, weight gain (ask if wastbands have suddenly become too tight
D. Change in mental status
E. Diagnostic findings in the oliguric phase
1. Increased blood urea nitrogen (BUN) and creatinine
2. Increased potassium (hyperkalemia)
3. Decreased sodium (hyponatremia)
4. Decreased pH (Acidosis)
5. Fluid overload (hypervolemic)
6. High Urine specific gravity (> 1.020 g/ml)
F. Diagnostic findings in the diuretic phase
1. Decreased fluid volume (hypovolemia)
2. Decreased potassium (hypokalemia)
3. Further decrease in sodium (hyponatremia)
4. Low urine specific gravity (< 1.020 g/ml)
G. Diagnostic lab works returns to normal in the recovery phase A. Excess fluid volume related to
B. Deficient fluid volume related to
C. Anxiety related to
D. Imbalanced nutrition: less than body requirements related to… A. Monitor intake and output (I & O) accurately: give only enough fluids in oliguric phase to replace losses; usually 400 to 500 ml/24 hr
B. Document and report any change in fluid volume status
C. Monitor lab values of both serum and urine to assess electrolyte status, especially hyperkalemia indicated by serum potassium levels over 5 mEq/L and ECG changes
D. Assess level of consciousness for subtle changes
E. Weigh daily: in oliguric phase; client may gain up to 1 lb per day
F. Prevent cross-infection
G. Kayexalate may be prescribed if K+ is too high
H. Provide low protein, modlelrate fat, high carbohydrate diet
I. Monitor cardiac rate and rhytm (acute cardiac dysrhymias are usually related to hyperkalemia
J. Monitor drug levels and interactions Normally kidneys excrete approximately 1 ml of urine per kg of body weight per hour.
For adults totoal daily surine output ranges between 1500 and 2000 ml depending on the amount and type of fluid intake, amount of perspiration, envionmental or ambient temp and the presence of vomiting and diarrhea
Electrolytes are profoundly affected by kidney problems. There must be a blanace between extracellular fluid and intracellular fluid to maintain homeostasis. A change in the number of ions or in the amount of fluid will cause a hshift in one direction or the other. Sodium and chloride are the primary extracellular ions. Potassium and phosphate are the primary intracellular ions
In some cases, persons in ARF may not experience the oliguric phase but may progress directly to the diruetic phase, during which the urine output may be as much as 10 L per day.
Body weight is a good indicator of fluid retention and renal status. Obtain accurate weights of all clients with renal failure; obtain weight on the same scale at the same time every day.
Fluid volume alterations Excessive fluid sympoms Dyspnea
Tachycardia
Jugular vein distention Peripheral edema Weight gain
Fluid deficient symptoms Decreased urin output Reduction in body weight Decreased skin turgor Dry mucsous membranes Hypotension
Tachycardia Weight loss
Watch for signs of hyperkalemia, dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea and nausea
Potassium has a critical safe range (3.5 to 5.0 mEq/L) because it affects the heart and any imbalance must be corrected by medications or dietary modification. Limit high potassium foods (bananas, orange juice, cantaloupe, strawberries, avocados, spinach, fish) and salt substitutes, which are high in potassium
Clients with renal failure retain diluted and serum levels may appear near normal. With excessive water retention, the sodium levels appear decreased (dilution). Limit fluid and sodium intake in ARF clients.
During oliguric phase, minimize protein breakdown and prevent rise in BUN by limiting protein intake. When the BUN and creatinine return to normal, ARF if determined to be resolved.
Pathophysiology Assessment Analysis Plans Hints
Chronic Renal Failure (CRF): end stage renal disease (ESRD)
Progressive, irreversible damage to the nephrons and glomeruli, resulting in uremia
A. Causes chonic renal failure are multitudinous
B. As renal function diminishes, dialysis becomes necessary
C. Transplantation is an alternative to dialysis for some clients A. History of high mediation usage
B. Family history of renal disease
C. Increased blood pressure (BP) and/or chonic hypertension
D. Edema, pulmonary edema
E. Neurologic impairment (Weakness, drowsiness)
F. Decreasing urinary function
1. HEMATURIA
2. PROTINURIA
3. CLOUDY URINE
4. OLIGURIC (100 TO 400 ML/DAY)
5. Anuric (< 100 ml/day)
G. Jaundice
H. Gastrointestinal GI upsets
I. Metallic taste in mouth
J. Ammonia breath
K. Dialysis
L. Previous kidney transplant
M. Lab information
1. Axotemia
2. Increased creatinine and BUN
3. Decreased calium
4. Elevated phosphorus and magnesium A. Excess fluid volume related to…
B. Imbalanced nutition: less than body requirements related to…
C. Decreased cardiac output related to… A. Monitor serum electrolyte levels
B. Weigh daily
C. Monitor strict I & O
D. Check for jugular vein distention (JVD) and other signs of fluid overload
E. Monitor for edema and pulmonary edema
F. Provide low protein, low sodium, low potassium, low phosphate diet
G. Administer aluminum hydroxide antacids to bind phosphates because client is unable to excrete phosphates (no magnesium based antacids) timing is important!
H. Encourage client's protein intake to be of high biologic values (eggs, milk meat) because the client is on a low protein diet
I. Alternate periods of rest with periods of activity
J. :Encourage streict adherance to medication regimen; teach client to obtain health care provider's permission before taking any over the counter medications.
K. Observer for complications
1. Anermia (administer antiaemetic drug)
2. Renal osteodystrophy (abnormal clcium metabolism causes bbone pathology)
3. Severe, resistant, hypertension
4. Infection
5. Metabolic acidosis
L. Living related or cadaver renal transplant
1. Monitor for rejection
2. Monitor for injection Accumulation of waste products from potein metabolsim is the primay cause of uremia. Protein must be restricted in CRF clients. However, if protein intake is inadequate, a negative nitrogen balance occurs, causing muslce wasting. The glomerular filtration rate (GFR) is most often used as an indicator of the level of protein consumption.
All persons in the united states are eligeble for medicare as of their first day of dialysis under special ESRD funding
Medicare card will indicate ESRD
Transplatiation is covered by medicare procedure; cover terminates 6 months postoperaively if dialysis is no longer required.
Protein intake is restricted until blood chemistry shows ability to handle the protein catabolites, urea and creatinine. Ensure high calorie intake so protein is spared for its own work; give hard candy, jelly beans or flavored carbohydrate powders.
The biggest difference between dialysate for hemodialysis and peritoneal dialysis is the amount of glucose. Peritoneal dialysis dialysate is much higher in glucose. For this reason, if the diasylate is left in the peritoneal cavity too long, hyperglycemia may occur.
As kidneys fail, medications must often be adjusted. Of particular importance is digoxin toxicity because digitalis preparations are extreted by the kidneys. Signs of toxicity in adults include nausea, vomiting, anorexia, visual disturbances, restlessnes,s ehadache, cardiac dysrhymia, an pulses <60 bpm.
3. Teach client maintain
immunosuppressive drug therapy meticulously
Pathophysiology Assessment Analysis Plans Hints
Urinary tract infection
Infection or inflammation at any site in the urinary tract (kidney, pyelonephritis; urethra, urethritis, bladder, cystitis; prostate, prostatitis)
A. Normally the entire urinary tract is sterile
B. The most common infectious agent is escherichia coli
C. Persons at the highest risk for acquiring UTI's
1. Diabetics
2. Pregnant women
3. ;men with prostatic hypertrophy
4. Immunosuppressed persons
5. Catherized clients
6. Anyone with urinary retention either short term or long term
7. Older women-- bladder prolapse
D. Diagnosis
1. Clean catch midstream urine collection for culture to identify specific causitive organism
2. Intravenous pyelogram (IVP) to determine kidney functioning
3. Cystogram to determine bladder functioning
4. Cystoscopy to determine bladder or urethra abnormalities A. Signs of infection including fever and chills
B. Urinary frequency, urgency, or dysuria
C. Hematuria
D. Pain at the costovertebral angle
E. Elevated serum WBC's (> 10,000) A. Acute pain related to…
B. Imparied urinary elimination related to….
C. Deficient knowedge related to… A. Administer antibiotics specific to infectious agent
B. Instruct client in the appririate medication regimen
C. Encourage fluid intake of 3000 ml of fluid/day
D. Maintain I/O
E. Administer mild analgesics (phenazopyridine (pyridium), acetaminophen, or aspirin)
F. Encourage clint to void every 2 to 3 hours to prevent residual urine from Stagnating in bladder
G. Develop and implement a teaching plan
1. Take entire presciption as directed
2. Consume oral fluids up to 3L/day (water juices)
3. Shower rather than bathe as a preventive measure. If bathing is necessary, never take a bubble or oil bath and avoid feminine hygine sprays
4. Cleans from the front to the back after toileting (women and girls)
5. Avoid cavvine
6. Void immediately after intercourse (women)
7. Void every 2 to 3 hours during the day
8. Wear cotton undergarments and loose clothing to help decrease perineal moisture
9. Practice good handwashing technique
10. Obtain follow up care The dkey to resolving UTIs with most antibiotis is to keep the blood level of the antibiotic constant. It is important to tell the client to take the antibiotics aroudn the clock and not to skip doses so that a consistent blood level can be maintained for optimal effectiveness.
Pathophysiology Assessment Analysis Plans Hints
Urinary tract Obstruction
Partial or completeblockage of the flow of urine at any point in the urinary system
A. Urinary tract obstruction may be caused by a
1. Foreign body (calculi)
2. Tumors
3. Strictures
4. Functional (e.g., neurogenic bladder)
B. When urinary tract obstruction occurs, urine is retained above the point of obstruction
1. Hydrostatic pressure builds causing dialation of the organs above the obstruction
2. If hydrostatic pressure continues to build, hydrohnephosis develops, and it can lead to renal failure A. Pain, usually quite severe, acute
B. Sympoms of obstruction
1. Fever, chills
2. Nausea, vomiting, diarrhea
3. Abdominal distention
C. Change in voiding pattern
1. Dysuria, hematuria
2. Urgency, frequency, hesitancy, noturia, dribbling
3. Difficulty in starting a stream
4. Incontinence
D. Those with the following condition are at risk for developing calculi [Show Less]