Nursing implementation : Kidney Disease

  • Nursing implementation
    • Health promotion
      • Individuals should have regular checkups that include a routine urinalysis and calculation of the estimated GFR
        • Diabetes or hypertension
        • People with a history (or a family history) of kidney disease
        • Repeated urinary tract infections
      • People with diabetes need to have their urine checked for albuminuria if routine urinalysis is negative for protein.
        • Report any changes in urine appearance (color, odor), frequency, or volume to HCP
      • Monitor kidney function with serum creatinine and BUN and GFR if are on potentially nephrotoxic medications
      • Prevention and detection of chronic kidney disease
        • Early detection and treatment are the primary methods for reducing chronic kidney disease.
        • Monitor BP to detect elevations so that treatment can be started early.
        • Treat hypertension appropriately and aggressively, since it is the second leading cause of chronic kidney disease.
        • Ensure proper diagnosis and treatment of diabetes mellitus, since it is the leading cause of chronic kidney disease.
      • Glycemic control for patients with diabetes
    • Acute care
      • In-hospital care is required for management of complications and for kidney transplantation (if applicable)
    • Ambulatory care
      • Encourage the patients to participate in their care
        • Include the following information in the teaching plan for the patient and caregiver.
          • Dietary (protein, sodium, potassium, phosphate) and fluid restrictions.
          • Difficulties in modifying diet and fluid intake.
          • Signs and symptoms of electrolyte imbalance, especially high potassium.
          • Alternative ways of reducing thirst, such as sucking on ice cubes, lemon, or hard candy.
          • Rationales for prescribed drugs and common side effects.
            • Examples:
              • Phosphate binders (including calcium supplements used as phosphate barriers) should be taken with meals.
              • Calcium supplements prescribed to treat hypocalcemia should be taken on an empty stomach (but not at the same time as iron supplements).
              • Iron supplements should be taken between meals.
          • The importance of reporting any of the following:
            • Weight gain >4 lb (2 kg)
            • Increasing BP
            • Shortness of breath
            • Edema
            • Increasing fatigue or weakness
            • Confusion or lethargy
          • Need for support and encouragement. Share concerns about lifestyle changes, living with a chronic illness, and decisions about type of dialysis or transplantation.
    • The expected outcomes are that the patient with CKD will maintain
      • Fluid and electrolyte levels within normal ranges
      • An acceptable weight with no more than a 10% weight loss