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GI Kidney power point notes, Slides of Nursing

GI Kidney key points with patho review, AKI, CKD, etc,.

Typology: Slides

2024/2025

Uploaded on 04/07/2025

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GI Part 2
Kidneys
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GI Part 2

Kidneys

What them kidneys do?

Patho Review

  • (^) Maintain body fluid volume
  • (^) Filter waste products for elimination
  • (^) Regulate blood pressure
  • (^) Acid-base balance
  • (^) Produce erythropoietin for RBC production
  • (^) Convert vitamin D to active form

Kidney Disease

Acute Kidney Injury (AKI)

  • (^) AKA acute renal failure
  • (^) Rapid decrease in kidney function leading to fluid, electrolyte, & acid-base imbalance
  • (^) Usually reversible
  • (^) Severity is based on how high BUN & creatinine are and how low urine output is
  • (^) S/Sx
    • (^) n/v, malnutrition, peripheral & pulmonary edema, HTN, weakness, seizures, AMS, lethargy, muscle twitching, dysrhythmias, crackles, hypoxia, SOB, hematuria, low UOP, uremia/azotemia
  • (^) Systemic issues
    • (^) Metabolic acidosis, hyperkalemia, hyponatremia, hypocalcemia
  • (^) Can sometimes progress to chronic kidney disease

Phases of AKI

  • (^) Onset:
    • (^) Begins with the onset of the event, ends when oliguria develops
    • (^) Lasts for hours to days
    • (^) UOP < 30 ml/hr, begin to see rise in BUN and creatinine
    • (^) Start to see mild electrolyte & acid-base abnormality
    • (^) Sx: fatigue, body aches, etc.
  • (^) Oliguria:
    • (^) Minimal urine output (100 to 400 mL/24 hr)
    • (^) Lasts for 1 to 3 weeks
    • (^) ALL labs abnormal
    • (^) Treat electrolyte abnormalities (esp potassium!)
  • (^) Diuresis:
    • (^) Begins when the kidneys start to recover, labs begin to normalize – but still watch close!
    • (^) Massive UOP (1-3L); can last for 2 to 6 weeks.
  • (^) Recovery:
    • (^) Continues until kidney function is fully restored and can take up to 12 months

AKI Treatments

 (^) Prevention  (^) Monitor labs  BUN, creatinine, ‘lytes  (^) Nephrotoxic Meds? Contrast?  (^) Fluid and electrolyte management  (^) Want equal I&O’s, daily weights  (^) Fluid Challenges  (^) Give bolus over 1hr to see if UOP increases or if we can help kidneys recover; may also use diuretics  (^) Pressors  (^) Treat electrolyte abnormalities as necessary  (^) Nutrition Therapy  (^) Avoid 3 Ps: Protein, Phos, Potassium  (^) Low Na  (^) Control fluids  (^) Medication Management  (^) Dextrose & Insulin – lower K  (^) Epogen & Procrit – raise RBCs  (^) Kayexalate – lower K  (^) Sodium Bicarb – help w/ metabolic acidosis  (^) Folic Acid & Iron -- supplement  (^) Amphojel – lower P  (^) Diuretics – improve filtration  (^) Lokelma – lower K  (^) Renal Replacement Therapy  (^) Last resort  (^) Continuous Dialysis (CVVH)  (^) Hemodialysis (HD)

Chronic Kidney Disease (CKD)

 (^) Progressive, irreversible kidney injury; kidney function does not recover  (^) Issues with metabolic & acid-base balance  (^) Slow progression (years)  (^) Goal: medically manage as long as possible  (^) End-stage renal disease (ESRD)  (^) High risk factor: DIABETES  (^) Will see: Azotemia/Uremia  (^) Neurological – Altered LOC, seizures, fatigue, lethargy, depression, coma, weak, dizzy  (^) Cardiovascular – HF Sx, HTN, HLD, dysrhythmias, tachycardia, & more   (^) Respiratory – pulmonary edema, SOB, pink frothy sputum, tachypnea, crackles  (^) Hematologic – anemia, low H&H, low RBC  (^) GI – ulcers, anorexia, N/V  (^) GU – decreasing UOP, increasing BUN & creatinine  (^) Skin – dry, itching, uremic frost, pale, decreased turgor

Stages of CKD

 (^) Progressive; can medically manage  (^) Don’t need dialysis right away  (^) Reduced glomerular filtration rate (GFR)  (^) Stage 1 – GFR > 90; still normal renal function  (^) Stage 2 – GFR 60-89; no buildup of waste, kidneys work harder, slight change in Sx  (^) Stage 3 – GFR 30-59; see build up of waste, increase in BUN & creatinine, issues with HTN and fluid volume  (^) Stage 4 – GFR 15-29; see more build up of toxins and issues with electrolytes, think about HD  (^) Stage 5 – GFR < 15; ESRD; severe fluid and electrolyte issues, excessive waste products; start dialysis or comfort cares

Nursing Care w/ CKD

  • Urinary Status
    • (^) I&O, UOP worsening?
  • (^) Vitals
    • (^) Assess for any signs of distress
    • (^) Pre & post dialysis
  • (^) Daily Weight
  • (^) Diet
    • (^) Low protein, phosphorus, potassium (3 Ps)
    • (^) Fluid & Na restriction
    • (^) Low carb, Low fat
    • (^) Ca, Fe, and vitamin supplements
  • Respiratory
    • (^) Monitor for fluid volume excess, listen for crackles, etc.
  • (^) Hold meds prior to dialysis
  • (^) Good skin care
  • (^) Electrolytes
    • (^) Pre and post dialysis Medications:
      • (^) Sodium Polystyrene (Kayexalate) – lower K
      • (^) Epoetin/Epogen – RBC booster
        • (^) Typically given on dialysis days
      • (^) Ferrous Sulfate - supplement
      • (^) Calcium Carbonate - supplement
      • (^) Phosphate Binders – lower P
        • (^) Renvela, PhosLo; take with food
      • (^) Furosemide
      • (^) Digoxin
      • (^) ACE inhibitors
      • (^) Seizure meds
        • (^) r/t electrolyte abnormalities and risk for seizures

Dialysis

Hemodialysis (HD)

 (^) Reasons: hyperkalemia, fluid overload, AKI, CKD  (^) With CKD, typically go 3x/week  (^) Each session being 3-4 hrs at a time  (^) Manage fluid overload that kidneys can't handle  (^) Manage electrolytes  (^) Use dialysate solution to draw waste and toxins out of blood  (^) Often use heparin as anticoagulation so blood won’t clot with HD machine  (^) Need large needle for access or large enough catheter to filter blood  (^) Line options:  (^) AV fistula, Mahurkar, or Perm Cath

Vascular Access Options for HD/CVVH

 (^) Arteriovenous (AV) fistula or graft  (^) Mesh artery and vein together, use pt own vessels  (^) Less clotting risk, less infection risk, more permanent option  (^) Usually done in the arm; ensure good circulation  (^) Assess if patent by: FEEL the THRILL & HEAR the BRUIT  (^) DO NOT use fistula arm for blood pressures, blood draws, or other lines  (^) Dialysis Catheter – Mahurkar or Perm Cath  (^) Often more temporary; Can be placed while waiting for fistula to mature  (^) Can be double or triple lumen  (^) Higher risk of infection  (^) Complications  (^) Thrombosis/Clots – why heparin is used to maintain patency of fistula or catheter  (^) Infection – esp w/ catheters; monitor dressing and assess for s/sx infection  (^) Aneurysm formation – caused by repeated needle sticks w/ fistula; may need other line or fistula  (^) Ischemia – rare; r/t decreased arterial blood flow, will see/feel poor circulation

Peritoneal Dialysis (PD)

  • (^) Catheter placed in abdominal wall into peritoneal cavity, instill dialysate fluid into abdomen
  • (^) Remove toxins and waste
  • (^) Can be done at home or in hospital; pt compliance a must!
  • (^) Less risk for fluid and electrolyte issues
  • (^) High risk for peritonitis r/t fluid sitting in abdomen
    • (^) Sterile technique in hospital; clean technique at home
  • (^) 3 Phases: infusion, dwell, drain
    • (^) During drain phase – fluid should be clear/pale yellow;
    • (^) Check if cloudy/discolored (BAD)
  • (^) Hand dialysate fluid bag above patient; drainage bag below the level of insertion  (^) Types  (^) Continuous ambulatory (CAPD)  (^) Continuous-cycle (CCPD)

Nursing Care for Peritoneal Dialysis

 (^) Before PD:  (^) Evaluate baseline VS, weight, laboratory tests  (^) Assess glucose because PD dialysate fluid has dextrose in it  (^) Monitor patient for respiratory distress, pain, discomfort  (^) Monitor prescribed infusion, dwell, and drainage times  (^) Observe outflow amount and pattern of fluid  (^) Whatever we infuse, we want at least that much coming out, ideally more  (^) Want equal I&Os  (^) Assess for peritonitis  (^) Check for kinks or blockages in tubing; have pt turn side to side to help with flow  (^) Ensure drainage bag is BELOW level of catheter insertion on the pt  (^) Will NOT see disequilibrium syndrome w/ PD  (^) Check for signs of infection  (^) Keep catheter site clean and dry; change gauze & tape as needed or per PD nurse orders