Question

13. Coordinate nursing care for the patient with CKD or end-stage kidney disease (ESKD).

Answer 1

CARE OF PATIENTS WITH CKD OR ESKD

When a patient is diagnosed as having CKD, conservative therapy is attempted before maintainance dialysis begins. The goals of conservative therapy are to preserve existing renal function, treat the clinical manifestations, prevent complications, and provide for the patient's comfort.

Drug therapy : for the correction of extracellular fluid volume overload or deficit, erythropoietin therapy to treat anemia, calcium supplementation, phosphate binders, antihypertensive therapy, measures to lower potassium, adjustment of drug dosages to degree of renal function.

Nutritional therapy : Calorie-protein malnutrition is a potential and serious problem that results from altered metabolism, anemia, proteinuria, anorexia, and nausea. Frequent monitoring of laboratory parameters, especially serum albumin and ferritin, and anthropometric measures are necessary to evaluate nutritional status.

Some foods with high potassium content that should be avoided are oranges, bananas, melons, tomatoes, raisins, deep green and yellow vegetables, beans and legumes.

Patient and family teaching: It is important to teach the patient and family because diet, drugs, and follow-up medical care are the responsibility of the patient. The patient should check a daily weight,and be able to identify signs and symptoms of fluid overload, hyperkalemia, and other electrolyte imbalances. The patient and family must understand the importance of strict dietary adherence.

. Explain dietary (sodium, protein, phosphate) and fluid restrictions.

. Teach alternative ways of reducing thirst, such as sucking on ice cubes, lemon, or hard candy.

. Explain that phosphate binders should be taken with meals.

. Calcium supplements prescribed to treat hypocalcemia directly should be taken on an empty stomach, but not at the same time as iron supplements.

. Iron supplements should be taken between meals.

. Explain the importance of reporting any weight gain of 4lb,increasing BP, shortness of breath, edema, increasing fatigue or weakness, confusion or lethargy.

When conservative therapy is no longer effective haemodialysis, peritoneal dialysis and transplantation are the available treatment options.

Nursing diagnosis and interventions :

. Excess fluid volume related to inability of kidney to excrete fluid and excessive fluid intake as evidenced by edema, hypertension, bounding pulse, weight gain, shortness of breath, pulmonary edema.

Goal:Maintains an acceptable body weight and fluid balance with fluid and sodium restrictions or with peritoneal dialysis or haemodialysis treatment.

. Risk for injury related to alterations in bone structure due to decreased calcium absorption, retention of phosphate, and altered vitamin D metabolism.

Goal:interventions to reduce risk of fractures.

. Imbalanced nutrition less than body requirements related to restricted intake of nutrients, nausea, vomiting, anorexia as evidenced by loss of appetite and weight.

Goal:Maintains an acceptable weight with no more than a 10% weight loss. Maintains serum albumin, creatinine, and haemoglobin and hematocrit.

. Risk for infection related to suppressed immune system, and malnutrition secondary to dialysis and uremia.

Goal:experiences no infections. Describes self care practices to decrease the risk of infection.