Description

  Treatment of choice for older adults and pts who have difficulty w/ vascular access  Pt will feel fullness when dialysate dwelling  Record amount of inflow vs outflow; outflow should be clear/light yellow and inflow amount should equal outflow amount, warm dialysate before instilling; keep outflow bag lower than abdomen  Peritonitis(complication): s/s= fever, purulent drainage, redness, swelling, cloudy/discolored outflow solution  Hyperglycemia (complication): monitor glucose and admin insulin as needed  Poor inflow/outflow (complication): caused by kinked/obstructed tubing or constipation; milk tubing to break up fibrin clots; pt should increase fiber and use stool softeners   urine output should be > 30mL/hr (if less notify HCP)  monitor for s/s of rejection (fever, HTN, pain at site)  encourage turning and deep breathing  urinary catheter care/continuous bladder irrigation  immunosuppressive meds (prednisone/cyclosporine) and monoclonal antibodies (basilixmab/daclizumab)  low-fat, high-fiber, increased protein, avoid concentrated sugars and carbsto control glycemic factors when on prednisone  no contact sports  Organ Rejection: (complication) -hyperacute: occurs within 48 hours of surgery; antibody-mediated response caused small clotsto form in kidney; irreversible; requiresimmediate removal -acute: occurs 1 week- years after surgery; tx requires increasing doses of immunosuppressants -chronic: occurs gradually over months to years   Onset phase: starts w/ onset of event and ends when oliguria develops; lasts hours-days  Oliguria phase: output= 100-400 mL/24 hrs; lasts 1-3 weeks  Diuresis phase: begins when kidneys start to recover; lasts 2-6 weeks  Recovery phase: continues until kidney fx restored; can take up to 12 months  Prerenal: reduction of blood flow to kidneys causing volume depletion  Intrarenal: direct damage to kidney from lack of O2  Postrenal: bilateral obstruction of structuresleaving the kidney  Labs: creatinine will gradually increase; BUN increased  Restrict K, Na, P, Mg (dependent on stage); high-protein diet   Stage 1: GFR > 90  Stage 2: GFR= 60-90  Stage 3: GFR= 30-59  Stage 4: GFR= 15-29  Stage 5: GFR < 15  Prevention: drink at least 2L water/day, stop smoking, limit alcohol, manage weight w/ diet and exercise and prevent/manage HTN and DM  S/S: (most RT FVO); slurred speech, lethargy, tremors/jerky movements, JVD, HF, HTN, SOB, tachypnea, crackles, anemia (pallor, weakness, dizziness), vomiting, pruritis, urea crystal in skin (uremic frost)  Labs: hematuria; proteinuria; gradual increase of BUN/creatinine; decreased sodium and calcium; increased K, P, and Mg; decreased Hgb/Hct  2.2lb daily weight increase= 1L of fluid retained  Restrict sodium, K, P, and Mg; diet w/ high-carb and moderate-fat  Meticulous skin care  Avoid aminoglycosides/amphotericin B, NSAIDs, ACE/ARBs, and contrast dye  Meds : digoxin; sodium polystyrene (helps decrease K); epo -alfa; ferrous sulfate; furosemide  Pts should avoid antacids containing Mg and take rest periods from activity   Untreated UTI9s can lead to pyelonephritis and urosepsis  Risks: sex, pregnancy, females, synthetic underwear/pantyhose, wet bathing suits, frequentsubmersion into baths/hot tubs, catheters,stool incontinence, DM, neurogenic bladder  S/S: lower back/abdominal pain; nausea; frequency/urgency; feeling of incomplete emptying/retention; hematuria; fever; nocturia; cloudy/foul -smelling urine  Older adult S/S : confusion, hypotension, tachycardia, tachypnea, fever (indications of urosepsis)  Labs : bacteria, WBC, RBC, positive leukocyte esterase and nitrates  Meds : fluoroquinolones, nitrofurantoin, sulfonamides, phenazopyridine (relieves discomfort; will turn urine orange)  Mgmt: Pt should drink at least 3L fluid a day; bathe daily for good hygiene; empty bladder q 3 - 4 hours instead of waiting until its full; urinate before and after sex; avoid bubble baths/feminine products/toilet paper that contain perfumes; don 9 t sit in wet bathing suit; a void tight clothin g/pant yhose