Renal care Nursing Quiz: Dialysis, Transplantation & Patient Management

In a patient on dialysis, it is important to closely monitor labs including chemistries, WBC count, and coagulation studies to ensure that the patient's blood levels are within the desired range. Frequent vital signs, including temperature, should also be monitored before, during, and after the procedure to assess the patient's overall health and identify any potential complications. Additionally, monitoring the patient's weight before and after the procedure at the same time every day can help track fluid balance and identify any excessive fluid gains or losses. Therefore, all of these factors should be closely monitored in a patient on dialysis.

In patients with stage 2-4 renal disease, consuming high amounts of protein can worsen their uremic symptoms. This is because the kidneys are not able to effectively filter and remove the waste products of protein metabolism, leading to a buildup of urea and other toxins in the blood. This can result in symptoms such as fatigue, nausea, and decreased appetite. Therefore, it is important for patients with renal disease to limit their protein intake to manage their symptoms and maintain kidney function.

In stages 4-5 (ESRD) patients, the kidneys are significantly damaged and are unable to function properly. As a result, certain substances need to be restricted in the diet to prevent further damage and complications. Protein needs to be restricted because the kidneys are unable to effectively remove waste products from protein metabolism. Fluids need to be restricted to prevent fluid overload and swelling. Potassium (K+) needs to be restricted because the kidneys cannot properly regulate potassium levels in the blood. Phosphorous needs to be restricted because the kidneys are unable to excrete excess phosphorous, leading to imbalances in calcium and phosphorous levels.

Dialysis is a medical procedure used to treat End-Stage Renal Disease (ESRD), which is a condition where the kidneys are no longer able to function properly. The major purpose of dialysis in ESRD is to correct imbalances of fluid, electrolytes, and acid-base in the body. When the kidneys are not functioning properly, these imbalances can occur, leading to complications and potential organ damage. Dialysis helps to remove excess fluid, electrolytes, and waste products from the blood, restoring the balance and preventing further complications. It does not specifically correct renal dysfunction, remove protein from the blood, or remove drugs from the blood.

After renal transplantation, the patient's immune system needs to be suppressed in order to prevent rejection of the transplanted kidney. Immunosuppressive medications are crucial in achieving this goal. These medications help to suppress the immune response and prevent the immune system from attacking the transplanted kidney. By taking immunosuppressive medications daily, the patient can ensure that their immune system remains suppressed, allowing the transplanted kidney to function properly. Therefore, immunosuppressive medications are critical for post-renal transplantation patients.

After a kidney transplant, the transplanted kidney is able to function more efficiently and has improved clearance of waste products such as blood urea nitrogen (BUN). BUN acts as an osmotic diuretic, meaning it increases urine production by drawing water into the urine. Therefore, increased urinary output is a likely finding post transplant due to the improved clearance of BUN by the transplanted kidney.

All of these are concerns in PD because peritoneal dialysis is a procedure that involves the insertion of a catheter into the peritoneal cavity, which can increase the risk of infection. Additionally, peritoneal dialysis can lead to fluid retention, hyperglycemia, increased triglyceride levels, and protein losses. Therefore, all of these factors are major risk factors associated with peritoneal dialysis.

Patients with glomerulonephritis may require fluid restriction because this condition affects the kidneys' ability to filter waste and excess fluid from the body. Fluid restriction helps to reduce the workload on the kidneys and prevent further damage. Patients with stage 1 renal failure may not require fluid restriction as their kidney function is still relatively normal. The patient with a UTI and the patient who is going to be a transplant donor may not necessarily require fluid restriction as their conditions may not directly affect kidney function.

Delirium is often the presenting sign of UTI in the elderly. This means that when an elderly patient presents with delirium, it is important to consider the possibility of a urinary tract infection (UTI) as the cause. UTIs are common in the elderly population and can present with atypical symptoms such as confusion or delirium. Therefore, it is crucial to assess renal function and consider the possibility of a UTI when managing delirium in elderly patients.

The conditions that place a patient at higher risk for developing CKD are recurrent urinary tract infections including pyelonephritis, hypertension, acute renal failure, DM (with uncontrolled glucoses), and glomerular nephritis. These conditions can all contribute to kidney damage and impair kidney function, leading to the development of CKD.

In Chronic Kidney Disease (CKD), there is a decrease in the filtration function of the kidneys, leading to the retention of waste products and electrolyte imbalances. Increased hematocrit and hemoglobin levels occur due to the kidneys' reduced ability to produce erythropoietin, a hormone that stimulates red blood cell production. Increased potassium levels result from impaired renal excretion. Metabolic acidosis occurs due to the kidneys' inability to excrete acid effectively. Decreased calcium levels occur because the kidneys are unable to activate vitamin D, leading to decreased absorption of calcium from the intestines. Decreased hematocrit and hemoglobin levels can also occur due to anemia associated with CKD. Increased calcium levels are not typically seen in CKD.