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Kidney Disease: Clinical Replacement Clinical Replacement 1: Kidney Disease Note to Student about Clinical Replacement: Please note the following when completing the assignment: To ensure students meet the required learning engagement hours for the course, this clinical replacement assignment has been created to serve as clinical hours. It has a time in module component that you will need to submit. All grading will be done by your clinical faculty, and they have been instructed to send it back to you if there are any areas that are not completed at a competence level (meaning your responses to the questions are comprehensive and show depth of knowledge and achievement of the course outcomes). There are no “points” associated with this work as it is for make-up of hours only, but your work will be taken into consideration as your faculty completes your mid-term and final clinical evaluations. Please make sure you are using in-text citations and a reference page for all work. Also note you cannot re-use old work you may have completed in this or another course. Finally, since this serves as your clinical day, failure to turn this assignment in on time could result in an unexcused absence and failure in the course. Simulation: Real Life 4. Module: RN Adult Medical Surgical Kidney Disease You will submit to the dropbox the following documents:
- Module report showing STRONG
- Completion of this paperwork
- Completed care plan
- Completed reflection
Kidney Disease: Clinical Replacement Prepare: Module 1 Introduction This scenario focuses on a female client who has a diagnosis of chronic kidney disease (CKD). It addresses client centered concepts related to effects of hyperkalemia, dialysis, and social determinants of health. Nursing focused concepts include client education, client communication, prioritization of care, and medication administration. Students will be expected to be knowledgeable of client assessments, telemetry principles, and electrolyte imbalances. Outcomes Upon completion of this module, you will be able to: Describe nursing care for clients experiencing alterations to regulation and metabolism. Apply the nursing process for clients experiencing alterations to regulation and metabolism. Identify essential collaborative interventions for clients experiencing alterations to regulation and metabolism. Competently execute essential skills related to the care of clients experiencing alterations to regulation and metabolism in lab, simulation, and clinical environments. Read/Consult ATI Adult Medical Surgical Nursing eBook o Chapters 44, 57 and 59 Harding, M.M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2023). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier, Inc. ISBN: 978-0-323-78961-5. o Chapters 17 and 51 Tasks
- Using the 5 step method presented in the Strategies for Success presentation (Transcript: Strategies for Success), complete the following questions: Chronic Kidney Disease a. What is the anticipated cause for the illness/problem? b. What signs and symptoms will need to be monitored for? c. What labs should the nurse be reviewing? d. What evidence-based interventions should the RN be anticipating performing? e. What orders will the RN anticipate? These will become your recommendations. Disequilibrium syndrome -- judy a. What is the anticipated cause for the illness/problem? i. Disequilibrium syndrome is when there is are neurological manifestations that occur after dialysis, generally, it happens soon after the initiation of a new dialysis session. It can also happen when someone who needs regular dialysis goes for an extended period of time without receiving dialysis and there is a build-up of waste in the blood.
NUR390 Nursing Care of the Adult 1 Kidney Disease: Clinical Replacement 4 Medicatio n Name Class Safe Dose Range Critical Assessment Data needed prior to administration How will you evaluate the effectiveness of the medication? What education must you provide before administering? Sevelamer Carbonate 800 mg Phosphate binder 400- mg
- If patient is taking Ciproflaxin or other quinolones.
- May decrease effectiveness of levothyroxine or increase adverse effects.
- Contraindicated for hypersensitive to sevelamer or other hypophosphatem ia drugs or patients with bowel obstruction. - Monitoring lowering of labs such as phosphorus , calcium, bicarbonate levels. - Take with food and maintain specific drug diet. - Take table whole and entirely, do not cut, chew, or crush. - Do not take if taking other Sevelamer drugs. - Can cause constipation. Docusate Sodium 100 mg Laxative 10-250 mg - Assess proper fluid intake, diet, and exercise.
- Do not give is pregnant or lactating.
- Used for patients recovering from MI, rectal surgery, or postpartum constipation.
- Not for hypertensive patients.
- Not for patients with bowel obstruction.
- Not for patients with symptoms of appendicitis, vomiting, or undiagnosed abdominal pain. Promotes softer stool mass and makes defecation relief possible. - Intake proper fiber intake such as bran, fresh fruits, and vegetables. - Stop medication and call PCP if have severe cramping. - Do not take OTC more than 7 days if N/V or abdominal pain are present. - Use drug occasionally and no longer than 1 week. Tacrolimus 0.1% Immunosuppressa nt
application s a day
- Allergies to the drug.
- If have had skin cancer or pre- cancer to that area or if have Netherton’s syndrome or any skin weakening Skin will clear of eczema. - Do not take by mouth. - Wash hands before and after administratio n. - Do not use on healthy
Kidney Disease: Clinical Replacement m. Atorvastatin 20 mg PO daily
- When you are a nurse on the floor and you have a client who goes to hemodialysis (HD), you will need to know which of the above medications you can give or not. Write a list of the medications you plan to give to your client PRIOR to going to HD.
Kidney Disease: Clinical Replacement i. Calcium gluconate will be administered to push potassium back into the cells and bring balance to the cells (Handing, 2023) j. Which nursing interventions are appropriate to address the risk of hyperkalemia in the client with chronic kidney disease? i. It is important for the nurse to monitor potassium levels and educate the patient to monitor potassium dietary intake as well as administer a diuretic like furosemide to lower potassium. ii. Monitor ECG rhythm for cardiac peak T-waves. iii. Monitor for hyperglycemia. iv. Monitor for hypotension post administration of calcium gluconate. k. What collaborative interventions do you anticipate for hyperkalemia. i. IV regular insulin and beta- adrenergic agonist. ii. Oral Kayexalate, binds potassium in the GI system for it to be eliminated through the stimulation of bowels. iii. Administer calcium gluconate. l. What precautions will the nurse need to take to administer furosemide via IV push? i. Monitoring blood pressure and ECG. ii. Monitor I/Os m. If Ana Sofia Swisher demonstrates a low blood pressure after hemodialysis, what action(s) would the nurse take? i. Elevate legs to increase blood return to the heart and increase blood volume and, therefore, blood pressure. n. How will the nurse know furosemide is effective at decreasing the potassium level in the client with chronic kidney disease? i. Serum potassium levels will be lowered. ii. Urine output will have increased. iii. Edema will decrease. o. Which assessment findings would suggest hemodialysis has achieved the desired client outcomes?
Kidney Disease: Clinical Replacement i. Fluid balance will have optimized by appearance of leg edema and optimized pitting edema. p. What is an arteriovenous (AV) fistula? i. It is an anastomosis between an artery and a vein where arterial blood flows through the vein. It is used for rapid blood flow during hemodialysis. Maturation needs to be reached, usually takes about 6 weeks after implantation before usage is allowed (Handing, 2023) q. Are there any safety concerns related to this type of fistula? i. Do not perform BP measurements on arm with fistula. ii. Do not insert IV or perform venipuncture in fistula. References Bhandari, B. (2023, May 29). Dialysis disequilibrium syndrome. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559018/#:~:text=Dialysis%20disequilibrium %20syndrome%20refers%20to,that%20accumulate%20in%20the%20blood. Harding, M.M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Evolve resources for Lewis’s medical-surgical nursing (12th ed.). Elsevier, Inc. ISBN: 9780323792356
