Explain the function of the kidneys in regulating fluids, electrolyte balance, acid–base balance, blood pressure, RBC production, and Vitamin D synthesis.

Learning Objective #1: Explain the function of the kidneys in regulating fluids, electrolyte balance, acid–base balance, blood pressure, RBC production, and Vitamin D synthesis.

a. What are the main functions of the kidneys?

b. During urine formation, which two substances should be reabsorbed and not excreted in the urine?

c. What two major electrolytes do the kidneys help regulate?

d. What is the role of the kidneys in maintaining serum pH through bicarbonate?

e. Explain the renin-angiotensin system in regulating blood pressure, including the roles of anti-diuretic hormone and aldosterone in this system.

f. How do the kidneys contribute to RBC production?

g. How do the kidneys contribute to Vitamin D synthesis?

Learning Objective #2: Explain the renal system changes and nursing implications for older people.

Learning Objective #3: Initiate education, preparation, and monitoring for patients undergoing diagnostic studies, including labs, 24-hour urine collection, any that use contrast media, and kidney biopsy.

a. What are the normal ranges for urine specific gravity, creatinine clearance, serum creatinine, serum BUN, and GFR?

b. What is the significance of abnormal values of urine specific gravity, creatinine clearance, serum creatinine, BUN, and GFR in kidney disorders?

c. What is the purpose and proper collection steps for a 24-hour urine collection?

d. What are the pre-, intra-, and post-procedure interventions and rationales for a patient who will receive intravenous contrast media during a diagnostic test?

Brunner and Suddarth Chapter 54

Reading:

· Chronic Kidney Disease, pp 1569-1570

· Acute Kidney Injury, pp 1576-1581

· ESKD, pp 1581-1589

· Renal Replacement Therapies, pp 1589-1602

Charts/Tables/Figures:

· Chart 54-1, Stages of Chronic Kidney Disease

· Figure 54-4, Causes of Acute Kidney Injury

· Chart 54-6, Assessing for ESKD

· Chart 54-7, Nursing Care for ESKD

Learning Objective #1: Differentiate between chronic kidney disease (CKD) and acute kidney injury (AKI).

a. What is the definition and diagnostic criteria of AKI?

b. What are the categories and causes associated with each category for AKI?

c. What is the definition of CKD?

d. What are the risk factors and causes of CKD?

Learning Objective #2: Explain the pathophysiology, clinical manifestations, medical management, and nursing management for patients with acute kidney injury.

a. Identify and describe the phases of AKI and estimated timeline for each.

b. What are the clinical manifestations (signs/symptoms) for each phase of AKI? How are these s/s for each phase of AKI related to the patho of the condition?

c. Explain the changes to the following labs in the oliguric phase of AKI: BUN, creatinine, GFR, creatinine clearance, potassium, magnesium, phosphorus, calcium, sodium, pH.

d. Explain why the following nursing management is necessary in AKI, what assessments for each should be completed, and what are the expected nursing and collaborative interventions for each?

i. Nutrition

ii. Fluids and electrolytes

iii. Metabolic rate

iv. Pulmonary function

v. Infection prevention

vi. Skin care

Learning Objective #3: Explain the pathophysiology, clinical manifestations, medical management, and nursing management for patients with chronic kidney disease.

a. What are the stages of CKD?

b. What are the main treatments in early stage CKD? Why?

c. Why does ESKD affect all body systems?

d. Explain the changes to the following labs in the ESKD: BUN, creatinine, GFR, creatinine clearance, potassium, magnesium, phosphorus, calcium, sodium, pH.

e. What are the signs/symptoms and nursing/collaborative interventions for the following pathologic changes in ESKD?

i. Activation of the RAAS system

ii. Reduced urea excretion and decreased bicarb reabsorption

iii. Inadequate erythropoietin excretion

iv. Hyperphosphatemia, hypocalcemia, and decreased Vit D synthesis

v. Hyperkalemia and hypermagnesemia

Learning Objective #4: Compare and contrast the renal replacement therapies, including hemodialysis, peritoneal dialysis, continuous renal replacement therapies.

a. What is the purpose of dialysis, regardless of type?

b. What acts as the semi-permeable membrane in hemodialysis vs. peritoneal dialysis?

c. What is a continuous renal replacement therapy, and when is it a preferred dialysis treatment?

d. Differentiate between temporary and permanent dialysis access. When is a temporary access used?

e. What is the difference between a hemodialysis fistula vs graft?

f. Differentiate the permanent dialysis access of hemodialysis vs. peritoneal dialysis.

Learning Objective #5: Identify the nursing management of the patient on hemodialysis.

a. What are the nursing considerations for a temporary dialysis access?

b. What are the nursing assessments and interventions for a hemodialysis fistula and graft?

c. What are the side effects of hemodialysis, and why do these occur?

d. What is the nursing/collaborative assessments and interventions for the following HD complications:

i. hypotension

ii. exsanguination

iii. dysrhythmias

iv. disequilibrium syndrome

Learning Objective #6: Identify the nursing management of the patient on peritoneal dialysis.

a. What are the nursing assessments and interventions for a peritoneal dialysis catheter?

b. Explain the phases of a peritoneal dialysis exchange, including the differences between AIPD, CAPD, and CCPD.

c. Explain the pre-, intra-, and post-PD (including patient education) nursing assessments/interventions and rationales for each.

d. Identify the signs/symptoms and management of the following PD complications

i. Peritonitis

ii. Exit site infections

iii. Catheter leakage

Learning Objective #7: Develop a perioperative plan of nursing care for the patient undergoing kidney transplantation.