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ADULT HEALTH II - III HESI Monday, March 18, 2013 4:55 PM Respiratory system Pathophysiology Nursing Assessment A. Tachypnea: shallow respirations with use of accessory muscles. Inflammation of lower respiratory tract B. Abrupt onset of fever with shaking and chills Caused by infectious agents (not reliable in O/A) Organisms reach the lungs in 3 C. Productive cough with pleuritic pain methods: D. Rapid bounding pulse 1. Aspiration E. In older adults sx include: 2. Inhalation 1. Confusion 3. H
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  Respiratory system Pathophysiology Nursing Assessment Analysis Plans Hints Pneumonia: Inflammation of lower respiratory tractCaused by infectious agentsAspiration1.Inhalation2.Hematogenous spread3.Organisms reach the lungs in 3 methods:Bacterial (gram pos and neg)1.Viral2.Fungal3.Chemical4.Pneumonia is classified according to causitive agentPneumonia may be community acquired or nosomcomialDebilitated by lung secretions1.Cigarette smokers2.Immoblie3.Imunosuppressed4.Expereincing a depressed gag reflex5.Sedated6.Experiencing neuromusclar disorders7.High risk groups includeTachypnea: shallow respirations with use of accessory muscles.A.Abrupt onset of fever with shaking and chills (not reliable in O/A)B.Productive cough with pleuritic painC.Rapid bounding pulseD.Confusion1.Lethargy2.Anorexia3.Rapid respiratory rate4.E.In older adults sx include:Pain and dullness to percussion over the affected lung areaF.Bronchial breaht sounds/cracklesG.Chest radiography indication of inflitrates with consolidation or pleural effusionsH.Elevated white blood cell coungI.ABG of hypoxemiaJ.On pulse oximetry a drop in O2 satruation (> 90 and ideally 95)K. Impaired gas exchange related to… A. Ineffective airway celarance related to… B. Activity intolerance related to… C. Risk for deficient fluid volume related to…. D. Ineffective breathing pattern related to… E.Assess suptum for volume, color, consistency and clarity.A.deep breathing care every 2 hours (many use incentive spiometer)1.Using humidity to loosen sevretions (may be oxylgenerated)2.Suctioning airway if necessary3.B.Assist client to cough productively by:Assess lung sounds before and after coughingC.Assess rate, depth, and pattern of respirations regularly (normal adult rate 16 to 20 breaths/min)D.Monitor Abg's (pO2 > 80mm2; Pco2 < 45mm hg)E.Monitor O2 saturation with pulse oximetry (ideally > 95%)F.Assess skin colorG.Assess mental status, restlessness, and irritabilityH.Administer o2 as prescribedI.Monitor temperature regularlyJ.Provide adequate rest periods, including uniterrupted sleep. K.Encourage at risk groups to annual pneumonia and influenza (flu) immuniziations. L.High risk for pneumoniaAny person who has an altered level of consciousness, has depressed or absent gag and cough reflexes or is susceptible to aspirating orophayngeal secretions, including alcoholics, anesthesized, those with a brain injury and those in a state of drug overdose and stroke victims are at high riskWhen feeding--raise the head of the bed and position the client on his or her side and not on the back.Bronchial brath sounds are heard over areas of density or consolidation. Sound waves are easily transmitted over consolidated tissues. HydrationEnables liquefication of mucous trapped in the bronchioles and alveoli, facilitating expectorationIs essential for client experiencing feverIs important because 300 to 400 mL of fluid is lost daily by the lugns through evaporation. Irritably and restlessnes are early signs of cerebral hypoxia; the cleint's brain is not recieiing enough of O2. Pneumonia PreventaivesOlder adults: flue shots; pneumonia, immunizations; avoiding soucres of infection and indoor pollutants (dust, smoke and aerosols); no smoking.Immunosuppressed and debilitated persons: infection avoidance, sensible nutition, adequate intake, balanced rest and activy. Comatose and immoblie persons: elevetion of head of bed to fed and for 2 hours after/ frequently turning Pathophysiology Nursing assessment Analysis Plans Hints Chronic airflow limitation Description: chonic lung disease includes chonic bronchitis; pulmonary emphysema and asthma. Emphysema and chonic boronchitis termed as chonic obstructive pulmonary disease (COPD) are characterized bronchospasm and dyspnea. The damage to the lung is not reversity and increases in the severity. Asthma, Unlike COPD, is an intermittent disease with reversible airflow obstruction. Changes in breathing pattern (eg. An increase with rate iand depth)Use of accessory breathing (barrel chest)Gernalized cyanosis of the lips, mucous memrbanes, face, nail beds ( blue bloaters)Cough (dry or productive)Higher Co2 than averageLow O2 as determined by pulse oximetary Decreased breath sound Coarse crackles in lung fields that tend disappear after coughing, wheezingDyspnea, orthopenaPoor ntuitionActivity intoleranceAnger1.Fear of being alone2.Far of not being able to catch breath3.Anxiety concerneing breathing manicested by:Ineffective airway clearance related toIneffective breathing pattern related to Impaired gas exchage related toActivity related toIn bed teach client to sit with arms resting on overbed table (tripod position01.In chair teach client to lean forward with elbows resting on knees (tripod position)2.Teach client to sit upright and bend slightly forward to promote breathingTeach diaphragmatic and pursed lip rbeathing. Teach prolonged expiratory phase to clear trappped airAdminister O2 at 1 -2 L per nasal canula. Pase activities to conserve energySelect small, frequent mealse1.Inscreased calories and protein2.Maintain adequate dietary intakeFavorite3.Dietary supplements4.Select foods that derive their calories from high fat rather than high carbohydrate level because Co2 that is a natrual end product of carbohydrate metablism and can elevate PaCo2 levelsFor people contiinuing to smoke tobacco, adiditional vatamin C may be necessary.Magnesium and clacium, because of their role in muscle contraction and relaxation, may be important for people with COPD. Routine monitoring of magnesium and phosphorus levels is important because of their role related to bone mineral density (osteoprorisis). Provide an adequate fluid intake (minimum 3 L day)Fluids should be taken between meals (rathern them) to prevent excess stomach distention and to decrease pressure on the diaphragm Instruct the client in relaxation techniques (teach when not in distress)Teach prevention of seconday infectionsTeach about medication regimenSmoking cessation is imparativeEncourage health promoting activities. Exposrue to tobacco smoke is the primary cause of COPD in the United States.Compensation occurs over time in clients over time in clients with chonic lung disease, and ABG's are altered. As COPD worsens the amount of O2 in the blood decreases (hypoxemia) and the amount of carbon dioxide (Co2) in the blood increases (hypercarbia), causing chonic repisratory acidosis (increased arterial carbon dioxide (paCo2), which results in metabolic a (increased arterial bicarbonate) as compensation. Not all clients with COPD are Co2 retainers, even when hypoxemia is present, because Co2 diffuses more easliy across lung memebranes than O2. In advanced emphysema, due to the alveoli bereing affected hypercarbia is is a problem rather than borchitis where the airway are affected.It is imparitive that basline data be obtained for the client. Productive cough and comfort can be facilited by semi fower or high power position, which lessens pressure on the diaphragm by abdominal organs. Gastric distention become a proity in these cliente because it elevates the idaphragm and inhibits full lung expansion. NORMAl ABG valuesAdult pH 7.35 -7.45Pco2 35 -45 mmHGPo2 80 to 100 mmhgHco3-21 to 28 mEq/LChildpH 7.36 -7.44Same as adultSame as adultSame as adultPink puffer: barrel chest is indicative of emphysema and is caused by the use of accessory muscles to breathe. The person works harder to breathe, but the amount of O2 taken is adequate to oxygenate the tissues. Blue bloater--insufficient oxygenation occurs with chonic bronchitis and leads to generalized cyanosis and often right sided heart failrue (cor pulmonale)Cells of the body depend on O2 to carry out their functions. Inadequate arterial oxygenation is manifested by cyanosis and slow capillary refill (< 3 seconds). A chonic sign is clubbing of the fingers. Caution must be used in administering O2 (not greater than 2L of O20 to a COPD client. The stimulus to breathe is hypoxia (hypoxic drive), not ADULT HEALTH II -III HESI Monday, March 18, 20134:55 PM  Study guides and Miscellaneous crap Page 1  the usualy hypercapnia, which is the stimulus to breathe for healthy persons. Therefore, if too mcuh O2 is given they may stop breathing. Helath promotion--Eatin consumes energy needed for breathing. Offer mechanically soft diets, which do not require as much chewing and digestion. Assist with feeding if needed.Prevent seconday infections: avoid corowds, contact with persons who have infectious diseases, and respriatory irritants (tobacco smoke)Teach the client to report any change in characteristics of sputum. Encourage client to hydrate well (3L/day) and decreases caffiene due to diuretic effect.Obtain immunizationw when needed (flu and pneumonia)When asked to pioritize nursing actions use the ABC rule:AirwayBreathing CirculationLook and listen! If breath sounds are celar but the client is cyanotic and lethargic, adequate oxygenation is not occurring. The key to respriatory status is assessment of breath sounds as well asl visualization of the client. Brath sound are better described, not named; e.g., sounds should be descrinbed as crackles, wheezes or high pitched whisteling sounds rather than rales, rhonchi, ect. Which may not mean the same thing to each clinical professional.Whatch out for NCLEX questions that deal with O2a delivery. In adults, O2 it must bubblet hrough some water solution so it can be humidified if given at > 4L/min or delivered directly to the trachea. If given at 1 -4/min or mask or nasal prongs the oropharynx and nasal pharynx provided adequate humidification. Pathophysiology Nursing assessment Analysis Plans Hints Tuberculosis: Transmission is airborneA.After initial exposrue, the bacteria encapsulate, they form a ghon lesionB.Bacteria remain dormant until later time, when clinical sympoms appearC.Communicable lung disease caused by an infection by mycobacterium tuberculosisIs often asymptomaticA.Fever with night sweats1.Anorexia, weight loss2.Malaise, fatigue3.Cough, hemoptysis4.Dsypnea, pleuritic chest pain with inspiration5.Cavitation or calicfication as evidenced on chest radiograph6.Positive sputum7.B.Symptoms include Knowledge deficiency (spefify) related to… A. Risk for infection related to… B.Imbalanced nutition less than body requirements related to…. C.Provide cleint teachingA.Take all priescribed medication daily for 9 to 12 months1.Wash hands using proper handwashing technique2.Report symptoms of deteriorating condition, especially hemorrhage3.B.Cough into tissues and dispose of immediately into specialCollect sputum cultures as needed; caliet many return to work after three negatives cultrues. C.Place client in respriatory isolation while hospitalizedD.Administer anti-TB medications as prescribedE.Refer client and high risk persons to local or state health department for testing and phrophylactic treatmentF.Tuberculosis (TB) skin testA positive TB skin test is exhibited by an inducation 10 mm orgreater in a diameter 48 hours after the skin test. Anyone who has received bacillus Calmette-Guerin (BCG) vaccine will have a positive skin test and must evaluated with chest radiograph. Teaching is very important with the client with TB. Drug therapy is usually long term (9 months or longer). It is essnetial that the cleint take the medicatiosn as prescibed for the entire time. Skipping doses or prematurlely terminating the drug therapy can result in a public health hazardTeaching points:Rifampin reduces effectiveness of oral contceptives; client should use other bierth control methods during isoniazid (INH); increased dilantin levelsEthambutol: vision check before starting therapy and monthsy therafter; may have to take for 1 to 2 years. Teach rational for combination drug therapy to increase compliance. Resistance develops slowly if several anti TB drugs given instead of just one drug at a time. Pathophysiology Nursing assessment Analysis Plans Hints Lung cancer Lung cancer is the elading cause of cancer related death in the united statesA.Cigarette smoking is responsible for 80 -90% of all lung cancersB.Exposure to occupational hazards such as asbestos and radioactive dust poses significant riskC.Lung cancer tends to appear years after exposrue; it is most common sdeen in persons in the fifth or sixth decade of lifeD.Lung cancer has a poor prognosis-5 year survivial rate is 14%E.Neoplasm of the lungDry hacking cough, early with cough turning productive disease progressesA.HoarsenessB.DyspneaC.Hemoptysis--rist colored or purulent sputumD.Pain in the chest areaE.Diminihed breath sounds, occasional wheezingF.Abnormal chest radiographG.Positive sputum for cytology for plural fluid. H. Chonic pain related to… A. Ineffective breathing pattern related to… B. Impaired gas exchange related to…. C.Imbalanced nutition: less than body reuqirements related to… D. Anxiety related to…. E.Nursing interventions are simlar to those implemented for clients with COPDA.Place client in SEMI fowler positionB.Teach pursed lip breathing to imporve gas exchangeC.Teach relaxation techniques; client often becomes anxious about rbeathing difficulty]D.Adminsister O2 as indicated by pulse oximetry of ABG'sE.Take measures to allay anxietyF.Keep client and family informed of impending tests and procedures1.Give client as much control as possible over personal care2.Encourage client and family to verbalize concerns3.Decrease pain to manageable level by administering analgesics as needed (within safety range for respiratory difficultyG.Toractomy for clients who have resectable tumor. (unfoturnately detection commonly occurs so late that the tumor is no longer localized and is amenable to resection)1.Pneumoectomy (removal of the entire lung2.Position client on operative side or backa.Chest tubes are not usually b.SurgerySome tumors are so large that they fil the entire lobes of the lung. When removed, large spaces are left. Chest tubes are not ususally used with these clients because it is helpful if the mediastinal cavity, where the lung used to be, fills up with fluid. This fluid helps to prevent the shift of the remaining chest organs to fill the empty space. Chest tubes:If the chest tube becomes disconnected do not clamp! Immediately place the end of the tube in a container of sterile saline or water until a new drainge system can cbe connected.if the chest tube is accidnetally removed from the client, the nruse should apply pressure immediately with an occlusive dressing and notify the HCP.Chest tubes:Fluctations tidaling in the fluid will occur if there is no external suction. These fluctating movments are a good indicator that the system is intact; they should move upward with each inspiration and downward with each expiration> if fluctutations cease, check for kinked tubing; accumulation of fluid in the tubing, occluaions or change the client's position because expanding lung tissue may be occluding the tube opening. Remember when external sucation is applied, the flutations cease. Most hospitals do not milk the chest tubes as a means of clearning or preventing clots. It is too easy to remove chest tubes. Mediastinal tubes may involve orders to be stripped because of their location compared to the larger thoracic cavity tubes.  Study guides and Miscellaneous crap Page 2  usedLobeectomy and segmental resection3.Position client on his or her backa.Check to ensure tubing is not kindked or obstructedb.Chest tubes are usually insertedc.Chest tubes4.Keep all tubing coiled loosely below chest levels, with connections tight and tapeda.Keep water seal and suction control chambers at the aporopriate water levelsb.Monitor the fluid drainage and amrk the time of measument and the fluid levelc.Observe for air bubbling in the water seal chamber and fluctuations (tidaling)d.Monitor the client's clinical statuse.Check the position of the chest drainage system.f.Encourage the client to rbeathe deeply periodicallyg.Do not empty collection chamberh.Do not strip or milk the tubesi.Chest tubes are not clamped routinelsy. If the drinage system breaks, place the distal end of the chest tubing connectiion in a steril water container at 2 cm level as emergency water seal j.Maintain a dry occlusive dressing. k.Attend to immunosuppresion factor1.Administer antiemetics prior to administering chemotherapy2.Take precautions in administering antineoplastics3.ChemotherapyProvide skin care according to hcp1.Instruct the client not to wash off the lines drawn by the radiologist2.Instruct client to sear soft connon garments only3.Avoid use of powders and creams on radiationg site unless specified by radiologist4.Radiation therapyVarious pathophysiologic conditions can be related to the nrusing dx ineffective breathing patterns.Inability of air sac to fill and empty propery (empysema, cystic fibrosis)Obstruction of the air passages (carcinoma, ashma, chonic bronchitis)Accumulation of fluid in the air sace (pneumonia)respiratory muscle fatigue (COPD) pneumonia. Pathophysiology Assessment Analysis Plans Hints Cancer of the larynx Proolonged use of alcohol and tobacco is directly related to the developmentA.Other contibuting factors includeB.Vocal straining1.Chonic laryngitis2.Family predisposition3.Industrial exposure to carcinogens4.Nutitional deficiencies5.Men are affected 8 times more often than womenC.Dx usually occurs between the age of 55 and 80D.The earliest sign is hoarseness or a change in vocal qualityE.Medical management incldues radiation therapy, often with adjuvant chemotherapy or surgical removal of the larynx--laryngectomyF.Neoplasm occurring in the larynx most commonly squamous cell in srcinMagnetic resonance imagingA.Direct laryngoscopyB.Assessing for hoarseness of longer than 2 weeks--early changesC.Assessing for color changes in the mouth or tongueD.Assessing for dysphagia, dyspnea, cough, hemotysis, weight loss, neck pain, radiating to the ear, enlarged cervical nodes, and halitosis (later changes)E.Radiographs of the head, neck and chestF.Computed tomography (CT scan of neck and biopsy. G.Nursing Diagnosis Anxiety related to…. A.Ineffective airway clearance related toB.Impaired verbal communication related to… C.Ineffective breathing pattern related to… D.Client undergoing laryngectomyallow client and fmily to observe and handle tracheostomy tubes and suctioning equipment1.Explain how and why suctioning will take place after surgery2.Plan for acceptable communication methods after surgery3.Consider literacy level4.Refer the cleint to a speech patholgist5.Discuss the planned rehabilitation program6.A.Provide preoperative teaching.Use simple communication1.Use planned alternative communication methods2.Keep call bell/light within reach at all times3.Ask client yes/no questions whenever possible4.B.Provide postoperative careAssess respiratory rate and characteristics every 1 to 2 hours1.Keep bed in semi fowler position at all times2.Keep larygnal airway humidified at all times3.Auscultate lung sounds every 2 -4 horus4.Provide tracheostomy care every 2 -4 hours and PRN5.Administer tube feedings as prescribed6.Encourage ambulation as early as possible7.Refer for sppch rehabiltiaion with artificial larynx or learn esophageal speech. 8.C.Promote respiratory functioningwith cancer of the larynx the tongue and mouth often appear white, gray, dark brown or black and may appear patchy. Tracheostomy care involves cleaning the inner canula, suctioning and applying clean dressing. Air entering the lungs is humidified along the nasobronchial tree. This natural humidifying pathway is gone for the client who has had a laryngectomy. If the air is not humidified before entering the lugns, secretions tend to thicken and become crusty. A laryngectomy tube has a larger lumen and is shorter than the tracheostomy tube. Observe the cleint for any signs of bleeding or occlusion, which are the greatest immediate postoperative risks (first 24 hours)Fear of choking is very real for lyngectomy clients. They cannot cough as they could earlier because the glottis is gone. Teach the glottal stop technique to remove secretions (take a deep breath, momentarily occlude the tracheostomy tube, cough and simultaneously remove the finger from the tube. Renal System Pathophysiology Assessment Analysis Plans Hints  Study guides and Miscellaneous crap Page 3  Acute Renal failure ARF occurs when metabolites accumulate in the body and urinary output changesA.There are three major types of ARFB.Oliguric phase1.Diuretic phase2.Recovery phase3.C.There are 3 phases of ARFAbrupt deteroiration of the renal systemHistory of taking nephrotoxic drugs (salicylates, antibiotics, nonsteroidal antiinflammatory drugs NSAIDS)A.Alteration in urinary outputB.Edema, weight gain (ask if wastbands have suddenly become too tightC.Change in mental statusD.Increased blood urea nitrogen (BUN) and creatinine1.Increased potassium (hyperkalemia)2.Decreased sodium (hyponatremia)3.Decreased pH (Acidosis)4.Fluid overload (hypervolemic)5.High Urine specific gravity (> 1.020 g/ml)6.E.Diagnostic findings in the oliguric phaseDecreased fluid volume (hypovolemia)1.Decreased potassium (hypokalemia)2.Further decrease in sodium (hyponatremia)3.Low urine specific gravity (< 1.020 g/ml)4.F.Diagnostic findings in the diuretic phaseDiagnostic lab works returns to normal in the recovery phaseG.Excess fluid volume related toA.Deficient fluid volume related toB.Anxiety related toC.Imbalanced nutrition: less than body requirements related to… D.Monitor intake and output (I & O) accurately: give only enough fluids in oliguric phase to replace losses; usually 400 to 500 ml/24 hrA.Document and report any change in fluid volume statusB.Monitor lab values of both serum and urine to assess electrolyte status, especially hyperkalemia indicated by serum potassium levels over 5 mEq/L and ECG changesC.Assess level of consciousness for subtle changesD.Weigh daily: in oliguric phase; client may gain up to 1 lb per dayE.Prevent cross-infectionF.Kayexalate may be prescribed if K+ is too highG.Provide low protein, modlelrate fat, high carbohydrate dietH.Monitor cardiac rate and rhytm (acute cardiac dysrhymias are usually related to hyperkalemiaI.Monitor drug levels and interactionsJ.Normally kidneys excrete approximately 1 ml of urine per kg of body weight per hour. For adults totoal daily surine output ranges between 1500 and 2000 ml depending on the amount and type of fluid intake, amount of perspiration, envionmental or ambient temp and the presence of vomiting and diarrheaElectrolytes are profoundly affected by kidney problems. There must be a blanace between extracellular fluid and intracellular fluid to maintain homeostasis. A change in the number of ions or in the amount of fluid will cause a hshift in one direction or the other. Sodium and chloride are the primary extracellular ions. Potassium and phosphate are the primary intracellular ionsIn some cases, persons in ARF may not experience the oliguric phase but may progress directly to the diruetic phase, during which the urine output may be as much as 10 L per day. Body weight is a good indicator of fluid retention and renal status. Obtain accurate weights of all clients with renal failure; obtain weight on the same scale at the same time every day. Fluid volume alterations Excessive fluid sympoms DyspneaTachycardiaJugular vein distentionPeripheral edemaWeight gain Fluid deficient symptoms Decreased urin outputReduction in body weightDecreased skin turgorDry mucsous membranesHypotensionTachycardiaWeight lossWatch for signs of hyperkalemia, dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea and nauseaPotassium has a critical safe range (3.5 to 5.0 mEq/L) because it affects the heart and any imbalance must be corrected by medications or dietary modification. Limit high potassium foods (bananas, orange juice, cantaloupe, strawberries, avocados, spinach, fish) and salt substitutes, which are high in potassiumClients with renal failure retain diluted and serum levels may appear near normal. With excessive water retention, the sodium levels appear decreased (dilution). Limit fluid and sodium intake in ARF clients.During oliguric phase, minimize protein breakdown and prevent rise in BUN by limiting protein intake. When the BUN and creatinine return to normal, ARF if determined to be resolved. Pathophysiology Assessment Analysis Plans Hints Chronic Renal Failure (CRF): end stage renal disease (ESRD) Causes chonic renal failure are multitudinousA.As renal function diminishes, dialysis becomes necessaryB.Transplantation is an alternative to dialysis for some clientsC.Progressive, irreversible damage to the nephrons and glomeruli, resulting in uremiaHistory of high mediation usageA.Family history of renal diseaseB.Increased blood pressure (BP) and/or chonic hypertensionC.Edema, pulmonary edemaD.Neurologic impairment (Weakness, drowsiness)E.HEMATURIA1.PROTINURIA2.CLOUDY URINE3.OLIGURIC (100 TO 400 ML/DAY)4.Anuric (< 100 ml/day)5.F.Decreasing urinary functionJaundiceG.Gastrointestinal GI upsetsH.Metallic taste in mouthI.Ammonia breathJ.DialysisK.Previous kidney transplantL.Axotemia1.Increased creatinine and BUN2.Decreased calium3.Elevated phosphorus and magnesium4.M.Lab information Excess fluid volume related to… A.Imbalanced nutition: less than body requirements related to… B. Decreased cardiac output related to… C.Monitor serum electrolyte levelsA.Weigh dailyB.Monitor strict I & OC.Check for jugular vein distention (JVD) and other signs of fluid overloadD.Monitor for edema and pulmonary edemaE.Provide low protein, low sodium, low potassium, low phosphate dietF.Administer aluminum hydroxide antacids to bind phosphates because client is unable to excrete phosphates (no magnesium based antacids) timing is important!G.Encourage client's protein intake to be of high biologic values (eggs, milk meat) because the client is on a low protein dietH.Alternate periods of rest with periods of activity I.:Encourage streict adherance to medication regimen; teach client to obtain health care provider's permission before taking any over the counter medications. J.Anermia (administer antiaemetic drug)1.Renal osteodystrophy (abnormal clcium metabolism causes bbone pathology)2.Severe, resistant, hypertension3.Infection4.Metabolic acidosis5.K.Observer for complicationsMonitor for rejection1.Monitor for injection2. L.Living related or cadaver renal transplantAccumulation of waste products from potein metabolsim is the primay cause of uremia. Protein must be restricted in CRF clients. However, if protein intake is inadequate, a negative nitrogen balance occurs, causing muslce wasting. The glomerular filtration rate (GFR) is most often used as an indicator of the level of protein consumption. All persons in the united states are eligeble for medicare as of their first day of dialysis under special ESRD fundingMedicare card will indicate ESRDTransplatiation is covered by medicare procedure; cover terminates 6 months postoperaively if dialysis is no longer required.Protein intake is restricted until blood chemistry shows ability to handle the protein catabolites, urea and creatinine. Ensure high calorie intake so protein is spared for its own work; give hard candy, jelly beans or flavored carbohydrate powders. The biggest difference between dialysate for hemodialysis and peritoneal dialysis is the amount of glucose. Peritoneal dialysis dialysate is much higher in glucose. For this reason, if the diasylate is left in the peritoneal cavity too long, hyperglycemia may occur. As kidneys fail, medications must often be adjusted. Of particular importance is digoxin toxicity because digitalis preparations are extreted by the kidneys. Signs of toxicity in adults include nausea, vomiting, anorexia, visual disturbances, restlessnes,s ehadache, cardiac dysrhymia, an pulses <60 bpm.  Study guides and Miscellaneous crap Page 4
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