Medical Management

I. Promote Fluid and Electrolyte and Acid Base Balance

A. Fluid Balance

Monitor fluid volume status Weight most accurate indicator (daily) Input and Output monitoring Assessment of skin turgor and mucous membrane Fluid restrictions Amount of fluids to be taken per day (400 ml (insensible fluid loss) + previous days urine output. Moisten the lips, give ice chips Diuretic therapy Furosemide and Mannitol are often use B. Electrolyte Balance

1. Hyperkalemia impaired potassium excretion; indication for dialysis; result from metabolic acidosis

If there is Emergency Hyperkalemia give 50% dextrose and regular insulin Can give sodium bicarbonate for acidosis Client can be given with Sodium Polystyrene Sulfonate (Kayexalate) can be given with Sorbitol to promote evacuation; can be given orally or rectally Avoid salt substitutes 2. Hyponatremia restriction of fluids

Fluid restrictions 3. Hypocalcemia decreased activation of Vit. D; hyperphosphatemia

Calcium Carbonate, Calcium Lactate and Vitamin D Emergency Hypocalcemia give Calcium Gluconate IV 4. Hyperphosphatemia impaired excretion of Phosphate by the kidneys in the urine

Phosphate binders they bind phosphate in the GI tract for excretion Aluminum hydroxide cause constipation so stool softener maybe given Aluminum Carbonate if use for a long period, this can caused dementia Calcium base phosphate binders excrete phosphorus but increased Ca. Calcium Carbonate Calcium Acetate 5. Hypermagnesemia impaired excretion of Magnesium by the kidneys

Magnesium mainly excreted in the urine; seen in antacids or enemas

Diuretic therapy Avoid magnesium containing antacids or enemas Emergence Hypermagnesemia Give Calcium Gluconate C. Acid Base Balance

Metabolic Acidosis

Impaired hydrogen ion excretion

Increased excretion of bicarbonate Accumulation of urea, creatinine and uric acid Hyperkalemia Give Sodium Bicarbonate alkalinic meds Give Sodium Lactate alkalinic meds Give Shohls solution treatment of metabolic acidosis; caused stomatitis II. Reserve Renal Function

Dopamine Hydrochloride to dilate renal arteries promoting renal perfusion Control of hypertension with the use of ACE inhibitors, diet and weight control III. Optimal Nutrition

High CHO diet to spare CHON metabolism Low CHON diet but with essential amino acids (50 proteins); 50 mg/day Serve foods in small amount because of nausea, anorexia and stomatitis IV. Improve Body Chemistry

Dialysis Hemodialysis Peritoneal dialysis Kidney Transplantation Fatigue r/t anemia and altered metabolic state Encourage frequent nap and discourage strenuous exercise.

Client needs to establish and maintain an appropriate exercise program.

 Hypnotics and sedatives must be used very cautiously because they may alter mentation. Deep