Renal Failure, Chronic Kidney Disease l End Stage Renal Disease for Nursing Exams, NCLEX RN & LPN

Summary

This video offers an in-depth overview of key nursing concepts related to chronic kidney disease (CKD) and acute kidney injury (AKI), focusing on lab values, treatment strategies, and priority interventions. It emphasizes the management of hyperkalemia, explaining the step-by-step approach starting with calcium gluconate and insulin. The importance of daily weight monitoring, avoiding nephrotoxic drugs, and understanding kidney replacement therapies like dialysis and transplants is also highlighted. With practical tips, clinical insights, and exam-focused advice, the video serves as an essential guide for nursing students preparing for the NCLEX and clinical practice.

Takeaways

• 😀 High potassium levels (hyperkalemia) can cause dangerous heart arrhythmias and should be treated promptly to prevent fatal complications.
• 😀 The priority treatment for high potassium levels with arrhythmias is administering calcium gluconate to stabilize the heart.
• 😀 If no dysrhythmias are present but potassium is elevated, the first step is to administer insulin and dextrose to shift potassium into cells.
• 😀 Dialysis and medications like kayexalate (polystyrene sulfonate) are less effective in the immediate treatment of high potassium levels and are used later.
• 😀 A key nursing intervention is daily weight monitoring, as a 1 kg increase correlates to 1 liter of fluid retention, which can lead to fluid overload and hypertension.
• 😀 Certain medications like NSAIDs, milk of magnesia, vancomycin, gentamicin, and contrast dye should be avoided in patients with kidney disease as they can worsen kidney function.
• 😀 Chronic kidney disease patients often miss dialysis, leading to severe electrolyte imbalances, especially elevated potassium.
• 😀 In cases of end-stage renal disease (ESRD), dialysis and eventual kidney transplantation are crucial for managing renal failure.
• 😀 The use of calcium gluconate to manage high potassium is prioritized when ECG changes (e.g., wide QRS) suggest arrhythmias.
• 😀 Regular nursing care includes preventing kidney damage by avoiding nephrotoxic substances and monitoring fluid balance closely to prevent complications.

Q & A

What is the first intervention when managing high potassium in patients with dysrhythmias?

The first intervention is to administer calcium gluconate IV to stabilize the heart and prevent deadly dysrhythmias. This is prioritized because it helps protect the heart muscles from the effects of high potassium.

Why is calcium gluconate used for patients with high potassium and dysrhythmias?

Calcium gluconate is used because it helps stabilize the heart's electrical activity and prevent the progression to life-threatening heart arrhythmias caused by high potassium levels.

What should be administered first if a patient has high potassium without signs of dysrhythmias?

If dysrhythmias are not present, the first intervention should be administering regular insulin and 50% dextrose IV. This treatment helps shift potassium from the bloodstream into the cells, lowering the potassium level.

How can you differentiate between cases where calcium gluconate is needed versus insulin and dextrose?

Calcium gluconate is used when there are signs of dysrhythmias, such as wide QRS complexes on the ECG. If there are no signs of dysrhythmias, insulin and dextrose should be used to lower potassium levels.

What is the importance of monitoring fluid retention in patients with kidney disease?

Monitoring fluid retention is crucial because it can lead to fluid volume overload and hypertension crises. Any unexpected fluid retention should be reported to the healthcare provider immediately.

What does a 1 kg weight gain indicate in patients with kidney disease?

A 1 kg weight gain corresponds to approximately 1 liter of fluid retained, which can be a sign of fluid overload and requires immediate medical attention to prevent complications.

Which medications should be avoided in patients with kidney disease to prevent further damage?

Medications that should be avoided include NSAIDs, milk of magnesia, and certain antibiotics like vancomycin and gentamicin. Additionally, contrast dye used in imaging can be harmful to the kidneys.

Why should contrast dye be avoided in patients with kidney disease?

Contrast dye is harmful to the kidneys because it can cause nephrotoxicity, similar to how thick cement can damage delicate machinery. It should be avoided or used with extreme caution in patients with kidney issues.

What is the role of dialysis in patients with end-stage renal disease?

Dialysis serves as a temporary solution to filter waste from the blood when the kidneys can no longer perform this function. It is typically used until a kidney transplant becomes available.

What are the most commonly missed questions in NCLEX related to kidney disease?

The most commonly missed NCLEX questions involve recognizing the proper order of interventions for high potassium, particularly differentiating between situations requiring calcium gluconate or insulin and dextrose, and understanding the impact of fluid retention on patient care.