AKI and CKD from the nurse's side
Both cause retention of fluid, potassium, acid, and waste products.
| Finding | Nursing concern |
|---|---|
| Potassium above 5.0 mEq/L, peaked T waves | Dysrhythmia risk: cardiac monitor, notify, anticipate treatment |
| Weight gain, crackles, edema | Fluid overload: fluid restriction, diuretics or dialysis as ordered |
| Rising BUN, confusion, itching, nausea | Uremia |
| Low hemoglobin | Anemia from low erythropoietin |
| High phosphate, low calcium | Bone and mineral disorder: phosphate binders with meals |
Adjust doses of renally cleared drugs; avoid NSAIDs and magnesium- or phosphate-containing products unless prescribed.
Hemodialysis access and care
Protecting the access protects the client's lifeline.
| Hemodialysis complication | Clue | Action |
|---|---|---|
| Hypotension | Dizziness, cramps, nausea during treatment | Notify dialysis team; position; fluids per protocol |
| Disequilibrium syndrome | Headache, restlessness, confusion, seizures | Slow or stop per protocol; notify |
| Bleeding | Prolonged bleeding at needle sites (heparin) | Pressure; monitor |
| Infection | Fever, access redness | Report; aseptic access care |
Weigh before and after dialysis; the difference reflects fluid removed.
Peritoneal dialysis
The peritoneum acts as the filter; infection is the main risk.
- Use strict aseptic technique for exchanges; wear masks as instructed.
- Warm dialysate with a dry heating method; never microwave.
- Report fever, abdominal pain, or cloudy drainage immediately.
Renal diet and teaching
Diet changes with the stage of disease and the type of dialysis.
| Nutrient | Guidance (as prescribed) | Examples to limit |
|---|---|---|
| Potassium | Limit | Bananas, oranges, potatoes, tomatoes, salt substitutes |
| Phosphorus | Limit; phosphate binders with meals | Dairy, cola, processed foods |
| Sodium | Limit | Processed and canned foods |
| Fluid | Restrict to prescribed amount | Count ice, soup, gelatin |
| Protein | Moderate before dialysis; higher on dialysis | Emphasize high-quality protein |
A renal dietitian individualizes the plan.
NGN-style case
Linking a missed treatment to a life-threatening lab value.
A client on hemodialysis missed two sessions. The client reports weakness and shortness of breath. Potassium is 7.0 mEq/L; the monitor shows peaked T waves; there are crackles and 3 kg of weight gain. What is the priority?
- Recognize cues: severe hyperkalemia with ECG changes, plus fluid overload.
- Analyze: immediate risk of fatal dysrhythmia.
- Place on a cardiac monitor, notify the provider immediately, and raise the head of the bed.
- Anticipate IV calcium, insulin with glucose, and urgent dialysis.
Answer. Hyperkalemia with ECG changes is the priority: monitor, notify, and prepare for emergency treatment and urgent dialysis.