What Types Of Vegtables Are Good For Weight Gain Org Nursing Considerations Of Diabetic Nephropathy

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Nursing Considerations Of Diabetic Nephropathy

Check your patient’s blood glucose levels frequently. As her kidney function declines, she may need less insulin or oral hypoglycemic medications. That’s because a third of insulin is metabolized and excreted by the kidneys, and as their kidney function declines, insulin is available in the bloodstream for longer. Monitor her for signs and symptoms of hypoglycemia, such as diaphoresis, nausea, or vomiting. If she shows signs of hypoglycemia, the doctor may reduce her insulin dose. Or, if your patient is taking an oral antidiabetic drug, the doctor may prescribe glipizide, which has a shorter half-life than other drugs and is metabolized by the liver into inactive metabolites for excretion by the kidneys.

If your​​​​ patient has hypertension, assess them for factors, such as obesity or alcohol consumption, that may contribute to hypertension. Also consider their current drug use. Many medications can increase blood pressure, including corticosteroids, NSAIDs, nasal decongestants, appetite suppressants, and tricyclic antidepressants. During physical examinations, check your patient’s blood pressure and compare the readings with those in their medical record.

Assess your patient for signs and symptoms of UTI. Frequent infections can accelerate the progression of nephropathy. If diabetic neuropathy affects her bladder, she may not be able to empty it completely. This can result in urinary stasis, which can increase the risk of infection. To prevent UTIs, encourage your patient to empty their bladder at least every 2 hours.

Determine if your patient is not taking nephrotoxic medications. If she is, inform her doctor. If she is to undergo a procedure that requires the use of radiographic dye, administer mannitol as prescribed to induce osmotic diuresis and minimize the nephrotoxic effects of the dye. Also, make sure your patient drinks all prescribed fluids after the procedure to dilute their urine, which can reduce the chance of nephrotoxicity from the dye.

If your​​​​ patient is receiving hemodialysis or peritoneal dialysis, help them adhere to the prescribed dietary and fluid restrictions. If she must follow a low-protein diet, advise her to minimize her intake of eggs, meat, and dairy products and to eat more starchy foods, fats, fruits, and vegetables. If she is struggling to consume enough calories to maintain her weight, suggest that she use a high-calorie nutritional supplement. However, keep in mind that peritoneal dialysis can increase the caloric absorption of the dialysate as it sits in the peritoneum. If this causes your patient to gain excess weight, urge her to reduce her total caloric intake, but not her protein intake. Monitor your patient’s fluid and electrolyte status by checking their weight each day.

During each dialysis treatment, assess your patient’s arteriovenous CAY or peritoneal access site for signs and symptoms of infection, such as redness, tenderness, or purulent drainage. Also assess circulation at the AV shunt or fistula by checking for a palpable thrill; auscultating for a bruit, which must be present; and feeling of warmth over the access site. Do not take a blood pressure reading in the arm that has the AV access site, as you may occlude it.

Remember that treatment options for end-stage kidney disease can involve difficult choices for your patient and their family. Give your patient the information she needs to make an informed choice. However, keep in mind that their ability to concentrate and think clearly can be affected by uremia. Therefore, when appropriate, delay important decisions about treatment options until after a dialysis treatment.

Offer support and encourage your patient to talk about their feelings and concerns. People react in different ways when they hear the diagnosis of kidney disease. Your patient may develop depression, anxiety or stress. So include meetings with a mental health professional, such as a psychiatric clinical nurse or psychologist, as part of your treatment plan. If appropriate, refer your patient and their family to support groups.

If your​​​​ patient is waiting for a kidney transplant, keep in mind that finding a suitable organ donor takes a long time and places significant pressure on the patient and their family. After your patient undergoes the transplant, her doctor will prescribe immunosuppressive drugs. The patient will have to take them for the rest of their life, and they can have serious adverse effects, such as increased risk of infection, weight gain, hallucinations and increased kidney damage.

The doctor will likely adjust your patient’s insulin dosage after a kidney transplant because of improved kidney function. And your patient will be taking medications, such as glucocortiosteroids and cyclosporine, that will raise their blood glucose levels.

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