RNSG 2432 Enhanced Concepts of Adult Health

Module 13:  Providing Patient-Centered Care for the Individual with Renal Disorders:  Chronic Kidney Disease/ESRD/Transplant

 

Module Objectives:  

Utilizing critical thinking and the nursing process, the student is expected to:

1.  Analyze comprehensive assessment findings by:

a.  Comparing and contrasting risk factors associated with renal disorders:

  • Chonic Kidney Disease/ESRD/Transplant

b.  Considering the etiology and pathophysiology for the following disorders:

  • Diffuse, bilateral disease of the kidneys with progressive destruction and scaring
  • Specific etiologies
  • Stages I-IV & V ( end-stage renal disease (ESRD))

c.  Considering the signs and symptoms and complications of the above disorders:

  • Cardiovascular
  • Hematologic
  • Immune system
  • Gastrointestinal
  • Neurologic
  • Musculoskeletal
  • Endocrine and Metabolic
  • Dermatologic

d.  Integrating the diagnostic tests with the etiology, pathophysiology and signs and symptoms including:

  • Urinalysis/culture;
  • Blood studies:
    • BUN, creatinine, electrolytes, CBC
  • Creatinine clearance
  • Renal ultrasonography
  • Kidney biopsy
  • Other

2.  Formulate relevant prioritized nursing diagnoses that address physical, psychosocial, and learning needs:

  • Impaired tissue perfusion
  • Imbalanced nutrition: less than body requirements
  • Risk for infection
  • Disturbed body image
  • Other

3.  Formulate patient and family centered goals and outcomes that facilitate health promotion, maintenance, and restoration.

4.  Utilize evidence based practice to prioritize, implement, and evaluate nursing interventions related to:

  • Safe environment; Risk reduction
  • Medication therapy:
    • Diuretics
    • Antihypertensives
    • Medications to manage electrolyte imbalances:
      • oral phosphorus binding agents; other
  • Diet therapy:
    • Fluid management
    • Increase carbohydrates
    • Restrictions:
      • dietary protein
      • water and sodium
      • potassium
      • phosphorus
  • Surgical/Medical interventions:
    • Types of dialysis:
      • management, potential complication, comparison, methods to access
    • Renal transplant:
      • tissue matching, potential rejection, immunosuppressive drugs, patient teaching
  • Patient teaching; Discharge teaching; Referrals
  • Therapeutic communication
  • Delegation
  • Others

5.  Collaborate with interdisciplinary health care team when providing patient-centered care.

6.  Evaluate patient responses to therapeutic interventions and revise goals and modify the nursing care plan.

7.  Integrate associated issues, trends, and informatics into nursing practice.

a.  Legal issues

b.  Ethical considerations

c.  Quality improvement

d.  Complementary medicine

Learning Activities:

1. Review module objectives.

2. Learning Resources:

Required: 

  •  

    • Read: Lewis p. 1170-1189 (CRF, Peritoneal dialysis, Hemodialysis); 1189-1195 (transplant) and (organ donation)
    • Review Lewis p. 1164-1170 (acute renal failure)
    • Review Powerpoint Presentation:  CRD & Dialysis & Transplant
    • Complete: Learning Guide
    • PDS Software: Critical Care: Gastrointestinal: Margie Thompson
      A 48-year-old liver transplant recipient in the SICU.(transplant drugs, hemodynamics)

Web sites (opt)

Chronic Renal Failure:

Transplant:

3. Complete Critical Thinking Exercises:

    • Ethical Dilemmas-Payment for Organs; Lewis p. 1225.
    • Ethical Dilemmas-Allocation of Resources, Lewis p. 1226. 
    • Case Study:  Juanita with CRF; Lewis p. 1231.

    Case study: Charlie 4 Star. Analyze the pros and cons of a transplant! (optional)

    View Bill Peckham's Self Dialysis (*most interesting!)

    Peritoneal dialysis video (Locate-Dialysis at Home- right side screen; view and discuss only!)

Interactive exercises:

4. Supplemental Learning:

Review NCLEX Review Questions, on the Student Companion  CD- rom accompanying text, Lewis Chapters 45-47.

5. Review module objectives and check for knowledge gaps.


6. Complete module quiz

  • Blackboard quiz: Renal: CRF (ESRD & Transplant)