RATIONALE: 4) To reduce the formation of oxalate calculi, urge the client to avoid foods high in oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley.
Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and organ meats do NOT produce oxalate and do NOT need to be omitted from the client's diet.
RATIONALE: 2) Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This may lead to cerebral edema and increased intracranial pressure (IICP).
S/S of ICCP include HA, nausea, and restlessness as well as vomiting, confusion, twitching, and seizures.
Fever and elevated WBC may indicate infection.
Popping or ringing in the ears, chest pain, dizziness, or coughing suggests an air embolus.
Chest pain, dyspnea, burning at the access site and cramping suggests acute hemolysis.
Renal System- INSPECTION:
SKIN: pallor, yellow-gray cast, excoriations, changes in turgor, bruises, texture (e.g., rough, dry skin)
MOUTH: stomatitis, ammonia breath odor
FACE & EXTREMITIES: generalized edema, peripheral edema, bladder distention, masses, enlarged kidneys
ABDOMEN: striae, abdominal contour for midline mass in lower abdomen (may indicate urinary retention) or unilateral mass (occasionally seen in adult, indicating enlargement of one or both kidneys from large tumor or polycystic kidney)
WEIGHT: weight gain secondary to edema; weight loss and muscle wasting in renal failure
GENERAL STATE OF HEALTH: fatigue, lethargy, and diminished alertness
s/s: Depends on location: visual, motor, neurologic, GI
HEADACHE AND SEIZURE
cognitive dysfunction, muscle weakness, sensory losses, aphasia, increased ICP, cerebral edema, obstruction of CSF pathways.
Crisis prevention: Prevent Intracranial Pressure, remove tumor if possible.
s/s: Risk complications: Swallowing/Arrest
Weakness, dysarthria, dysphagia, difficulty sitting up,
Eye and periorbital muscles most affected- manifested by diplopia, ptosis, ocular palsies
Sx least evident in the AM and most evident w/effort as the day proceeds
Crisis: Sudden exacerbation of motor weakness putting client at risk for respiratory failure and aspiration:
MYASTHENIC CRISIS: Respiratory, and swallowing muscles too weak. Risk complications: Swallowing/Arrest
THYMOMA-A rare neoplasm, usually found in the anterior mediastinum and originating in the epithelial cells of the thymus.
Assess an maintain respiratory, swallowing, atelectasis.
Flaccid paralysis, respiratory failure, GI symptoms, severe muscle weakness, vertigo. Tx: Atropine
Difficulty chewing, speaking, walking. Shakiness, muscle weakness, tinnitus, visual problems, incontinent,
Ataxia, Nystagmus, Spasticity, tremors, dysphagia, speech impaired, fatigue
Help pts identify triggers: illness, stress
Tonic Phase: Loss of consciousness; muscles contract 10-20 sec
Clonic Phase: rhythmic contraction <2min
Aura: warning sx
HAVE SUCTION, AIRWAY, O2 AT BEDSIDE!
Protect pt: lower to floor, pad siderails, pillow under head, don't restrain, allow post-ictal rest.
Prevent Aspiration: turn side, loosen neck clothing, suction.
Ongoing: Monitor VS, LOC, O2 saturation, Glasgow coma scale, reassure & orient pt after seizure
Motor changes: opposite side, balance, coordination, gait, proprioception
Sensory Changes: Aphasia, Agnosia, Apraxia, Visual problems, hemianopsia
Cognitive Changes: impaired memory, disoriented
Paralysis, difficulty swallowing, talking, memory, pain.
Assessment includes: glasgow coma scale/LOC
dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, instant coffee, Ovaltine, tea, worcestershire sauce