Renal Nursing & Dialysis for NCLEX: AKI, CKD, Hemodialysis & Peritoneal Dialysis
Comprehensive NCLEX review of renal nursing. Covers acute kidney injury, chronic kidney disease, hemodialysis, and peritoneal dialysis nursing care.
Renal Nursing and Dialysis for NCLEX Preparation
Renal nursing is a high-yield NCLEX topic that covers acute and chronic kidney conditions, dialysis management, and fluid-electrolyte balance. Understanding renal pathophysiology and nursing interventions is essential for exam success.
Acute Kidney Injury (AKI)
AKI is classified by cause: prerenal (decreased blood flow to kidneys from dehydration, heart failure, or hemorrhage), intrarenal (direct damage to kidney tissue from nephrotoxic drugs, glomerulonephritis, or rhabdomyolysis), and postrenal (urinary obstruction from kidney stones, tumors, or BPH). AKI presents with oliguria (less than 400 mL/day), elevated BUN and creatinine, hyperkalemia, metabolic acidosis, and fluid overload. The oliguric phase is the most dangerous due to the risk of hyperkalemia and pulmonary edema. Treatment focuses on correcting the underlying cause, managing fluid balance, and potentially initiating dialysis.
Chronic Kidney Disease (CKD)
CKD is staged by glomerular filtration rate (GFR). Stage 5 (GFR below 15) is end-stage renal disease requiring dialysis or transplant. CKD complications include anemia (decreased erythropoietin), renal osteodystrophy (impaired vitamin D activation), hyperkalemia, metabolic acidosis, and uremia. Nursing management includes restricting sodium, potassium, phosphorus, and fluid intake. Administer erythropoiesis-stimulating agents for anemia and phosphate binders with meals.
Hemodialysis
Hemodialysis removes waste products and excess fluid through an external machine. Access types include AV fistula (preferred, lowest infection rate), AV graft, and central venous catheter (temporary). For AV fistula care, assess for thrill (palpable vibration) and bruit (audible whooshing). Never take blood pressure, draw blood, or start an IV in the fistula arm. Monitor for complications including hypotension, muscle cramps, and disequilibrium syndrome.
Peritoneal Dialysis
Peritoneal dialysis uses the peritoneum as a semipermeable membrane. Dialysate is instilled, dwells in the peritoneal cavity, then drains by gravity. Monitor for peritonitis: cloudy effluent, abdominal pain, fever, and rebound tenderness. Use strict aseptic technique during exchanges. Review with our clinical nursing flashcards and practice renal nursing cheat sheets.