electrolyte balance. The result is accumulation of nitroge- nous waste products in the blood and uremia . CKD affects each body system (Table 37.6).
Evidence-Based Practice Clinical Question
What is the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes? Evidence This study analyzed data from the 2005 through 2014 National Health and Nutrition Examination Surveys for 1,376 adults who had diabetes and CKD to look at the effect that social determinants of health had on mortality. Social determinates of health relate to socioeconomic; psychosocial; neighborhood environment; and political, cultural, and economic factors that people experience during their lifetime. This analysis looked at family income to poverty ratio, food insecurity, and depression. It was found that these social determinants had a cumulative effect on mortality that increased by 41% for each addi- tional social determinant. Depression was independently associated with mortality (Ozieh et al, 2021). Implications for Nursing Practice
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Evidence-Based Practice boxes feature an in-depth look at research that supports the best care and describe how that knowledge applies in practice.
Chapter 12
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and the type of surgery performed can predict postoperative urinary retention (Abdul-Muhsin et al, 2020). After outpatient surgery, patients may be required to void before discharge.
urologica urinary c such as o • Recogniz frequentl dribbles m emptying bladder s need for complica • Assist pa and provi male pati voiding. • Use techn unable to running w patient’s catheteri • Have pati pelvic mu • Notify th distended timefram EVALUATIO patient is a or complic
17/03/22 5:14 PM 1. You verify that the IV controller pump is set at what rate? 2. How many milliliters do you record as Mrs. Owens’s total intake for the last 12 hours? • Intake for 12 hours: • 8 oz coffee Cue Recognition exercises provide practice in identifying actions to take when presented with patient cues or data. • 4 oz orange juice • 6 oz tomato soup with the PCA pump, what action will you take? 6. Which team members do you collaborate with? 7. What action do you take to support the needs of the patient and family? Suggested answers are at the end of the chapter. CLINICAL JUDGMENT Mrs. Owens returned from a bowel resection 2 days ago. She is receiving 1,000 mL of 0.9% normal saline solution over 10 hours on an IV controller pump. Chapter 12 CLINICAL JUDGMENT Mrs. Wood, age 42, returns to the surgical unit after a hysterectomy. Her postoperative vital signs and data collection findings are normal. Mrs. Wood rates her pain level at 9 out of 10, and the nurse notes that she moans occasionally, repeatedly moves her legs, and pulls at her covers near her abdominal incision. She is drowsy but repeatedly says it hurts. In the PACU, a PCA pump was started. The last dose of medication was delivered 45 minutes ago. Her family is at her bedside trying to talk to her about her experience. 1. What nonverbal pain cues do you find Mrs. Wood is displaying? 2. How do you document Mrs. Wood’s pain? 3. What action do you take to relieve Mrs. Wood’s pain? 4. When will you next monitor Mrs. Wood’s pain level? 5. If Mrs. Wood indicates that her pain remains unrelieved
vention ns and ve care lectro- passing urine cement er elec- similar inuous uid and patients ate the RT pro- ic fluid can be
• WORD • BUILDING • hemodialysis: hemo—blood + dialysis—passage of a solute through a membrane uremia: ur—urea + emia—in the blood Clinical Judgment case studies and questions help you practice and think about what you are learning, and then apply the learning to clinical decision-making. An awareness of social determinants of health, and screen- ing for them as well as for depression in CKD patients, to plan interventions or make referrals (e.g., for Meals on Wheels or mental health services) may help reduce mortal- ity for CKD patients. Reference: Ozieh, M. N., Garacci, E., Walker, R. J., Palatnik, A., & Egede, L. E. (2021). The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrology, 22 (1), 76. https://doi.org/10.1186/s12882-021-02277-2
Nursing Care of Patients Having Surge
Traditionally, after GI surgery, bowel sounds were moni- tored by the nurse. The patient was kept NPO until flatus and bowel sounds returned. It is now known that bowel sounds are not correlated with bowel motility and the patient’s abil- ity to safely drink and eat postoperatively. In fact, patients can be hydrated and fed early, which promotes healing and faster recovery. Follow your institutions’ policy if monitor- ing bowel sounds is required. CUE RECOGNITION 12.3 The surgeon’s orders for a patient who had a colectomy are NPO with IV fluids and an NG tube to low intermittent suction to be irrigated prn. The patient reports stomach pressure and nausea with a need to vomit. What action do you take? Suggested answers are at the end of the chapter.
move in bed, to get out of bed, and to walk. Mon els that may interfere with movement. Observe tolerance for activity.
Nutrition Notes Nourishing the Postoperative Patient After surgery, 5% glucose in 0.45% normal salin nously is commonly prescribed. This is done to catabolism (muscle protein being used for ener a patient is fasting. However, this prevention do long. One liter of this solution contains 170 calo nourished adults may tolerate not eating for up but malnourished adults should be fed early to impacting their recovery. Advocate for a nutritio your patients following surgery. Patients usually progress from clear liquids t diet as soon as possible. Offer water first, then c to see patient’s tolerance. If “diet as tolerated” is the patient should be asked, “What sounds goo Offering a full dinner when the patient doesn’t may “turn off” the appetite. soft, bow bladder d 10. He is r hands du really hur 1. What a 2. What a sympto CLINIC Mr. McDo laparosco report yo normal pa analgesic 20 mL at 1 light dinn McDonald three ban abdomen
• 3/4 cup gelatin • 2 cups of water • 1,200 mL of 0.9% normal saline solution IV • Output for 12 hours: • 1,700 mL of urine Suggested answers are at the end of the chapter.
NURSING DIAGNOSES, PLANNING, AND IMPLEMENTATION
Imbalanced Nutrition: Less Than Body Requirements related to NPO, pain, and nausea
NURSING DIAGNOSES, PLANNING, AND IMPLEMENTATION
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