Page 375 - Critical Care Nursing Demystified

360 CRITICAL CARE NURSING DeMYSTIFIED

Ask patients if they have had changes in sexual habits like impotence or
decreased sexual energy/drive, dysmenorrheal, or amenorrhea. Uremic poison-
ing can cause issues with sexual health.

Inspection
A close look at the patient can tell the astute critical care nurse a wealth of
information. All body systems need to be inspected. Some of the following
signs/symptoms can be seen in patients with renal disease.
Determine the patient’s level of consciousness and reasoning. High levels of
retained by-products of metabolism like urea and nitrogen can lead to changes
in sleep patterns, fatigue, lethargy, headaches, blurred vision, confusion, and
consciousness. They can also lead to symptoms of anxiety, depression, and
psychosis.
Observe the patient for tremors or spasms. Hypocalcemia that can develop
in renal failure can cause neuromuscular excitability, resulting in cells depolar-
izing unchecked. Placing an inflated BP cuff over an arm for 10 minutes can
stimulate Trousseau’s sign, which looks like carpopedal spasms, a clinical sign
of tetany. The patient may also tell you that he or she has numbness and tin-
gling (paresthesias) around the mouth or extremities. Tapping on the patient’s Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
facial nerve can also cause twitching of the facial muscles, which is known as
Chvostek’s sign. A calcium level should be checked as these muscular contrac-
tions can lead to seizure if not treated.

NURSING ALERT
If the patient has a positive Chvostek’s and Trousseau’s sign, he or she is at risk for
laryngospasm. Have intubation and cardiac arrest equipment available; notify the
health care provider immediately.

Look at the overall color of the patient’s skin. A pale or sallow complexion
can indicate renal-failure-induced anemia. Is the skin moist and intact? Fre-
quently, patients with renal diseases will develop pruritus and have dry, itchy
skin with areas of excoriation. Does the patient have periorbital, sacral, or pedal
edema; is it pitting or nonpitting? Edema in the extremities can indicate fluid
retention when failing kidneys stop excreting excess fluid.
Next, focus in on the patient’s breathing; is the rate easy and unlabored?
Compensation for metabolic acidosis can be seen by an increased rate and
depth of breathing (Kussmaul’s respirations). Kussmaul’s respirations are caused