Page 377 - Critical Care Nursing Demystified

362 CRITICAL CARE NURSING DeMYSTIFIED

Normally the nurse will not auscultate any sounds over the kidneys. How-
ever, if the patient has renal artery stenosis a bruit may be heart over the left
and right upper abdominal quadrants.

Percussion

Ask the patient to void before the percussion. Percussion of the kidneys may
be done to check for enlargement from polycystic disease. Does the patient say
he or she has pain or tenderness when you percuss this area? Reported discom-
fort can indicate infection or tumor. Percussion of the bladder should be done
to determine fullness and pain.

Palpation

Palpate the patient for peripheral edema. In fluid volume overload, fluid translo-
cates from the vascular system into the interstitial spaces. Check the patient for
strength in the extremities. Weakness in the legs can signal that the patient is
developing uremic neuropathy.
Palpate the patient’s joints and move the patient’s extremities through his or her
range of motion. Does the movement cause bone or joint pain; does it illicit par- 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.
esthesias or numbness in any of the extremities? Joint problems can result from
vitamin D deficiency and demineralization of the bone from low calcium levels,
leading to renal osteodystrophy. Uremic toxins can result in pain and paresthesias.
Usually the kidneys cannot be palpated as they lie deep within the abdomen and
are protected by muscle. However, in thin patients they can sometimes be felt dur-
ing deep inspiration. They should feel smooth and round without masses or lumps.
The bladder can be palpated and should feel smooth, without masses or nodules.
In addition to performing a through and ongoing physical assessment, the
nurse will also be involved in preparing the patient to undergo and screen diag-
nostic and laboratory tests.

Collaborative Diagnostic and Laboratory Tools

2 The laboratory and diagnostic tools are monitored by the critical care nurse and
it is essential to understand how they change if damage occurs to the kidneys.

Laboratory Tools

The following are a list of laboratory values that a nurse would need to monitor
for a patient with kidney failure.