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Other Drugs: Hypocalcemia and hyperphosphatemia may be treated with aluminum antacids that bind dietary phosphorus. If long-term effects of aluminum hydroxide are a concern, an oral calcium (with vitamin D) preparation may be given. Recombinant erythropoietin (Epogen) may be given for the treatment of anemia. If the patient undergoes renal transplantations, immunosuppressives such as azathioprine (Imuran) or cyclosporine (Sandimmune) are prescribed. Corticosteroids may also be given at this time to decrease antibody formation.

Independent

To help the patient deal with fluid restrictions, use creative strategies to increase the patient's comfort and compliance. Use ice chips, frozen lemon swabs, hard candy, and diversionary activities. Give medications with meals or with minimal fluids to maximize the amount of fluid that is available for patient use. Skin care is important because of the effects of uremia. Uremia results in itching and dryness of the skin. If the patient experiences pruritus, help the patient clip the fingernails short and keep the nail tips smooth. Teach the patient to use skin emollients liberally, to avoid harsh soaps, and to bathe only when necessary. You may need to speak to the physician to request an as-needed dose of an oral antihistamine such as diphenhydramine

814 Renal Failure, Chronic

(Benadryl). If the patient is hospitalized, frequent turning and range-of-motion exercises assist in preventing skin breakdown. If the patient is taking medications that cause frequent stools, teach the patient to clean the perineum and buttocks frequently to maintain skin integrity.

The patient needs to plan the week's activities to incorporate the level of fatigue, the dialysis routine, and any desired activities. The patient may also find that cognitive activities are more easily accomplished on certain days in relationship to dialysis treatments. Reassure the patient that this is not unusual but is caused by the shift of fluid and waste products. Counseling relative to role function, family processes, and changes in body image is important. Sexuality counseling may be required. Reassure the patient that adaptation to a chronic illness with an uncertain future is not easy for either the patient or the significant others. Participate when asked in discussions related to feasibility of home dialysis, placement on the transplant list, and decisions related to acceptance or refusal of dialysis treatment. Encourage decisions that increase feelings of control for the patient.

If the patient undergoes a renal transplantation, provide preoperative and postoperative care as for any patient with abdominal surgery. Monitoring of fluids is more important for these patients than for other surgical patients because a decrease in output may be an early sign of rejection. Other signs include weight gain, edema, fever, pain over the site, hypertension, and increased white blood cell count. Emotional support is important for the patient and family, both preoperatively and postoperatively, because both positive and negative outcomes produce emotional turmoil. Teaching about immunosuppressive drugs is essential before discharge.

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