Okay, now let’s look at something
that you’re much more likely to see
in your practice—nephrotoxicity.
First, let’s break that word down—nephro
means kidney, and toxic means,
yeah, just what it sounds like
(bad news for your kidneys).
So, these drugs can be kidney damagers.
Well, first up, we’ve got our
old friends, the antibiotics.
These are 2 specific antibiotics that you want
to be aware of—gentamicin and amphotericin B.
Now, I want to be careful with drugs that
I know can really damage the kidneys.
I have to know what my patient’s kidney
function is before I give them the medication,
while I’m giving any of these medications,
and then after the medication
because even if I give
these at appropriate doses
and we think the patient’s doing okay, these
can cause significant damage to the kidneys.
So, radiocontrast media—
that’s the type of dye that they put in when
they’re going to take them down and do a test.
So, if a patient is on a really
common medication like metformin,
a medication that we use for type 2
diabetics (it’s an oral medication),
if we combine radiocontrast
media and that metformin,
it could severely damage their kidneys.
So, here’s how it rolls.
You have to, first of all, make sure that you
know all the meds that your patients are on,
any patient that’s going to
have radiocontrast media
(you want to assess them to see if
they’re on a medication like metformin
and then we’re going to hold that medication for
1 to 2 days before they receive the contrast
and 1 to 2 days after they get the contrast).
So, let’s break that down.
If the test is on Wednesday, we’re going to
hold that metformin on Monday and Tuesday.
They’re going to have
that test on Wednesday
and then we’re going to give them a window of
Thursday and Friday off of that medication
so that they have a real safety net to
make sure their kidneys are not impacted.
So, what we’ll need to do during that
time period is we’ll need to make sure
that we do something else to control their blood
sugar since they can’t take their metformin.
Now, another group of medications, look!
There’s another old friend—ACE inhibitors.
Remember, we talked about them with angioedema.
Also, they can be really hard on kidneys.
NSAIDS which are nonsteroidal
Okay, you’re like, “What are
those and do I take those?”
I bet if I went around in your house or
wherever you are watching this video,
and we looked in a purse or a
backpack, everyone has these.
You might know it as ibuprofen, naproxen,
Aleve—that’s what an NSAID is.
Now, those are over-the-counter ones.
We’ve got stronger, more potent
medications that are NSAIDS
but know that they can really be hard on kidneys.
My own father was really sick.
He was vomiting and got dehydrated, but he has
really bad arthritis so he took an NSAID because,
of course, he is elderly and they always
consistently take their medications
and he didn’t want to hurt, but the
combination of being really dehydrated
and already having kidneys
that were challenged,
he continued to take that medication
without flushing out through the kidneys,
threw him into acute renal failure that ended
up with weeks and weeks in the hospital.
Now lithium salts are a psych
medication and we use those a lot—
it’s a mood stabilizer so we can
use that with schizophrenia
and we can use it with bipolar disorder,
but they can really also be hard on the kidneys
and we’ll talk more about that
medication in the psych module.
The last one is chemotherapy.
Chemotherapy is kind of a necessary evil.
It’s a horrible disease to treat cancer
but sometimes the chemotherapy gives
us bigger problems even than the cancer
and cisplantin is another one that
can end up with some toxicities.
So, what should I do as a nurse if
my patient is taking a medication
that I know has a possibility
of being nephrotoxic?
Well, I’m going to watch their serum
creatinine—that’s a blood test that you draw,
lab will come up and draw the blood for you and
these are the normal levels for women and for men.
So, what’s your job as a nurse is to make
sure to know which meds are nephrotoxic,
make sure that you have this data
and information on your patients,
and know what normal is because
if your patient, male or female,
already has an elevated creatinine, you’re
going to want to stop the medication
and notify the healthcare
Now, when I say elevated,
that means a level greater than 1.1 for
women and greater than 1.3 for men.
Now, these are just ranges for
you to kind of get an idea.
When you start working in a hospital
or a clinic or an outpatient setting,
every lab will have a little
bit different values,
but they’ll tell you what their normals are.
But for now, we’ll use these values.
Don’t let it stress you out
if every textbook you use
or every lab that you see has
a little bit different values.
Just find the midrange value to memorize,
and we think this one’s a pretty good one.
Just find the midrange value to
memorize and stick with that
as you progress through nursing school,
and when you get into practice,
you’ll see the values printed on
every lab report that comes back.
So, for kidney function, you’re
going to look at creatinine level
and you’re going to look at the BUN.
Now, normal is 7 to 20 if we’re looking at mg/dL,
and if that is elevated, (greater than 20),
that tells us the kidneys are in trouble;
they’re having problems.
So, you want to draw this type of lab work
and make sure we have this information
before the medication is given, during
the administration of the medication,
and afterwards just to check and make sure
that the kidney function is doing well.