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18 Cards in this Set
- Front
- Back
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What is acute renal failure? causes?
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- inability of kidneys to filter out wastes and fluid, reduced GFR
causes Prerenal failure - decreased blood flow to kidneys - hypoveolemia, hypotension, redouced CO, HF, etc - vascular disorders intrarenal failure - parenchymal damage (acute tubular necrosis), infection (pyelonephritis), toxins - CKD, diabetes, HF, htn, cirrhosis postrenal failure - obstructions |
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normal value of creatinine
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< 1.0 mg/dL
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anuria vs oliguria
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oliguria <500 mL/day
anuria <80 mL/day |
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manifestations of renal failure
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decreased GFR results in
- most commonly, oliguria (<500mL/day) and - inability to concentrate urine urine (sp gravity < 1) - BUN steadily increases (as protein metabolites build up) (azotemia) - creatinine increased, indicates reduced renal function - hyperkalemia --> dyrhythmias - metabolic acidosis (buildup of acid waste) --> ABG, kussmaul resp - also anemia, due to reduced erythropoietin production |
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Prevent acute renal failure
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- adequate hydration
- prevent shock, infection, precursors fo sepsis - monitor CVP, urine output |
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What drugs are nephrotoxic
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- aminoglycosides - gentamycin, tobramycin
- polymyxin B, amphotericin B - vancomycin, cephalosporin, amikacin - also, long term NSAID use - and radiocontrast studies |
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assessment of chronic RF (ESRD)
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- dec GFR -> inc phosph --> dec Ca
acidosis anemaia sodium, water retnetiion |
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Complications of ESRD
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- hyperkalemia
- pericarditis, effusion, tamponade due to inc urea - htn - anemia (dec erythropoeitin production) - bone disease (inc phosph, dec calcium) |
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Nursing monitor for worsening of ESRD
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renal failure
- nausea, vomiting, changes in UO, ammonia breath hyperkalemia - muscle weakness, diarrhea, abdominal cramps, arrhythmia |
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treatments for ESRD
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Ca, and Phos binders
- ca carbonate (Os-cal) - calc acetate (Phos - lo) Antihypertensive, Cardiovascular - inotropics digoxin, dobutamine Epogen for anemia Dialysis |
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nursing diagnoses for renal failure and interventions
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excess fluid volume
- I&O - limit fluids imbalanced nutrition - regulation protein and fluid intake and potassium - sodium supplement - 500ml + previous day's output |
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dialysis. what is it? how does it work?
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- dialysis basically replaces the functioning of the kidneys
- removes urea (nitrogenous wastes), excess water, and toxins - only water soluble drugs can be removed (meds bound to albumin cannot) - dialyzer = semipermiable membrane that acts as kidney - by diffusion, toxins and wastes move into the dialysate - excess fluids is removed by ultrafiltration (to lower pressure) |
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signs patient is due for dialysis
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signs of uremia- inc BUN
- metallic taste and nausea - mental confusion, lethargy also - *pericardial friction rub (pericarditis) due to effects of urea is urgent for dialysis |
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kinds of dialysis
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- hemodialysis - dialyzer
- peritoneal dialysis - dialysate infused into peritoneum. peritoneal membrane acts as filter, toxins move into peritoneum. fluid is then drained. - continuous renal replacement therapy |
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Nursing management of hosptialized pt on dialysis
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!!! - do not administer htn meds on day of dialysis --> severe hypotension
- do not use blod presure or draws on pt's dialysis arm - monitor fluids, I&O, uremia, electrolytes - diet - restrictions on fluid, sodium, potassium, protein - pruritis care |
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types of vascular access for dialysis
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acute hemodialysis
- double lumen, cuffed hemodialyiss catheter into subclavian, internal jugular, femoral vein permamnet access - atriovenous fistula - fusing artery and vein - atriovenous graft - grafting a vessel between an artery and vein |
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nursing diagnoses kidney surgery
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1. ineffective airway clearance, ineffective breathing pattern r/t surgical incision pain
- analgesics, splint incision, frequent turning, early ambulation 2. actue pain 3. impaired urinary eliminiation 4. risk for fluid imbalance |
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signs of renal transplantation rejection
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- oliguria, inc BP, wieght gain, edema
- fever, tenderness over kidney |
