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38 Cards in this Set
- Front
- Back
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Definition of Chronic Renal Faliure
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- when the kidneys are no longer capable of maintaining an internal environment consistent with life.
- Less than 15% GFR (stage 5) - Damage to kidneys is irreversible |
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Is damage to the kidneys reversible after a person is diagnosed with chronic renal failure?
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No.
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What are the stages of chronic renal failure?
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Stages 1-2 = impairment
Stages 3-4 = insufficiency |
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What is certain when a person is diagnosed with Chronic Renal Failure
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Death
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What stage of Chronic Renal Failure is a person in when their GFR is < 15%
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Stage 5
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Treatment Modalities for Chronic Renal Failure
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- Conservative Management: diet and nutrition
- Renal Replacement Therapies: dialysis and transplantation - Palliative care |
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What are the two forms of dialysis?
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- hemodialysis
- peritoneal dialysis |
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What kind of dialysis do the young and old do better with?
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Peritoneal dialysis
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Common causes of Chronic Renal Failure
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- Diabetic nephropathy
- Hypertensive nephropathy - Glomerulonephritis - Pyelonephritis - Polycystic Kidney disease |
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70% of chronic renal failure cases are caused by what?
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- Diabetes or hypertension
- It changes their microvasculature in the kidneys and it becomes ischemic which leads to necrosis |
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What is glomerulonephritis
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- and antigen/antibody condition where the body attacks the kidneys
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What is pyelonephritis
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Inflammation related to infection within the kidneys
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What is polycystic kidney disease
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A genetic condition where plasma like fluid builds up in the kidneys
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What happens to fluid balance in ESRD?
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- Fluid volume won't be well regulated
- Nursing problem: Fluid volume excess. It is rare for fluid volume deficit to occur |
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What happens to electrolyte balance in ESRD?
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- The body will retain electrolytes if they're low in the blood.
- The body will release them if they're high in the blood - Especially concerned about Na and K - Nursing problem with elevation in Na: alteration in mental status (seizures) - Nursing problem with elevation in K: arrhythmias |
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Elevation in Na causes:
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alterations in mental status (seizures)
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Elevation in P causes:
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Arrhythmias
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What happens to acid/base balance in ESRD?
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- Remember that the kidneys are the body's 3rd system to keep acid/base in balance
- Nursing problem with metabolic acidosis: decreased cellular activity (depression) |
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What happens to the excretion of metabolic wastes in ESRD?
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- BUN and creatinine levels change
- Nursing problem: elevation in creatinie and BUN causes acidosis and azotemia |
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How is creatinine produced?
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- a break down of the skeletal muscle system
- an increase affects every system in the body |
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How is BUN affected by ESRD?
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- the increased protein in the diet and blood in the GI system causes these levels to rise
- an increase affects every system in the body |
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How is the excretion of medications affected by ESRD?
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- many medications are excreted by the kidneys. If the kidneys are not working properly, medication levels can become toxic.
- Nursing Problem: toxicity and increased side effects from drugs |
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How is the regulation of BP affected by ESRD?
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- the regulation of the RAA system is off
- Nursing problem: hypertension - potential for stroke, blindness, MI |
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How is the regulation of Vitamin D affected by ESRD?
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- Vitamin D is activated in the kidneys. Activated Vit D helps regulate how Ca is absorbed, used and stored in the body.
- Nursing problem: osteoporosis - risk for injury,alteration in comfort - Nursing problem: hypocalcemia - seizures |
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How is erythropoietin production affected by ESRD?
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- Erythropoietin is produced by the kidneys. If the kidneys are not working correctly there will not be correct production of RBCs in the bone marrow
- Nursing problem: decreased tissue perfusion (arterial), fatigue, activity intolerance |
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What is the AAA Triad?
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- Azotemia: increased blood urea nitrogen and serum creatinine levels suggestive of renal impairment by without outward symptoms of renal failure. UNABLE TO REMOVE THESE FROM THE BLOOD IN RF
- Acidosis - Anemia |
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Normal BUN and Creatinine levels
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BUN = 5-20 mg/dL
Creatinine = .5-1.5 mg/dL |
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Normal pH level
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7.35 - 7.45
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Normal Hgb and hct levels
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* Hgb = 15 g/dL
* hct = 45% - Hct can be decreased in renal failure due to hydrationstatus or b/c the RBCs are actually lower |
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What are the kidneys not able to remove from the blood in renal failure?
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BUN and creatinine
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How are BUN and creatinine kept low during ESRD?
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- Protein intake is controlled (.8-1.5 g/kg)
- Calories are provided by CHO - Avoid dieting - Avoid catabolic states - Avoid GI bleeding - Dialysis * ESRD PTS NEED TO EAT A VERY STRICT DIET B/C OF THE AFFECTS THAT COULD HAPPEN TO THEIR BUN AND CREATININE - eating too much or too little can increase the BUN and creatinine |
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What is acidosis and how does it occur?
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- hydrogen and ammonia in serum - decreased bicarbonate reabsorption
- end products of protein metabolism hyperkalemia (K/H shift) |
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How is acidosis corrected?
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* bicarbonate PO or IV
* Shohl's solution * Give IV slowly to prevent hypocalcemia and tetnay - Giveing a lot of bicarbonate by IV can cause it to combine with Ca which can cause tetany * Keep protein and K controlled in diet * Dialysis |
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Which ABG in ESRD?
pH 7.5 pCO2 30 HCO3 21 pH 7.31 pCO2 50 HCO3 25 pH 7.48 pCO2 45 HCO3 28 pH 7.33 pCO2 34 HCO3 20 |
- 1 and 3 are out b/c this is alkalosis
- 2 is respiratory because of the increased pCO2 - ANSWER = 4 |
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What is anemia and how does it occur?
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- Erythropoietin production is lost
- shortens life span - limited intake of protein - bone marrow suppression - loss of blood from dialysis or GI tract |
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how is anemia corrected/managed?
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* minimize blood loss with repeated tests
* avoid blood transfusions or use sparingly (transfusions decreases the success of a transplant) - eat iron rich foods (ferrous sulfate and folic acid/B9) - human recombiant EPO or Procrit (helps stimulate RBC production) - androgen hormone |
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Nursing goals of the pt with ESRD
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- maintain homeostasis (with diet and dialysis)
- prevent complications - teaching for discharge (learn to care for themselves) - support life style changes - quality of life issues - ethical issues - financial issues |
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ESRD nursing diagnosis: At risk for medication toxicity
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* medication dosing amounts will most likely change for a person with ESRD
* Decrease dosing * Check for K and Mag in all meds - Mag = 1.5 - 2.5 mg/dL - Increased K is not good, but increased Mag can cause an alteration in consciousness |
