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37 Cards in this Set

  • Front
  • Back
Define acute renal failure
- often reversible
- abrupt deterioration of kidney function
Define chronic renal failure:
- irreversible
-slow deterioration of kidney function characterized by increasing BUN and creatinine.
- eventually dialysis is required
During the oliguric phase of renal failure, protein should be severely restricted. What is the rationale for this restriction?
Toxic metabolites that accumulate in the blood (urea, creatinine) are derived mainly from protein catabolism
Identify two nursing interventions for the client on hemodialysis
1. do NOT take BP or perform venipunctures on teh arm with teh AV shunt, fistula, or graft
2. Assess access site for thrill and bruit
What is the highest priority nursing diagnosis for clients in any type of renal failure?
Risk for imbalanced fluid volume
A client in renal failure asks why he is being given antacids. How should the nurse respond?
Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into blood stream, therby preventing rising phosphate levels; must be taken with meals.
List 4 essential elements of a teaching plan for clients with frequent UTI's
1. fluid intake 3 L/day
2. Good handwashing
3. Void every 2-3 hours during waking hours
4. Take all prescribed meds
5. wear cotton undergarments
What are the most important nursing interventions for clients with possible renal calculi?
1. straning all urin is the most important intervetnion
2. I/O documention
3. administer analgesics prn
After kidney surgery, what are the primary assessments the nurse should make?
1. Respiratory status (breathing is guarded bc of pain)
2. Circulatory status ( the kidney is very vascular and excessive bleeding can occur)
3. Pain assessment
4. Urinary assessment (most importantly, assessment of urinary output).
Acute renal failure occurs when .....accumlate in teh body and urinary output changes.
What is the normal amount of kidney excretion in 24 hours?
1 ml of urin/kg/hr which equals
1-2 L in 24 hours
What are the 3 phases of acute renal failure?
1. Oliguric
2. Diuretic
3. Recovery
ARF RN Assessment:
1. History of taking what kind of drugs?
2. Alterations in urinary what?
3. Weight would be gained or lost?
4. Change in what status?
1. Nephrotoxic drugs (salicylates, antibiotics, NSAIDs)
2. urinary output
3. edema, weight gain
4. mental status
ARF RN Assessment:
* Diagnositc findings in the Oliguric Phase:*
1. I/D BUN and creatinine
2. I/D postassium
3. I/D sodium
4. I/D pH
5. Fluid over/under load
6. I/D urine specific gravity
1. I
2. I - hyperkalemia
3. D- hyponatremia
4. D- acidosis
5. Overloaded-hypervolemic
6. I- (1.020 < )
ARF Diagnostic Findings in Diuretic Phase:
1. I/D fluid volume
2. I/D potassium
3. Further I/D in Na
4. H/L urine specific gravity
1. D- hypovolemia
2. D- Hypokalemia
3. D- hyponatremia
4. L- < 1.020 g/ mL
In some cases, persons in ARF may not experience the oliguric phase but may progress directly into the diuretic phase, during which the urine output may be as much as ....L/ day
ARF Interventions:
1. Monitor I/O accurately: Give only enough fluids in oliguric phase to replace losses; Usually ....-.... ml/24 hr
2. Document and report any change in fluid....status
3. Monitor lab values for both serum and urine to assess electrolyte status, esp. Hyper-K indicated by a serum K level over....mEq/l and ECG changes
1. 400-500 ml/24hr
2. fluid volume
3. 7 mEq/L
ARF Interventions
4. Assess level of consciousness for subtle changes
5. Weigh daily: in oliguric phase, pt may gain up to ...lb/day
5. 1 lb/day
ARF Interventions
6. ..... may be prescribed if K+ is too high
7. Prevent cross-infection
6. Kayexalate
ARF- Prerenal
1. Descprtion
2. Causative Factors
1. Interference with renal perfusion
2. Hemorrhage
Decreased CO
Decreased renal perfusion
ARF- Intrarenal
1. Description
2. Causative Factors
1. Damage to renal parenchyma
2. Prolonged prerenal state
Intratubular obstruction
Infections (glomerulonephritis)
Renal injury
Vascular lesions
Acute pyelonephritis
1. Description
2. Causative Factors
1. Obstruction in the urinary tract anywhere from the tubules to the urethral meatus
2. Calculi
Prostatic hypertrophy
ARF- Sings of (hypo/hyper) K+
cardiac irregularities
muscle cramps
ARF- Interventions
1. provide ...protein, ....fat, and ...carb diet
2. Limit fluid and ....intake
1. low protein
mod. fat
high carb
2. sodium
Safe level (3.5-5.0 mEq/l)
It effects the heart, and any imalance must be corrected by meds or dietary modification. Limit high K+ foods such as...... and .... substitutes, which are high in potassium.
Bananas, avocados, spinach, fish
Salt substitutes
During oliguric phase, minimize protein breakdown and prevent rise in BUN by limiting ....intake.
When BUN and creatinine return to normal, ARF is determined to be resolved.
Chronic Renal Failure: End stage renal disease (ESRD)
= Progressive, irreversible damage to teh nephrons and glomeruli, resulting in .....
CRF Assessment
1. History of high med usage
2. family history of renal disease
3. I/D BP?
4. Edema, pulmonary edema
5. Neuro impairment (...,...)?
3. Increased
5. Weakness, drowsiness
CRF Assessment
Decreasing urinary function:
1. Hematuria
2. Proteinuria
3.Cloudy urine
4. Oliguric (...to...ml/day)
5. Anuric (less than...ml/day)
4. 100-400
5. <100
Accumulation of waste products from protein metabolism is the primary cause of ......
Protein must be restricted in CRF clients.
If protien intake is inadequate, a neg. Nitrogen balance occurs, causing .....wasting.

muscle wasting
CRF Assessment
6. Yellowish skin
7. GI upsets
8. what kind of taste in mouth?
9. What kind of breath?
10. Dialysis
11. Previous kidney transplant
8. metallic
9. ammonia
CRF Assessement

The ..... ..... rate (GFR) is most often used as an indicator of the level of protein consumption.
Glomerular filtration rate (GFR)
CRF Assesment- Lab Info
1. Azotemia
2. I/D BUN and creatinine?
3. I/D Calcium?
4. I/D Mg and P?
2. Increased
3. Decreased
4. Elevated
CRF Interventions
1. Monitor serum electrolyte levels
2. Weigh daily
3. Monitor strict I/O
4. Check for .... ... ... (...) and other signs of fluid overload
5. Monitor edema, pulmonary edema
6. Provide ... protein, ...sodium, ...potassium, and .... phosphate diet
Jugular vein distension (JVD)

CRF Interventions
7. Administer .....hydroxide antacids to bind phosphates because client is unable to excrete phosphates (no mg-based antacids). Timing is important!
8. Encourage protein intake to be of high....-value (eggs, milk, meat) bc the client is on a low-protein diet.

CRF- Complications
1. Anemia (Administer ...-...drugs)
2. Renal .... (Abnormal calcium metabolism causes bone pathology)
3. Severe, resistant hypertension
4. Infection
5. Metabolic ......
1. antianemic drugs
2. renal osteodystrophy
5. acidosis
Antianemic: Biologic Response Modifer (BRM Drug:

Erhtropoietin (Epogen)
1. Indications:
2. AR
3. RN Interventions!
1. Anemia due to decreased production of Erythropoietin in end stage renal disease; Stimulates RBC production, increases HgB, reticulocyte count, and HcT
AR: increased risk of thrombosis in elderly
3. ! monitor Hct weekly; reprot levels over 30% to 33% and increases of more than 4 points in less than 2 weeks.
! Explain that pelvic and limb pain should stop after 12 hrs
! Do not shake vial; shaking may inactivate the glycoprotein
! Discard unused contents; does not contain preservatives