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37 Cards in this Set
- Front
- Back
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Define acute renal failure
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- often reversible
- abrupt deterioration of kidney function |
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Define chronic renal failure:
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- irreversible
-slow deterioration of kidney function characterized by increasing BUN and creatinine. - eventually dialysis is required |
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During the oliguric phase of renal failure, protein should be severely restricted. What is the rationale for this restriction?
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Toxic metabolites that accumulate in the blood (urea, creatinine) are derived mainly from protein catabolism
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Identify two nursing interventions for the client on hemodialysis
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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 |
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What is the highest priority nursing diagnosis for clients in any type of renal failure?
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Risk for imbalanced fluid volume
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A client in renal failure asks why he is being given antacids. How should the nurse respond?
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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.
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List 4 essential elements of a teaching plan for clients with frequent UTI's
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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 |
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What are the most important nursing interventions for clients with possible renal calculi?
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1. straning all urin is the most important intervetnion
2. I/O documention 3. administer analgesics prn |
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After kidney surgery, what are the primary assessments the nurse should make?
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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). |
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Acute renal failure occurs when .....accumlate in teh body and urinary output changes.
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metabolites
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What is the normal amount of kidney excretion in 24 hours?
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1 ml of urin/kg/hr which equals
1-2 L in 24 hours |
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What are the 3 phases of acute renal failure?
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1. Oliguric
2. Diuretic 3. Recovery |
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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 |
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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 < ) |
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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 |
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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
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10
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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 |
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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
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ARF Interventions
6. ..... may be prescribed if K+ is too high 7. Prevent cross-infection |
6. Kayexalate
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ARF- Prerenal
1. Descprtion 2. Causative Factors |
1. Interference with renal perfusion
2. Hemorrhage Hypovolemia Decreased CO Decreased renal perfusion |
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ARF- Intrarenal
1. Description 2. Causative Factors |
1. Damage to renal parenchyma
2. Prolonged prerenal state Nephrotoxins Intratubular obstruction Infections (glomerulonephritis) Renal injury Vascular lesions Acute pyelonephritis |
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ARF-Postrenal
1. Description 2. Causative Factors |
1. Obstruction in the urinary tract anywhere from the tubules to the urethral meatus
2. Calculi Prostatic hypertrophy Tumors |
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ARF- Sings of (hypo/hyper) K+
dizziness weakness cardiac irregularities muscle cramps diarrhea nausea |
Hyperkalemia
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ARF- Interventions
1. provide ...protein, ....fat, and ...carb diet 2. Limit fluid and ....intake |
1. low protein
mod. fat high carb 2. sodium |
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ARF- K+
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 |
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ARF
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. |
protein
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Chronic Renal Failure: End stage renal disease (ESRD)
= Progressive, irreversible damage to teh nephrons and glomeruli, resulting in ..... |
uremia
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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 |
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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 |
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CRF
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. |
uremia
muscle wasting |
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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 |
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CRF Assessement
The ..... ..... rate (GFR) is most often used as an indicator of the level of protein consumption. |
Glomerular filtration rate (GFR)
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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 |
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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)
low |
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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. |
Aluminum
biologic |
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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 |
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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 |
