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What is the definition of ACUTE RENAL FAILURE?
- RAPID decline in renal function
- REVERSIBLE with prompt treatment
- Most common with HOSPITAL PATIENTS
What are the MOST COMMON CAUSES of ACUTE RENAL FAILURE?
What are the FOUR PHASEES of ARF?
What is the INITIATION phase of ARF?
Starts with the insult to the kidney and ends with the beginning of urinary symptoms (decreased urine output, fluid retention, electrolyte imbalance)
What is the OLIGURIA phase of ARF?
- Urinary symptoms are present (characterized by a decrease in urinary output, lab values are apparent)
- ALL SERUM LEVELS are INCREASED: potassium, cr, and BUN (all elevated)
- Decreased Cr clearance
What is the DIURESIS phase of ARF?
- GRADUAL increase in UOP
- Labs get better - improves slightly
What is the RECOVERY PHASE of ARF?
- Improvement in renal function - labs are back to normal
- Time range: 3-12 months
What are the CATEGORIES (classifications) of ARF?
What is PRERENAL failure? (ARF)
- The result of impaired blood flow that leads to HYPOperfusion of the kidney and a decrease in GFR
- Volume Depletion - d/t renal losses, hypovolemia, GI losses, hemorrhage, diuretics
- Impaired Cardiac Insufficiency - d/t MI, HF, dysarrythmias
- Vasodilation - d/t sepsis, anti-HTN meds; basically any meds that cause vasodilation
What is INTRARENAL failure? (ARF)
- The result of ACTUAL damage to the kidney
- Nephrotoxins - esp. aminoglycosides and radiocontrast agents
What is POSTRENAL failure? (ARF)
- The result of obstruction somewhere distal to the kidney (so after the kidney)
- Tumor, enlarged prostate, stones, etc
What are the clinical manifestations of ARF?
- Decreased urine output (oliguria) - but sometimes, it UOP will remain normal
- FLUID RETENTION - peripheral edema, pulmonary edema, SOB
- Lab values
What are the lab values that you look for in ARF?
- BUN - elevated
- Creatinine - elevated
- Cr clearance - decreased
- Electrolyte - imbalanced
- Potassium in the body - increased
- Phosphorous in the body - increased
- Calcium - decreased
- Urine specific gravity - decreased (because the urine is dilute - it is below 1.003 - 1.030)
- Urine osmolarity - decreased
- Hct/Hg - decreased
- Metabolic acidosis
Why is the urine specific gravity decreased?
Because of the inability of the kidney to concentrate the urine
What kind of MEDS do you give for RENAL FAILURE?
- Elevated BP - give anti-HTN
- Anemia - give EPO, iron supplements
- Hyperkalemia - Kayexalate, IV D50, insulin, albuterol sulfate - to shift potassium back into the cells
- Increased phosphate in body - give phosphate binders - aluminum hydroxide
How do you treat renal failure?
- Eliminate drugs that are nephrotoxic (mostly for ARF)
- Symptomatic teratment (for anemia, bone absorption, hyperkalemia, etc)
- Renal diet / nutrition - moderate protein, low sodium
- Hemodialysis - can be used for acute and chronic
- Daily weights
- Fluid restriction
- Skin protocol - prone to impaired skin integrity because dry skin is prone to ulercation and breakage
If patient gains weight, develops hypertension - what should you be concerned about in relation to renal failure?
Fluid retention - may manifest as peripheral edema, ascites, pulmonary edema, SOB, fatigue
What are drugs are nephrotoxic?
- Antibiotics - aminoglycosides, gentamycin, vancomycin, cyclosporine
- Ace - inhibitors
What kind of nutrition / diet should you encourage with Renal Failure?
- Moderate protein
- Low sodium
- Do not give DASH (sodium supplement) - because it has a high potassium content
What are some nursing diagnosis related to ARF?
- Excess fluid volume - r/t to decrease UOP
- Imbalanced nutrition - less than body requirement r/t to N/V
- Knowledge deficit - r/t to condition and treatment regimen
What is the definition of CHRONIC RENAL FAILURE?
- PROGRESSIVE, IRREVERSIBLE kidney disease (aka CKD, ESRD)
- Normal GFR : 120-125 ml/minute
- ESRD GFR : less than 15 ml/minute
What are the MOST COMMON CAUSES of CHRONIC RENAIL FAILURE?
- Diabetes Mellitus
How does diabetes cause CRF?
- Glomeruli and arterioles befcome sclerosed
- Glomerulus loses selective permeability to filter
How does HTN cause CRF?
Damages the blood vessels and filters in the kidney
What is renal failure?
- Kidneys are unable to remove body's metabolic wastes or perform their regulatory functions leading to altered fluid, electrolyte, and acid-based balance
- The kidney is unable to excrete the wastes - that's where the clinical s/sx come into play
What are signs and symptoms of Chronic Renal Failure?
- Because the kidney cannot excrete wastes - the following substances build up in the system: Urea, Creatinine, Hormones, Electrolytes
- CHF, Pulmonary Edema
- Dyspnea, SOB
What is Uremia?
- A symptom of CRF
- An increase in nitrogen waste products that causes:
- Foamy Urine
- Metallic Taste in Mouth
What are the COMPLICATIONS of CRF? - what can it progress to?
- Dyspnea, SOB
- Bone disease