Card Set Information
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
: 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
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
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
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?
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)
: 120-125 ml/minute
: less than 15 ml/minute
What are the MOST COMMON CAUSES of CHRONIC RENAIL FAILURE?
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
What is Uremia?
A symptom of CRF
An increase in nitrogen waste products that causes:
Metallic Taste in Mouth
What are the COMPLICATIONS of CRF? - what can it progress to?