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Progressive inablility for the kidneys to function over time with a GFR of less than 20% and serum Creatinine level over 5.0mg/dL
Chronic renal failure
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stage 1
- diminished renal reserve
- GFR greater than or equal to 90
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Stage 3
- Moderate reduction (renal insufficiency)
- GFR: 30-59
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Stage 4
- Severe reduction (renal failure)
- GFR: 15-29
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Stage 5
- Renal failure (end stage renal failue)
- GFR: below 15 (or dialysis)
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Causes of crf
- diabetes and hypertension
- glomerulonephritits
- polycystic kidney disease-common disease of younger adults
- Autoimmune (lupus)
- Renal obstructions of malformations ( Kidney stone, bph)
- Mycins!!- aminoglycosides
- Repeated severe infections (pyelonephritis)
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What to patients with crf not tolerate well
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If kidneys are not working, patients are usually acidotic. What do they sometime give them to raise the ph
Bicarbonate or Acetate
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SIGNS AND SYMPTOMS
sodium and water balance:
- hypertension -heart failure
- Increased vascular volume: heart failure, edema, increased or decreased urine output, eventually a fixed osmilarity
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S&S
Potassium balance:
Hyperkalemia:(fix with kaexelate or d50 w/ reg insulin)
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S&S
Erythropoietin production
- Erythropoietin production:
- anemia-25-27% hemocrit is all they can tolerate
- uremic coagulapathies
- pt, ptt, inr will all be abnormal,because acidosis more prone to gi bleeds
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S&S
Acid-base balance
Acidosis, skeletal buffering- osteodystrophy(too little ca and too much phoshrous, must lower the phosphrous)
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S&S
Activation of vitamin d
Activation of Vitamin D: hypoalcemia-osteodystrophy, hyperparathyroidism- vitamin d and c
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S&S
elimination of nitrogenous waste
- Uremia-symptom of renal failure, high uric acid, gets frost on the skin, itchy skin,
- Pericarditis
- Skin disorders, GI upset, neruological manifestations, sexual disfunction
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S&S
phosphate elimination
hypocalcaemia, hyperparathyroidism, osteodystrophies
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Oliguria
200-300 ccs per 24 hours
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Anuria
urine output less than 40ccs per 24 hours
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polyuria
- results from inability of kidneys to concentrate urine
- occurs mostly at night
- specific gravity will be around 1.010
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how do they do a 24 hour urine creatinine clearance
- best to determine how their gfr works
- has to have all urine
- get rid of first pee
- keep all other voids
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What should you expect to give patient with high phosphorous
calcium carbonate
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what should you expect for nutritional therapy
- PRO restrictions (unless on HD)
- Sodium and h2o restrictions (unless contridicted)
- Potassium restriction
- Phoshorus restrictions ( take phosphate binders at mealtime and calcium supplements on empty stomach)
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Anemia management medications
- Procrit and epogen
- Synthetic hormones that increase rbc production, needs two weeks to make work
- best way to watch hemoglobin?
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What is the goal for lipid managment
Lowering ldl below 100 and triglycerides below 200
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IV Insulin
- Potassium management
- IV glucose to manage hypoglycemia
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IV 10% Calcium Gluconate
- Potassium management
- raises thereshold for excitation
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Sodium biacarbonate
- Potassium management
- shifts potassium into cells
- corrects acidosis as well
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Kayexalate
- cation- exchange resin
- resin in bowel exchanges potassuim for sodium
- evacuates potassium- rich stool from body
- educate patient that diarrhea may occur due to laxative in preparation
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Nursing intervention key concepts
- i&o's daily weights labs, bleeding, weights, ca, k, and phosphate level, H&H, Pro levels, Fluid overload
- Monitor toxic medications, cbc for anemia, monitor urine output for quality of urine (specific gravity, creatinine clearance)
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Nursing diagnosis
- Excess fluid volume
- risk for injury
- imbalanced nutrition: less than
- greieveing
- risk for infection
- knowledge deficit
- ineffectictive coping mechanism
- denial
- impaired family dynamics
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Filtering blood through an access using arterial and venous blood via a dialyzer device( artificial kidney) 3 days a week
hemodialysis
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filtering system using th peritonieal cavity as a semipermeabloe membrane with a dialysisi solution. nightly
Pertioneal dialysis
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Requires an venous access
Dietary restrictions
More potential complications with bleeding
Most effective clearance
More expensive3e
Must be heomdynamically stable
Potential for more complications
Must have a good BP before dialysis- check med befor they go for med and BP
Hemodialysis
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Easy access, no vascular interuption
Can cause peritonitis
Simple training
few hemodynamic complications
peritoneal dialysis
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Nursing inverventions for peritoneal dialysis
- monitor for peritonititis
- STRICT monitoring of inflow and outflow
- CAPD (continuous ambulatory pd) monitor fluid status during
- Strict aseptic technique
- Monitor for infection, tunneling , bleeding
- monitor vital sighns at intial treatments
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Nursing interventions for hemodialysis
- monitor:
- access device, teach patient care of
- bleeding pre and post
- vitals
- wet and dry weight
- neurological state
- disequilibrium syndrome
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