1. 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
  2. stage 1
    • diminished renal reserve
    • GFR greater than or equal to 90
  3. stage 2
    • mild reduction
    • GFR: 60-89
  4. Stage 3
    • Moderate reduction (renal insufficiency)
    • GFR: 30-59
  5. Stage 4
    • Severe reduction (renal failure)
    • GFR: 15-29
  6. Stage 5
    • Renal failure (end stage renal failue)
    • GFR: below 15 (or dialysis)
  7. 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)
  8. What to patients with crf not tolerate well
    • hemoglobin
    • hematocrit
  9. If kidneys are not working, patients are usually acidotic. What do they sometime give them to raise the ph
    Bicarbonate or Acetate
    sodium and water balance:
    • hypertension -heart failure
    • Increased vascular volume: heart failure, edema, increased or decreased urine output, eventually a fixed osmilarity
  11. S&S
    Potassium balance:
    Hyperkalemia:(fix with kaexelate or d50 w/ reg insulin)
  12. 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
  13. S&S
    Acid-base balance
    Acidosis, skeletal buffering- osteodystrophy(too little ca and too much phoshrous, must lower the phosphrous)
  14. S&S
    Activation of vitamin d
    Activation of Vitamin D: hypoalcemia-osteodystrophy, hyperparathyroidism- vitamin d and c
  15. 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
  16. S&S
    phosphate elimination
    hypocalcaemia, hyperparathyroidism, osteodystrophies
  17. Oliguria
    200-300 ccs per 24 hours
  18. Anuria
    urine output less than 40ccs per 24 hours
  19. polyuria
    • results from inability of kidneys to concentrate urine
    • occurs mostly at night
    • specific gravity will be around 1.010
  20. 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
  21. What should you expect to give patient with high phosphorous
    calcium carbonate
  22. 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)
  23. Anemia management medications
    • Procrit and epogen
    • Synthetic hormones that increase rbc production, needs two weeks to make work
    • best way to watch hemoglobin?
  24. What is the goal for lipid managment
    Lowering ldl below 100 and triglycerides below 200
  25. IV Insulin
    • Potassium management
    • IV glucose to manage hypoglycemia
  26. IV 10% Calcium Gluconate
    • Potassium management
    • raises thereshold for excitation
  27. Sodium biacarbonate
    • Potassium management
    • shifts potassium into cells
    • corrects acidosis as well
  28. 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
  29. 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)
  30. 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
  31. Filtering blood through an access using arterial and venous blood via a dialyzer device( artificial kidney) 3 days a week
  32. filtering system using th peritonieal cavity as a semipermeabloe membrane with a dialysisi solution. nightly
    Pertioneal dialysis
  33. 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
  34. Easy access, no vascular interuption
    Can cause peritonitis
    Simple training
    few hemodynamic complications
    peritoneal dialysis
  35. 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
  36. Nursing interventions for hemodialysis
    • monitor:
    • access device, teach patient care of
    • bleeding pre and post
    • vitals
    • wet and dry weight
    • neurological state
    • disequilibrium syndrome
Card Set
Chronic renal failure