Renal Failure

  1. What is the definition of ACUTE RENAL FAILURE?
    • RAPID decline in renal function
    • REVERSIBLE with prompt treatment
    • Most common with HOSPITAL PATIENTS
    • Ischemia
    • Nephrotoxins
  3. What are the FOUR PHASEES of ARF?
    • Initiation
    • Oliguria
    • Diuresis
    • Recovery
  4. 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)
  5. 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
  6. What is the DIURESIS phase of ARF?
    • GRADUAL increase in UOP
    • Labs get better - improves slightly
  7. What is the RECOVERY PHASE of ARF?
    • Improvement in renal function - labs are back to normal
    • Time range: 3-12 months
  8. What are the CATEGORIES (classifications) of ARF?
    • Prerenal
    • Intrarenal
    • Postrenal
  9. 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
  10. What is INTRARENAL failure? (ARF)
    • The result of ACTUAL damage to the kidney
    • Nephrotoxins - esp. aminoglycosides and radiocontrast agents
    • Ischemia
    • Infections
  11. What is POSTRENAL failure? (ARF)
    • The result of obstruction somewhere distal to the kidney (so after the kidney)
    • Tumor, enlarged prostate, stones, etc
  12. 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
    • Fatigue
    • Lab values
  13. 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
  14. Why is the urine specific gravity decreased?
    Because of the inability of the kidney to concentrate the urine
  15. 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
  16. 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
  17. 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
  18. What are drugs are nephrotoxic?
    • Antibiotics - aminoglycosides, gentamycin, vancomycin, cyclosporine
    • Radiocontrast
    • Ace - inhibitors
    • NSAIDS
  19. 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
  20. 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
  21. 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
    • Diabetes Mellitus
    • Hypertension
  23. How does diabetes cause CRF?
    • Glomeruli and arterioles befcome sclerosed
    • Glomerulus loses selective permeability to filter
  24. How does HTN cause CRF?
    Damages the blood vessels and filters in the kidney
  25. 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
  26. 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
    • HTN
    • CHF, Pulmonary Edema
    • Arrhythmias
    • Pericarditis
    • Dyspnea, SOB
    • Pneumonia
    • Anemia
  27. What is Uremia?
    • A symptom of CRF
    • An increase in nitrogen waste products that causes:
    • Fatigue
    • Foamy Urine
    • Metallic Taste in Mouth
  28. What are the COMPLICATIONS of CRF? - what can it progress to?
    • Hyperkalemia
    • Pericarditis
    • Dyspnea, SOB
    • HTN
    • Anemia
    • Bone disease
    • Thrombocytopenia
Card Set
Renal Failure
Renal Failure