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Renal failure

Terms in this set (85)

What are the three life sustaining tasks done by the kidney?
Balance solutes and water
Excrete wastes and conserve nutrients
Regulate acid/base balance
What is oliguria and is it chronic or acute?
It is the excretion of less than 16 ml an hour and less than 400 ml excreted in 24 hours. It is often acute
What is azotemia and is it chronic or acute?
The development of urea in the blood and it is chronic
What is Fluid retention:edema and is it acute or chronic?
It is caused by holding fluid in the peripheral vascular system
What is metabolic acidosis and is it chronic or acute?
Kidney cannot make enough bicarb and there is a low to normal pH more so acute
What is uremia and is it chronic or acute?
Build up of urine in the blood and it is chronic
What is anemia and is it chronic or acute?
It is caused by the kidney's failing to produce enough erythropoetin due to damage. Chronic
What is hypertension and is it acute or chronic?
Caused by accelerated atherosclerosis increased fluid volume due to the renin-angiotensin system not functioning. Chronic
What is confusion caused by?
Build up of waste products in the body
What is lethargy caused by?
Metabolic acidosis and waste build up
What does GFR measure?
The amount of fluid that goes through filtration in one minute. Normal is 120-125
What electrolytes do you need to watch with renal failure?
POTASSIUM
Phosphorus
Magnesium
Sodium
What is creatinine used to measure?
Kidney function this is the most accurate measure of it
It is a 24 hour collection of urine and it tests the waste products
What is BUN and what does it measure?
Does not tell us specifically about the kidney, but tells us about the amount of urea nitrogen in the blood
Why do we use a CT scan on the kidney?
To look for masses in the kidney
Why do we use a cystoscopy?
To look for a blockage
Why do we use a MRI?
To look for structural abnormalities
What do we use a renal biopsy for?
To look for diseases and processes
What do we use a renal angiogram for?
To look at blood flow through the kidney
Why do we look at ABG's with renal failure?
Because of the Bicarb in relation to metabolic acidosis
Why do we do a Intravenous pyleogram?
It is dye in the renal system to look at function
What is a CAT scan and what are some important questions we must ask before doing it?
Assesses kidney function with dye and is hard on the kidney
It is important to ask if they have any allergies to shellfish or iodine
How is renal failure different from prerenal failure?
With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure
With prerenal failure, there is less response to such diuretics as furosemide (Lasix)
With prerenal failure, an IV isotonic saline infusion increases urine output
With prerenal failure, hemodialysis reduces the BUN level
3. Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.
Polystyrene sulfonate (Kayexalate) is used in renal failure to:

Correct acidosis
Reduce serum phosphate levels
Exchange potassium for sodium
Prevent constipation from sorbitol use
3. In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.
What is Acute renal failure?
Common in older adults
Need to do a quick reversal or it will turn into chronic renal failure
Treat with prevention and hemodialysis
Caused by ischemia and nephrotoxins
What are the three different causes of renal failure?
Pre-renal- Kidneys are not getting perfused
Intra-renal- damaged to the nephrons
Post renal- urine unable to be excreted
What causes pre-renal failure?
Trauma/Surgery
Hypovolemia
Blood loss/hemorrhage
Dehydration
Sepsis
Heart failure
Medications- diuretics, vasoconstrictors, ACE inhibitors, NSAIDS
How do we treat pre-renal failure?
Replace what was lost
Fluids or blood
Dopamine 1-3 mc/kg as it vasodilates
Vasoconstrictors- Epiniphrine and Levophed
Treat the cause
Prevent additional damage
Monitor urine output and kidney function
Placed on hemodialysis until kidney function returns
What can cause Intra-renal failure?
Acute tubular necrosis
DIC
Radiation
Rhabdomylosis
Glomerulonephritis
How do we treat intra-renal failure?
Identify and treat the cause
Hydrate
Treat infection with antibiotics
Compensate using dialysis until function returns
What can cause post renal failure?
BPH
Kidney and bladder stones
Blood clots
Tumors
Neurogenic bladder- back injury
How do we treat post renal failure?
TURP or OR for BPH
Surgical removal of tumors
Lithotripsy for stones
Hemodialysis till cause is fixed
What is the initiation phase of acute renal failure?
Limited decrease in kidney function
Few signs or symptoms
Main goal is prevention
What is the maintenance phase of acute renal failure?
The kidney begins showing signs of failing
Oliguria is present
S/S of renal failure are presented
This will lead to chronic renal failure if not treated
What is the recovery phase of acute renal failure?
The kidney's begin to repair
The tubular cell repair begins
There is a gradual return to a normal GFR
Diuresis occurs
__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi)
A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal
C. Post renal
Agents that damage the kidney tissue are called:
A. Nephrons
B. Nephrotoxins
C. Antibodies
D. Enterotoxins
B. Nephrotoxins
Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).
400
________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as nephrons are destroyed and renal mass is reduced.
Chronic
The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal
A Pre-renal
During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids
Maintenance
Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________.
A. Hematuria
B. Oliguria
C. Uremia
D. Nephrotoxins
C. Uremia
_________ renal Failure is a rapid decline in renal function with an abrupt onset
Acute
Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension, Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels?
A. Initiation phase
B. Maintenance phase
C. Recovery fase
D. Intrarenal phase
B. Maintenance phase
When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure.
A. End-stage renal disease (ESRD)
B. Renal insufficiency
C. Acute tubular necrosis
D.Dialysis
A. End stage renal disease
________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissur breakdown due to trauma, heatstroke)
A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal
B. Intra-renal
When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intake are ________.
A. Encouraged
B. Limited
C. Restricted
B. Limited
_________ is the most frequent complication during hemodialysis.
A. Hypotension
B. Bleeding
C. Infection
D. Dialysis dementia
A. Hypotension
Which is the treatment of choice for many clients with end-stage renal disease?
A. Hemodialysis
B. Kidney transplant
C. Continuous Renal Replacement Therapy (CRRT)
D. Peritoneal dialysis
A. Kidney Transplant
Which of these drugs is nephrotoxic?
A. Diuretics
B. ACE inhibitors
C. NSAIDs
D. Sodium bicarbonate/ Potassium bicarbonate
C. NSAIDS
The client with renal failure should be on which type of diet?
A. High protein, high carbohydrate, low calorie
B. Adequate calorie intake, high carbohydrate, limited protein
C. Limited protein, low carbohydrate, adequate calorie intake
D. Low calorie, limited protein, low carbohydrate
B. Adequate calorie intake, high carbohydrate, limited protein
A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance?
A. Hyponatremia
B. Hyperkalemia
C. Hyperphosphatemia
D. Hypercalcemia
A. Hyponatremia
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?
A.
Blood urea nitrogen 50 mg/dl
B.
Hemoglobin of 10.3 mg/dl
C.
Venous blood pH 7.30
D.
Serum potassium 6 mEq/L
D. Serum Potassium of 6
Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
A.
Hypernatremia.
B.
Hypokalemia.
C.
Hyperkalemia.
D.
Hypercalcemia.
C. Hyperkalemia
A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client?
A.
Polyuria
B.
Polydypsia
C.
Oliguria
D.
Anuria
A. Polyuria
A client with acute renal failure is aware that the most serious complication of this condition is:
A.
Constipation
B.
Anemia
C.
Infection
D.
Platelet dysfunction
Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure
For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
A.
Encouraging coughing and deep breathing
B.
Promoting carbohydrate intake
C.
Limiting fluid intake
D.
Providing pain-relief measures
C. Limiting fluid intake
List the pathological causes for chronic kidney disease:
Hypertension, diabetes, Glomerulonephritis, nephrotic syndrome, polycystic kidney disease, lupus, nephotoxic agents, kidney stones, traumas
What natural process can lead to chronic kidney disease?
As you age your number of nephrons fall as does the GFR.
What is happening in stage one of CKD?
Kidney damage with normal GFR function
What is happening in stage two of CKD?
Mild decrease in the GFR
What is happening in stage three of CKD?
Moderate decrease in GFR
What is happening in stage four CKD?
Malnutrition and poor absorption
What is happening in stage five CKD?
End stage renal/kidney failure. Individual is placed on dialysis
What is renal insufficiency?
Stage 1 and 2 of chronic kidney disease
Having 20%-50% of what your renal function is supposed to be
What is renal failure?
Stage 3 and 4
This is to have less than 20% renal function
What is end stage renal failure?
Stage 5
Individuals only have less than 5% renal function
What are signs and symptoms of chronic renal failure?
Edema, Urine breath, Loss of appetite, increased risk for infection, mental status change, confusion,
Increased potassium, phosphorus, and magnesium
While there is a decrease in calcium
There is an increase in atherosclerosis, hypertension, and they are at risk for cardiac tamponade
Anemia too
They can develop GI bleeds and osteoporosis related to calcium depletion
How do we manage chronic renal failure?
Through diet restrictions: Control fluids
Decrease intake of phosphorus, sodium, and potassium
Decrease protein intake
Increase calcium by eating tums
Teach about hemodialysis restrictions
Peritoneal dialysis
Kidney transplant
There is also the option of not treating
What are foods that are high in phosphorus?
Organ meat, Dark soda, Hot dogs, sausage, salt substitutes, dried beans, and peanut butter
What are nursing diagnosis for chronic renal failure?
Disturbed body image
Risk for depression
Self care deficit
What is the number one nursing diagnosis for acute and chronic renal failure?
Ineffective tissue perfusion
Acute more than chronic
Monitor medications- ACE and ARBS
Avoid nephrotoxic medications such as: NSAIDS, Aminoglycocides, ACE inhibitors, contrast dye
Monitor, I/O, weight, respiratory status, BUN and creatinine
Treat electrolyte imbalance
What interventions do we do for the nursing diagnosis of Risk for excess fluid volume?
I/O, daily weights, LUNG SOUNDS, edema checks
Monitor for hypertension, pulmonary edema
Restrict fluids
Administer diuretics if the patient still has kidney function
Dialysis if the patient does not have kidney function
What nursing interventions do we do for the nursing diagnosis of Imbalanced nutrition?
Monitor renal diet intake
Limit fluid, low protein, sodium, potassium, and phosphorus.
Small frequent meals
Give antiemetics, antacids, pepcid, protonix
Hyperphophatemia-use phosphorus binder calcium carbonate
Hyperkalemia-Kayexelate + insulin + glucose + bicarb
Supplement iron/folate
Give epogen
Give vitamin D
What medications should be avoided with chronic kidney disease?
Alka-seltzer
milk of mag
Asprin
Enema or laxative
Vitamins
Herbal supplements
What are some interventions for the nursing diagnosis for at risk for infection?
Increased risk with a hemocath
Increased risk with CRF and uremic syndrome
Check for signs and symptoms of infection
Good hand washing
Teach about dialysis site care
Monitor WBC AND PROCALCITONIN
What are some interventions for the nursing diagnosis of deficient knowledge?
Teach client about disease
Teach about infection control
Fear/anxiety
Depression
Spiritual needs
What are common electrolyte imbalances in acute renal failure?
Hyperkalemia, hyperphosphatemia, hypocalcemia, and hypermagnesemia are common electrolyte imbalances in acute kidney failure
What is renal osteodystrophy?
Renal osteodystrophy is a condition due to chronic kidney disease and renal failure, with elevated serum phosphorus levels, low or normal serum calcium levels, and stimulation of parathyroid function, resulting in a variable admixture of bone disease (deformation of bone, weak/brittle bone, abnormal bone metabolism).
The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted?
A. Auscultate for pericardial friction rub
B. Assess for crackles
C. Monitor for decreased peripheral pulses
D. Determine whether the client is able to ambulate
A. Auscultate for pericardial friction rub
The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation.
Crackles and tachycardia are symptomatic of fluid overload; fever is not present.
The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found?
A. Blood pressure 118/78
B. Weight loss of 3 lbs during hospitalization
C. Dyspnea and anxiety at rest
D. Central venous pressure (CVP) of 6 mm Hg
C. Dyspnea and anxiety at rest:
Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.
When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure?
A. Diltiazem (Cardizem)
B. Lisinopril (Zestril)
C. Clonidine (Catapres)
D. Doxazosin (Cardura)
B. Lisinopril (Zestril): Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers (diltiazem/Cardizem) may indirectly prevent kidney disease by controlling hypertension but are not specific to slowing progression of kidney disease.
The RN has just received change-of-shift report. Which of the assigned clients should be assessed first?
A. A client with chronic kidney failure who was just admitted with shortness of breath
B. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted
C. A client with azotemia whose blood urea nitrogen and creatinine are increasing
D. A client receiving peritoneal dialysis who needs help changing the dialysate bag
A. A client with chronic kidney failure who was just admitted with shortness of breath:
This client's dyspnea may indicate pulmonary edema and should be assessed immediately.
Which clinical manifestation indicates the need for increased fluids in the client with kidney failure?
A. Increased blood urea nitrogen
B. Increased creatinine
C. Pale urine
D. Decreased sodium
A. Increased blood urea nitrogen: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment.
The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock)
A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal
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