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If outflow drainage is inadequate with peritoneal dialysis what should the nurse do?
check for kinks, roll or turn patient
What does aging do to the kidneys?
shrinks them, creates urgency to void and incontinence, blood flow decreases by 10% per decade
What other reasons would BUN be elevated?
hypovolemia, starvation, dietary, hydration, nephrotoxic, UTI's
What does the Creatinine Clearance show?
How well the kidneys are functioning, the most accurate renal test
Prerenal cause of ARF
hypovolemia, fluid shifts, gram negative sepsis, decreased C.O., Decreased peripheral vascular resistance, vascular obstruction
If fluid is in the tissue rather than in the vascular space and there is decreased peripheral vascular resistance what is needed?
A fluid bolus
Acute tubular necrosis?
most common cause of intrinsic renal failure. abrupt damage b/c of decrease blood flow associated with shock. characterized by destruction of tubular epithelial cells
Intrarenal cause of ARF
Acute tubular necrosis, damage from nephrotoxins, rhabdomyolysis, surgery, crush injuries, electric shock, use of statin drugs, seen in patients "found down"
Post renal cause of ARF?
Prostate disease, obstruction (stones), pelvic trauma, surgical accidents, spinal cord injury
A condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure
Onset phase of acute renal failure
starts with the precipitating event and continues to the development of renal symptoms (labwork)
Oliguric - Anuric phase of acute renal failure
lasts 1-8 weeks, the longer this phase lasts the poorer the prognosis
What is most important in the diuretic phase of acute renal failure?
Hydration! Patients can die in the this phase if they aren't hydrated
Recovery phase of acute renal failure
3-12 months long, mild abnormalities, decreased concentration of urine
What is patient at risk of for the rest of their life in the recovery phase of acute renal failure?
Fluid and Electrolyte imbalances
Medical management of ARF
Prevention, hydration, adequate diuresis, watch labwork, I&O, weights, maintain fluid and electrolyte balance, replace renal function (dialysis), prevent infection
Complications associated with ARF
Pericarditis (fluid backs up), Tachy, fever, friction rub, seizures (due to increased BUN), anemia (due to bleeding from trauma)
Nursing management for ARF
fluid volume deficit or excess, imbalanced nutrition, impaired skin integrity, risk for infection, anxiety
Clincial manifestations of CRF
Electrolyte imbalance which includes weakness, diarhea, abd cramping, hyperkalemia, hypercalcemia, loss of blood pressure regulation, loss of erythropoietin
maintain themselves at home, used for clients with severe cardiovascular disease
Nursing management before dialysis
complete assessment, v/s, weight, assess the access site (listen for bruit on fistula), review lab results, check meds
Nursing Management after dialysis
assessment, v/s, weight, assess access site, monitor for s/s of bleeding or infection, watch for signs of confusion, decreased level of consiousness, sudden severe headache, monitor lab results, administer meds
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