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acute renal failure 2


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What is acute renal failure?
The sudden, rapid deterioration in kidney function
What is acute renal failure characterized by?
* accumulation of nitrogenous waste products
ex. creatinine and urea
* decreased urine output
What laboratory values are monitored for acute renal failure?
Which one is the best indicator?
1) BUN and Creatinine
2) Best indicator- Creatinine
What is Azotemia?
The accumulation of BUN and creatinine
Three types of renal failure and what is their etiology?
1) Prerenal- decreased blood flow to the kidneys

2) Postrenal- obstruction of flow below kidneys

3) Intrarenal- direct damage to nephrons and kidney parenchyma from disease or nephrotoxic substances
What are the two most common causes of prerenal failure?
Hypovolemia (ex. hemorrhage, burn patient)

Heart failure
What is produced as the body's natural response to hypovolemia?
Angiotensin II- powerful vasoconstrictor
Are NSAIDS and ACE inhibitors dangerous for those who have renal problems?
What lab value is important to know before a test procedure that uses contrast dye?
Creatine b/c contrast dye can cause renal failure, esp. in diabetes.

The kidneys have to work extra hard to get the dye out.
What is used prophylactically before procedures that use contrast dye?
What is chronic renal failure?
It is a progressive, irrreversible deterioration in kidney function leading to:
1) the inablility to eliminate waste
2) inability to maintain F&E blalance
What are the two main causes of Chronic Renal Failure in the US?
* Diabetes Mellitus
* Hypertension
What are some clincal cardiac manifestations of CRF?
*HTN (b/c fluid overload)
*hyperkalemia (changes in EKG)
- Cardiac Tamponade
What is the triad symptoms of pericarditis?
1) JVD
2) muffled heart sounds
3) narrowing pulse presssure

[difference between diastolic and systolic gets closer]
What are the pulmonary manifestations of CRF?
*Pulmonary edema
*Pleural effusions
Acute renal failure is generally recognized by what clincal observations?
AnsweR: Fall urinary output and increase in BUN and.or creatinine; oliguria is common
Acute renal failure follows three phases, what are they?
1) Initiation phase: begins with the onset of the event causing tubular necrosis; this phase ends when tubular injury occurs.

2) Maintenance phase: Begins w/i hours of the initiation phase and typically lasts 1-2 weeks; characterized by persistent reduction in GFR and tubular necrosis.

3) Recovery phase: Begins when GFR and tubular fx have recovered and there is not further elevation of the BUN and creatinine; renal fx. improves rapidly the 1st 5-25 days and continues up 1 year.
What should be included in the nursing assessment when caring for a pt. with acute renal failure?
1) Wight
2) VS -- watch for orthostatic hypotension due to diuretics)
3) hydration status
4) I&O
5)pain status and eefect of meds.
What are the common signs and symptoms of renal failure?
1) Skin- yellow,edema, ecchymosis, uremic frost
2) ENT- urinous brath
3) Pul- crackles, effusion, tachypnea
4) CV- HTN, S3 or S4, dysrhythmia
5) GI- bleeding
6) Neuro- changes in LOC
7) Neuromusc- tremors, hyperreflexia.
What would the diagnostic tests show in acute renal failure?
1) Electrolytes
2) BUN and Creatinine
4) CBC
5) UA
1) Electrolytes (hyperkalemia, hyponatremia, hyperphosphatemia)
2) BUN and Creatinine (both elevated)
3) ABGS (metabolic acidosis)
4) CBC (anemia)
5) UA (fixed specific gravity, protein, casts)
Why is Creatinine a more accurate test than BUN when assessing renal fx,?
Answer: Creatinine is more accurate than BUN because it is not affected by proteins in the diet or fluid status; the BUN to creatinine ratio should be 10:1; the cratinine does not increase unless one-quarter of nephrons ar enot fx.
When should you weigh an ARF patient?
Answer: At the same time each day to document fluid volume status. Restrict fluids as ordered.
What position should you put an ARF in to enhance cardiac and respiratory fx?
Answer: Semi-folwer's position
Why is it important to monitor the skin status of an ARF pt.?
Answer: It is important to monitor the skin status because increased edema can decrease tissue perfusion and increase the risk for skin breakdown.
What are the most common causes of chronic renal failure?
*Diabetic neuropathy
* glomerulonephritis
*cystic kidney disease
* urologic disease
Describe the treatment that would be given to a renal failure patient for hyperkalemia.
1) Sodium polystyrene sulfonate (Kayexalate); works w/i 1-4 hours and binds with K+ in the bowel and is excreted in the feces. Calcium gluconate is used to prevent cardiac disfx but does not lower K+

2) Insulin in DSW forces K+ back in to cells because potassium follows insulin into cells

3) NaHCO3 (sodium bicarb) is infused to promote excretion of K+ in urine. Controls metabolic acidosis.
What are the three types of dialysis?
1) Hemodialysis
2) Continuous renal replacement therapies
3) Peritoneal dialysis
For hemodialysis, how soon do the AV fistulas or AV grafts take to be used for dialysis after surgery?
1) AV fistula is anatomic (join artery and vein together)-- can't be used for 1-3 m/o after surgery
2) AV grafts are synthetic-- an can't be used for 2-4 weeks after surgery.

Note: In the mean time...have to use a temporary access point: Subclavian, IJ, femoral caths.
What is an important teaching for those who have a AV graft or fistula?
Answer: Do not wear constrictive clothing on limb w/ access device. do not sleep on or carry anything heavy on area of access device.
How do you know if the AV graft or fistula is working?
(2 ways)
1) Palpate "thrill"
2) Auscultate bruit
Where do you draw blood and place BP cuff on a dialysis pt?
Answer: On limb that does not have the access device.

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