elevated, no, unable to excrete protein metabolism byproducts
What will be the labs for BUN and creatine for chronic renal failure? Is it because of dehydration? Why?
100, 60, 15
What is a good GFR? GFR for chronic renal failure? GFR for dialysis?
Potassium, Magnesium, Phosphorous will be high, calcium will be low
What electrolytes will be high in chronic renal failure? What lyte will be low in renal failure?
risk for cardiac problems, arrhythmia, death
What happens if kidneys cant excrete K?
risk for muscle and heart problems
What happens if kidneys can't excrete Mg?
phosphorous
Which lyte will cause the least problems with renal failure?
decrease RBC, Hbg, Hct, erythropoietin stimulates bone marrow causing low levels
What will happen to the RBC and Hct and Hbg with renal failure? Why?
yes
Is it normal for patients with ESRD or dialysis to have creatine above normal 2,3, or 5? (normal: 0.7-1.4)
fluid overload, electrolyte imbalance, dialysis site condition
When someone has renal failure you should look for ____, ___, ____
fluid overload
Assessment of person diagnosed with chronic renal failure with ___: generalized edema (not limited to lower legs, hands), periorbital edema--critical , crackles or pulmonary edema--critical
electrolyte imbalance
Assessment of person diagnosed with renal failure with ___: dysrhythmias, chest pain, muscle cramp, pain, weakness, confusion
dialysis access site condition
Assessment of person diagnosed with renal failure with ___: basically lifeline for kidneys since kidneys aren't working, can have issues with occlusion, infection, damage
periorbital edema, uremic frost, extreme fatigue
what are hallmark signs of renal failure?
periorbital edema
fluid around eyes, usually have fluid in lungs too if fluid in eyes because fluid storage is used up in legs, feet, hands
uremic frost
skin feels "sandy", causes itching-- is sign of ___?
after, elevated
extreme fatigue is worse ___ (before or after) dialysis or when BUN and cr are extremely (elevated/ decreased) Notes: f and e are abnormal, patient is anemic. Patient will sleep before and after dialysis
peritoneal dialysis
-Implant catheter in abdomen surgically
used for patient's peritoneal cavity as filter for dialysis -Take fluid that is hypotonic and infuse it in abdomen and because it is hypotonic , all lytes and fluid will pull out
3-4 hours, 6-8 hours at night (4-6 times a day), for years
how long will hypotonic fluid stay in peritoneal cavity for peritoneal dialysis? how long at night? how long can patients wear peritoneal dialysis
infection because it is near the organs
what is the biggest risk for peritoneal dialysis? why?
sterile technique -sterile gloves
wear mask
nobody in room
what precaution do you need for peritoneal dialysis?
dialysis catheter
-look like IV lines but have arterial and venous side -Placed surgically to make sure in correct circulation -Drain venous side and put back in arterial side -high risk of infection, bleeding, bruises, clotting (bc accessed regularly) (don't mess with arterial side)
3 times a week
when do you access dialysis catheters?
dialysis catheter
When change dressing for ___, do sterile technique. Wear mask. Purpose: only for dialysis, no IVs, no meds. Only exception if get permission from renal physician bc may occlude blood vessel or have blood clots
dialysis graft
-use mesh tubing to connect vein to artery -needles are inserted in ___ +: less chance of injury to vessel -: bc ___ is foreign material, immune system will attack. High risk of occlusion, clots, inflammation.
dialysis fistula
-connect artery and vein directly -needles will be inserted in vessel +: less chance of infection, clots, inflammation -: more chance of injury of vessel
thrill (vibration under skin when palpate) bruit (swoosh sound when auscultated) positive for thrill and bruit
what do you assess for a fistula and graft? what do you chart?
goals and interventions for chronic renal failure
ā¢Manage fluid volume / electrolyte balance ā¢Prevent pulmonary edema ā¢Manage nutrition ā¢Manage medications / prevent injury ā¢Prevent infection (risk r/t dialysis)
fluid, sodium, potassium, phosphate
What dietary considerations must be controlled for CRF?
no
water restriction? CRF patients with alot of output and filtering well, they can get rid of fluid
yes, extremely
water restriction? how restricted? CRF patients who don't get rid of fluid
1 liter, fluid loss through sweating and breathing
how much fluid do CRF on water restrictions get per day? why?
high calories with vitamin supplementation
CRF dietary consideration: Replace foods with___
foods high in sodium
cheese, processed meats (deli meat, bacon, sausage, etc), salted butter, margarine, canned vegetables, canned soups
foods high in potassium
bananas, potatoes, tomatoes, avocados, green leafy vegetables, milk, yogurt, citrus fruit/ juice, lemon, pineapple, squash, beans
foods high in phosphorous
whole grain products, most cereals, milk, cheese, beans, nuts, peanut butter sandwich -eat white grain instead
0.6-0.8 g/kg/day
how much protein can CRF pre-dialysis patients eat in a day?
1.2-1.3g/kg/day
how much protein can CRF post-dialysis patients eat?
carefully portioned, double
Patients with CRF will receive high protein foods, but these will be ____. EX eggs, chicken
Protein intake will ___ once dialysis starts
-white rice, pasta, white bread -potatoes, sweet potatoes (bc high potassium)
What carbohydrates can CRF patients eat? What carbs can't CRF patients eat?
olive oil
what fats can CRF patients eat?
foods lower in potassium (for CRF patients)
apples, peaches, carrots, green beans, white bread and pasta, white rice, rick milk (not enriched), cooked rice, wheat cereals, grits, apple, grape, cranberry juice
foods higher in potassium (not for CRF patients)
oranges, bananas, orange juice, potatoes, tomatoes, brown/wild rice, bran cereals, dairy foods, whole wheat bread and pasta, beans, nuts
kidneys
How are most meds excreted?
meds stay active if not metabolized by the liver
What is the risk of giving meds for CRF patients?
lower med amount or given less frequently
How are doses adjusted for CRF?
pull water soluble meds out
Dialysis removes fluids, how will this affect water soluble meds?
-tell dialysis RNs meds the patient is taking that morning -ask what meds patient can have safely before dialysis (won't lose) -ask what meds after dialysis to give
If you don't know if you should give a med before or after dialysis ask/tell the dialysis department by___, ___, ___
fluid volume deficit, infection, loss of dialysis access site
Dialysis safety: Main risks related to dialysis include: ___, ___, ____
fluid volume deficit
Dialysis safety: ___ dehydration, orthostatic hypotension, dizzy
infection
Dialysis safety:____ watch out bc accessing the circulation or abdomen regularly
loss of dialysis access site
Dialysis safety:___ If have lines, graft, fistula-- don't put bp cuff on arm, don't draw lab work, no IV on arm, no fingerstick (sometimes)
sudden but temporary as long as it is treated
How to describe the longevity of acute renal failure?
prerenal, intrarenal, postrenal
3 causes of acute renal failure
prerenal acute renal failure
anything that decreases perfusion to the kidney
prerenal acute renal failure causes
severe dehydration blood loss (severe injury/ low BP) obstruction in blood vessel (leading up to kidney-full or narrowing)
intrarenal acute renal failure
anything that directly injures the kidneys
intrarenal acute renal failure causes
infections nephrotoxic meds injury over kidneys (ie sport injury)
postrenal acute renal failure
anything that obstructs urine flow below the kidneys
postrenal acute kidney failure causes
prostate enlargement renal stones (most partial obstruction, needs to be severe obstruction (for renal failure)
chronic renal failure
Onset: gradual Curable: only with transplant (new kidney) Diet/Fluid restriction: yes, lifelong, complex Anemia: common, chronic F and E imbalance: yes
acute renal failure
Onset: sudden Curable: yes, if treated in time Diet/Fluid restriction: STRICT but temporary Anemia: rare (no disrupt of erythropoietin) F and E imbalance: yes
injury/ cause happens
What is the first stage of ARF?
Stage 2, oliguric phase
Stage ARF? urine output--minimal to none (no output for 1 day or 2 days, hours) Labs: BUN and Creatine: Elevated Acid Base Imbalance: Metabolic Acidosis K, Mg, P are high GFR is decreased
Stage 3, diuretic phase
Stage ARF? Urine output: massive amounts, usually at least 4000ml (kidneys will regain their ability to get rid of fluid but will not effectively filter) Greatest risk? -Electrolyte depletion, dehydration (pull lytes k, mg out, risky for patients. See cardiac dysrhythmia, muscle weakness, pain, cramp, chest pain)
Stage 4 , recovery phase
Stage ARF? output normalizes, balances intake Labs: mostly normal immediately. Gradually improve more as the body heals and regulates everything -lytes normal -BUN/ creatine normal
<7 or 8
When is Hbg # concerning/ worrisome?
< mid 20s
When is Hct # concerning/ worrisome?
6
When K # concerning/ worrisome?
doctor or surgeon
Who changes your peritoneal catheter?