Chronic and Acute Renal failure Davis

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

•Manage fluid volume / electrolyte balance
•Prevent pulmonary edema
•Manage nutrition
•Manage medications / prevent injury
•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

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?