Acute Kidney Failure pt 2

Recognize Cues (Assessment)

•Hx & Physical

-DM, HTN, contrast media

-Asterixis, Lethargy, Seizure, Encephalopathy (NEURO)

•Meds- OTC

•Diagnostic testing

Analyze Cues (Analysis)

•Daily Weight

•BP

•Edema

•Lung crackles

•S3 gallop

•JVD

•Fluid volume overload

•Pericardial friction rub- Uremic pericarditis

•Diffuse rash

•Uremic frost crystals- evaporated sweat

Prioritize

•Fluid and electrolytes

•Volume overload

•HYPERKALEMIA #1

•Cardiac output

•Perfusion

Planning

•Completely recover without any loss of kidney function

•Maintain normal fluid and electrolyte balance

•Have decreased anxiety

•Adhere to and understand need for careful follow-up care

Implementation

•Accurate I/O

•Daily weights

•Assess for signs of hypervolemia or hypovolemia

•Assess for potassium and sodium disturbances

•Dietary restrictions (potassium & phosphorus)

•Fluid Restriction

•NO nephrotoxic drugs

Nutrition Implementation

Restrictions: Potassium 40 mEq and Phosphorus 800 mg per day.

Caloric intake should be monitored to avoid Catabolism to prevent breakdown of body protein.

Calories- 35 to 50 kcal/kg per day.

Eliminate Nephrotoxic Meds Vancomycin, Tetracycline, Acetaminophen

Avoid nephrotoxic medications

Limit potassium and phosphorus

Give diuretics during oliguric phase if fluid volume overload is present may be needed during the recovery period.

Provider might adjust to doses of medications that are excreted through kidney to decrease chances of toxicity.

loop diuretics such as Furosemide (Lasix) are used to increase

excretion of water, electrolytes,

Contraindicated if kidneys are not producing urine and hepatic coma. 

HypERKalemia can cause a FATAL cardiac rhythm and needs to be treated quickly based upon the symptoms present.

Treatments for hypERKalemia are

Dietary restriction

Potassium-binding resins

Combination of insulin, IV dextrose, B2 agonists, calcium gluconate to stabilize cardiac membrane, and hemodialysis (severe)

Sodium polystyrene sulfonate (Kayexalate)

is a hypOKalemic.

Exchanges sodium ions with potassium ions in intestine with potassium being expelled and lowers serum potassium levels.

Kayexalate is contraindicated in

Pt who have HypERKalemia that is life-threatening and in those who have impaction or bowel obstruction.

Should be used cautiously in Pt with HTN, HF, geriatric population.

Adverse reactions Kayexalate

Intestine necrosis

Low Calcium, Potassium, Magnesium (CPM)

Sodium retention

Taken orally or rectally up to four times a day PRN to decrease potassium

In Kayexalate the Nurse

should instruct Pt to NOT take Antacids or Laxatives during treatment and that frequent labs will need to be drawn to monitor electrolyte levels.

Beta-2 agonist Albuterol (Salbutamol) works

together with insulin and glucose to LOWER serum potassium levels by shifting the potassium into cells. 

Albuterol is contraindicated in Pt who had

Allergic reactions to adrenergic amines

Used cautiously in Pt who have HD, DM, HTN, hypeERTHYroidism, Seizures.

Albuterol Adverse reactions

include Restlessness, HA, Bronchospasm, Chest pain, Increased blood glucose, Tremors, HypOKalemia. (RHBCITH)

Taken by mouth or through inhalation 3 or 4 times per day.

For Albuterol the Nurse

should instruct on the need to rinse mouth after use of the inhaler.

Pt should notify Provider for any manifestations such as Palpitations, Dizziness, Chest pain (PDC)

Calcium Glucate

raises the threshold at which dysrhythmias will occur, serving to temporarily stabilize the myocardium.

Insulin

Insulin promotes the uptake of potassium into cells as sodium is transported out

Nephrotoxic Drugs

Aspirin

Allopurinol

Acetaminophen

Cortisone

Cimetidine

Lithium

Methotrexate

Pantoprazole

Tetracycline

Vancomycin