Renal concepts

Page 1: Alteration in Renal Perfusion from Chronic Renal Failure

Fluid Volume Excess
- Caused by altered elimination in renal failure
- Monitoring is crucial; a weight gain of 1 kg (2.2 lbs) equals approximately 1 liter of fluid retained.
- Nursing Care:
  - Weigh the patient regularly and monitor intake & output (I&O)
  - Assess neurological status and vital signs
  - Limit fluid and sodium intake
  - Refer to the chapter on Fluid Balance for specific interventions.
Altered Electrolyte Balance
- Hyponatremia (Dilutional)
- Hyperkalemia
- Metabolic Acidosis
- Other concerns: Immobility, Skin integrity issues, Infection risks, Anemia from decreased erythropoietin production.
- Look for indications of fluid retention which can lead to pulmonary edema, and heart failure due to fluid overload.
- Monitor for dysrhythmias related to hyperkalemia and assess for muscle twitching or diarrhea.
- Avoid salt substitutes due to high potassium content.

Continually assess respiratory rate (RR), arterial blood gases, BUN, creatinine levels, and monitor heart rhythm.
Consider starting dialysis for patients with severe metabolic acidosis.
Maintain skin integrity by keeping fingernails clipped and assessing for skin breakdown and pruritus.
Emotional support for coping with chronic illness.
Dietary adjustments towards low sodium, potassium, and protein.
Encourage hydrotherapy for respiratory function; assessment of breath sounds every 4 hours per protocol.

Symptoms:
- TWITCH (muscle spasms): Trousseau's sign, facial twitching (Chvostek's sign), seizures, hypotension, increased deep tendon reflexes (DTR).
- Monitor for dysrhythmias: prolonged ST segment, prolonged QT interval on ECG.
- Increased nausea and vomiting.

Initiate seizure precautions, reduce environmental stimuli, administer calcium supplements, and phosphate binders with meals.
Evaluate results for signs of bone disorders and ensure emergency equipment is present during treatment.

Trousseau's sign should be absent, no dysrhythmias, improved gastrointestinal symptoms, and no signs of tetany. Maintain stable blood pressure and normal DTR.

Symptoms:
- EDEMA: Pitting edema, decreased hematocrit, elevated weight, increased BP, HR, RR.
- Monitor serum sodium levels and assess mental status (lethargy, seizures).

Restrict fluid and sodium intake, monitor I&O, weight checks daily, and implement diuretics/dialysis as needed. Provide stool softeners to counteract constipation risk.

Fluid overall reduction with continued evaluation of neurological changes. Normal BP and HR monitoring alongside serum sodium within normal limits.

Metabolic acidosis due to lactic acid accumulation; respiratory compensation involves increased RR and depth to blow off CO2.
Fluid overload can cause adventitious breath sounds and respiratory complications.

Assessment for nutritional intake is crucial in managing chronic renal failure and related anemia.
Monitor for potential GI bleeding and assess skin integrity.

Look for signs of anxiety or depression due to physical changes. Monitor CNS reactions to increased waste products.

Respiratory evaluations, BP monitoring, anemia assessments, and nutritional intake reviews.

Kidneys are essential for regulating fluid/electrolyte balance and waste removal via glomerular filtration.
- GFR < 15 mL/min indicates kidney failure.
- Fluid overload due to inability to excrete profits can lead to complications.

Elevated phosphorus (> 4.5 mg/dL) can lead to hypocalcemia.
- The inverse relationship of calcium and phosphorus levels must be remembered.
- Hemoglobin and hematocrit may be low due to decreased erythropoietin production.

Monitor for adequate respiratory status and fluid retention leading to imbalance; include emotional support and nutritional needs.
Look for signs of anemia and manage through appropriate interventions.

Address fluid overload, provide support for anemia and fatigue, active infection management, and ensure thorough assessments for malnutrition.