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Renal Failure
Causes:
Pre-Renal = due to
decreased renal
perfusion without
ischemic injury.
Hypovolemia
Hemorrhage
Dehydration
Excessive GI fluid
losses
Excessive fluid losses
due to burn injury
Decreased vascular
filling
Anaphylactic shock
Septic shock
Heart failure and
cardiogenic shock
Decreased renal perfusion
Vasoactive mediators
Drugs (ACE inhibitors)
Diagnostic agents
(radioactive agents)
Renal Failure
Acute Renal Failure a sudden severe loss of renal
function; potentially reversible if factors causing the
condition are corrected or resolved.
Stages of ARF:
Onset short time from precipitating event to onset of
oliguria / anuria
Oliguric Phase period during which output less than
four hundred ml in twenty four hours; if longer prognosis
is poor; 1-3 weeks
Manifestations:
Subjective
Pharmacological management:
Potassium lowering agents:
Eg: Dextrose 50% with insulin-facilitates Potassium
transport back into cells. Calcium gluconate
Kayexelate given via enema; retain for 30-60 mins;
promotes potassium excretion from the lower GI tract
Sodium Bicarbonate
May undergo peritoneal/hemodialysis depending on
MDs recommendation
Provide calm, supportive atmosphere
Assist in coping life-style and self-concept
Promote HOPE and opportunity for client to express
feelings about self
Hypertension
Hypocalcemia and Hyperphosphatemia
RenalOsteodystrophy
Kussmauls respirations to compensate for
metabolic acidosis
Uremic fetor = uriniferous odor of breath from
ammonia
Uremic frost = powdery substance on the skin
from urate water, usually present in ESRD, late
sign
Peripheral neuropathy, numbness and
paresthesias = due to hypocalcemia
Correct Anemia:
Blood transfusion for immediate correction of Anemia
Recombinant Human Erythropoetin (Epogen) 50-100
U/kg 3x a week IV to manage anemia by stimulating
erythrocyte production; not for immediate correction
of anemia.
Expected effect = increased hematocrit in weeks
Nursing Responsibility:
May elevate BP
Do not shake vial because it will inactivate the
drug
Kidney transplantation from a compatible donor for
client with ESRD
Dialysis
= a process used to remove fluid and waste
products from the body when the kidneys
are unable to do so because of impaired
function or when toxins or poisons must be
removed immediately to prevent permanent
or life-threatening damage.
2 Forms of Dialysis
1. Hemodialysis refers to the flow of a
patients blood from a vascular access
through a catheter and tubing to an
artificial kidney.
2. Peritoneal Dialysis refers to the instillation
of dialysate into a patients peritoneal cavity.
Principle of Dialysis
Dialysate solution
used on the opposite
side of the membrane
of the blood that
controls the amount
and direction of
movement across the
semipermeable
membrane of wastes
and other substances.
Hemodialy
sate
Peritoneal
Dialysate
Sodium
130-135
1 4 0-1 4 1
Calcium
2.5 -3.5
3.5
Magnesi
um
0.5-1.0
0.5-1.5
Potassiu 0-2.0
m
0- 4
Chloride
100-119
96-102
Acetate
32 - 38
Lactate
35-40
Bicarbon 30-38
ate
Glucose
1-200mg/dl
Dextrose 1.5%
4. 25%
15g/dl
42.5g/L
Hemodialysis
Hemodialysis = a process used for patients who
are acutely ill and require short-term dialysis
(days to weeks) or for patients with end-stage
renal disease (ESRD) who require long-term
therapy.
= uses dialyzer, a synthetic, semipermeable
membrane replaces the renal glomeruli and
tubules and acts as the filter for the impaired
kidneys.