Exam 2- Acute Renal Failure

causes of post renal failure

-prostate -tumor -kidney stone

problem before it gets to the kidney

pre-renal failure

A client developed cardiogenic shock after suffering a severe myocardial infarction and failure. The client now has developed acute renal failure. The client's family asks the nurse why the client has developed acute renal the nurse should base the response on the knowledge that there was: 1a decrease in the blood flow through the kidneys 2an obstruction of urine flow from the kidneys 3a blood clot formed in the kidney 4structural damage to the kidney resulting in acute tubular necrosis

1

The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? 1use the unaffected arm for blood pressure measurements 2draw blood from the cannula for routine laboratory work- access is only for dialysis 3percuss the cannula for bruits each shift 4inject heparin into the cannula each shift

1

The client with acute renal failure is recovering and asks the nurse "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's status will most likely 1continue to improve over a period of weeks 2result in the need for permanent hemodialysis 3improve only if the client receives a renal transplant 4result in end-stage renal failure

1

what are the 3 stages of chronic renal failure

1. diminished renal reserve 2. renal insufficiency 3. ESRD

what is the glucose concentration for dialysis

1.5-4.25

what is the osmolality of dialysis

1.5-4.25%

A client with chronic renal failure receives hemodialysis three times a week. In order to protect the fistula, the nurse should: 1take the blood pressure in the arm with the fistula 2report the loss of a thrill or bruit on the arm with the fistula 3Maintain a pressure dressing on the shunt 4Start a second IV in the arm with the fistula

2

During the peritoneal dialysis, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent dialysis catheter in place. The nurse should recognize that the bleeding: 1is expected with a permanent peritoneal catheter 2indicates abdominal blood vessel damage 3can indicate kidney damage 4is caused by too-rapid infusion of the dialysate

2

A client has been admitted with acute renal failure. What should the nurse do? Select all that apply. 1.Elevate the head of the bed 30 - 45 degrees 2.Take vital signs 3.Establish an IV access site 4.Call the admitting healthcare provider for prescriptions 5.Contact the hemodialysis unit

2,3,4

A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis, What should the nurse instruct the client to do? Select all that apply. 1Remind healthcare providers to draw blood from veins on the left side 2Avoid sleeping on the left arm 3Wear wristwatch on the right arm 4Assess finger on the left hand for warmth 5Obtain blood pressure from the left arm

2,3,4

The client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should 1.Assess the dialysis access for a bruit and thrill 2.Insert an indwelling urinary catheter and drain all urine from the bladder 3.Ask the client to turn toward the left side 4.Warm the dialysis solution in the warmer

4

Self-limiting condition of sudden loss of kidney function to excrete urine and nitrogenous wastes and to maintain fluid, electrolyte and pH balance. 50% recover with conservative management

Acute renal failure

management of intra-renal failure

•Correct the underlying problem (infection?) •Is the tubular membrane intact? •Patient survives imbalances •Watch the T wave- hyperkalemia •Medications to decrease potassium •Rectally to get rid of potassium (TEST QUESTIONS k-exitilate)

A clinical syndrome of progressive, irreversible kidney deteriorization. When kidney function is inadequate for sustaining life, chronic renal failure is referred to as end-stage renal disease (ESRD). We can slow the process down. Goal: Sustain/Maintain renal function and slow down process

Chronic renal failure

what is stage 1 renal failure

Diminished renal reserve oDecreased renal reserve oHard to detect oBlood chemistries are normal oApparent only when other stressors push kidney beyond its functional capacity

what is stage 3 renal failure

ESRD oRenal function minimal or absent oDeath will ensue without treatment oMetabolic alterations oCardiac alterations oHematologic alterations oGastrointestinal alterations oNeurologic alterations oRespiratory alterations

management of pre-renal failure

If the underlying cause can be corrected quickly (hypovolemia, decrease CO), the renal failure is corrected. Best management is prevention.

how do you get rid of potassium

K exilate

what is stage 2 renal failure

Renal Insufficiency oGFR reduced to 50% oReabsorption may be impaired Polyuria (early) Oliguria (late) oPermanent damage is present oElectrolyte imbalance oHypertension oDiagnosis

•Soluble is sterile •Can be electrolyte balanced as needed •Osmolarity altered based on fluid removal requirement (1.5-4.25%) •Glucose concentration adjusted for water removal (1.5-4.25%) •Heparin, antibiotics, insulin added as needed

dialysis

occurs with hemodialysis: Characterized by dementia, speech alterations, myoclonus, asterixis, convulsions

dialysis encephalopathy

occurs with hemodialysis: oPatients with ESRD who are being treated on hemodialysis. Included headaches, nausea, emesis, blurring vision, muscle twitching, disorientation, tremors and seizures

disequilibrium syndrome

•Diffusion of dissolves particles from one compartment to the other through semi-permeable membrane •Cleanses accumulates wastes, removes excess fluids, metabolic by-products •Maintain/restores buffer system and electrolyte levels

hemodialysis

Problem is in the kidney. Acute Tubular Necrosis ATN Characterized by ischemic damage.

intra-renal failure

problems in the kidney

intra-renal failure

nursing interventions for chronic renal failure

oI/O strict oWeight oContinual general assessment for changes in physiological state oDietary and fluid restrictions oPatient educations oPrepare for dialysis

advantages of peritoneal dialysis

oMore independence without a cycler oNo fistula oCan be completed at home, more freedom

•Peritoneum is dialyzing membrane •Uses diffusion and osmosis principles to exchange fluid and solutes •Peritoneal cavity is rich in capillaries so excellent blood supply for exchange

peritoneal dialysis

Contraindications of peritoneal dialysis

peritonitis, recent abdominal surgery, abdominal adhesions, impending transplant

Problem is an obstruction either lower in the urinary tract or elsewhere in the abdomen, external to the renal/urinary system

post renal failure

after the kidney, bladder

post-renal failure

Before it gets to the kidneys (cardiac output) •Initial problem is not in the kidney. Kidney is inadequately perfused resulting in kidney tissue hypoxia and ischemic injury. Not perfusing adequately- heart failure

pre-renal failure

complications of hemodialysis

•Hypotension- due to the amount of fluid being pulled off right away •Shock •Electrolyte changes •Sepsis •Blood loss- from AV fistula. Will clot then possibly break off or when port comes disconnected •Hepatitis •Disequilibrium syndrome oPatients with ESRD who are being treated on hemodialysis. Included headaches, nausea, emesis, blurring vision, muscle twitching, disorientation, tremors and seizures •Dialysis encephalopathy oCharacterized by dementia, speech alterations, myoclonus, asterixis, convulsions

nursing interventions for post renal failure

•Monitor for potential causative agents •Medication administration and monitors for effectiveness •Dietary restrictions •Strict I/O and weight •Supportive for patient and family •May need dialysis

nursing interventions for hemodialysis

•Monitor vital signs, lab values,weights, I/O, adequate nutrition •Monitor patency of access device oFeel a thrill hear a bruit •Hold antihypertensives and sedatives prior to procedure •Hold medications which can be filtered out during dialysis •Monitor for post-procedure complications

s/s of intra-renal failure

•Oliguria <400 ml/day •Anuria •Hypernatremia •Hyperchloremia •Acidosis (ph) •Increased nitrogenous wastes, azotemia •Increased bun •Increased creatine

management of post renal failure

•Once the causative problem is removed or corrected, the person must be supported while renal function is diminished and tubular system is regenerating •Hydration •Monitor for fluid volume excess (fluid overload s/s: peripheral edema, high BP, tachycardia, increased CVP) •Diuretics •Dopamine (renal dose) less than 3 •Weigh daily •Maintain accurate I/O Renal replacement therapy

complications of peritoneal dialysis

•Peritonitis •Abdominal pain- getting used to the influx of fluid •Insufficient flow- reposition the patient •Leakage around catheter site- increased in abdominal pressure •PD fluid coming back cloudy (pus)- what do you do? oClamp it and call the provider

causes of intra-renal failure

•direct trauma •acute glomerulonephritis •acute pyelonephritis •hemoglobinuria/myoglobinuria •damage to other cells/tissues •Blood transfusion reactions •Nephrotoxins (toxins, organic solvents, pesticides, mercury, arsenic, lead, heavy metals) •Venoms (copperhead, centipede) •Drugs (amino glycosides, NSAIDS, cocaine, lithium, contract media, cyclosporine)

causes of pre-renal failure

•hypovolemic shock •vasodilation •third spacing •dehydration •sepsis & DIC •CHF •hypoxia of any origin

s/s of pre-renal failure

•oliguria < 400 mL/day •anuria •hypernatremia hyperkalemia •hyperchloremia •acidosis (\pH) •nitrogenous wastes - azotemia •BUN, creatinine- high levels!

people at risk for pre-renal failure

•post-surgical •cardiac pathology •trauma •burns •anaphylaxis