Renal Failure
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Acute Phases (4) OODR
- 1. Onset of injury (initiation)
- 2. Oliguric Phase ( LOW urine output 400mL/ 24 hrs or <30m/ hr ) High SG
- 3. Diuresis Phase (HIGH urine output; 3-6 L/day to flush out the problem ) Low SG
- 4. Recovery Phase ( takes about a year )
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Oliguric phase key findings PIP
- Anorexia
- N & V
- Dreceased urinary output
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Treatments for ARF
Fluid bolus or Diuretic; PUSHES from Oliguric phase to diuresis phase
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Acute Kidney Injury Patho (3) PIP
- Prerenal → Prefusion decreased; low oxygen.
- Intrarenal → Inside the renal
- Postrenal → Blockage past the renal
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Prerenal is caused by?
- Obstruction such as embolism, tumor, blood clot
- Low BP
- Low cardiac output w/ ECG dysrhythmia or HF
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Intrarenal is caused by?
- Infection
- CT contrast
- Antibiotics
- Long term use of NSAIDS
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Postrenal is caused by?
- Kidney Stones
- Tumor
- Benign prostatic hyperplasia (Big swollen prostate)
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Kidney waste
- Hydrogen ions (pH under 7.35 = Metabolic Acidosis)
- Urea (BUN over 20 = Bad kidney) leads to uremic frost, crystallized urea deposits on skin, which causes prutitis
- Creatinine (over 1.3 = Bad kidney)
- Urine output (<30mL/hr = kidneys in distress)
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What is GFR
- Glomerular Filtration Rate
- How much blood the kidneys can filter per min
- NORMAL over 90mL/min
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5 Stages of CKF
- 1 ~ 90+ GFR
- 2 ~ 89-60 GFR
- 3 ~ 59-60 GFR
- 4 ~ 29-15 GFR
- 5 ~ 15 or less GFR (end stage renal disease)
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Causes of CKF?
- Old age
- Chronic damage; uncontrolled diabetes, HTN, & autoimmune diseases
- Infection that causes glomerulonephritis
- Polycystic kidney disease (cysts in kidneys)
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Diagnostic to determine how well kidneys are functioning
Creatinine Clearance Test - how well GFR is working
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Signs & Symptoms CHRONIC
- Oliguria
- Fatigue & Weakness
- Fluid Retention (edema)
- HTN → strokes, HA, kidney damage
- Anemia
- Azotemia/ Uremia
- Uremic pruritus
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Hypertensive Crisis Key Signs
- Headaches
- Nausea & Vomiting
- Changes in mental status
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Fluid Volume Overload Key Signs
- Crackles in lungs / Dyspnea
- JVD
- Bounding Pulses
- Tachycardia
- Pitting edema (pale, cool skin)
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Electrolytes
- HIGH Sodium
- HIGH Phospherous = LOW calcium → osteoporosis and risk for fractures
- HIGH Potassium HIGHEST PRIORITY
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HIGH K+ causes?
- Peaked Twaves
- ST elevation
- Wide QRS complex
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Sign of high k+
weak, lethargic, bradycardia
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Treatment for high k+
- 1. IV Calcium Gluconate = Dysrhythmias
- 2. IV 50% Dextrose + R Insulin
- 3. Kayexalate (exchanges Na for K in the intestines)
- 4. Dialysis
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Nursing Interventions
- Daily Weights (1kg = 1L of fluid)
- AVOID Drugs bad for the kidney; NSAIDS, Milk of magnesia, Antibiotics, CT contrast dyes
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Diet
- RESTRICT Na+ & K+ (NO canned foods, processed meats. package foods) (NO salt substitutes, leafy veggies, avacados, carrots, tomatoes, strawberries, oranges, or bananas)
- DECREASE P & Protein (NO dairy) (LOW protein = less stress on kidney)
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Dullness to percussion of the bladder following voiding indicates?
incomplete bladder emptying
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