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Adult Health Test 2 > Acute Renal Failure > Flashcards

Acute Renal Failure Flashcards

Differentiate between 3 types of Acute Renal Failure (ARF) based on H+P, labs, and diagnostic tests. Compare and contrast assessment findings for each phase of Acute Renal Failure Explain rationale of therapeutic management for a client in Acute Renal Failure Describe priorities of nursing care for a client in each phase of Acute Tubular Necrosis (ARF) Develop nursing strategies to minimize complications of Acute Renal Failure Develop an individualized plan of care for a client in acute ren

1
Q

Renal Anatomy and Function

A
  • Renal perfusion – 1200ml/min. Kidneys receive 20-25% of CO @ rest
  • Regulate filtrate – tubular reabsorption, and tubular secretion
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2
Q

Sudden deterioration in renal function characterized by:

A 
Change in urine output - oliguria, anuria, normal urine volume
Increased serum creatinine and BUN
Fluid Overload
Electrolyte imbalance
Acid-base imbalance
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3
Q

Types of Acute Renal Failure

A

Prerenal (55 % of all ARF)
Intrarenal/Intrinsic (40% of all ARF)
Postrenal (5% of all ARF)

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4
Q

Prerenal cause:

A

hypoperfusion / diminished renal perfusion

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5
Q

Prenrenal

A 
Hypovolemia
-Burns –> fluid loss
-Dehydration
-Gastrointestinal losses (N/V/D)
Impaired cardiac output - pump not working
-Myocardial Infarct
-Heart Failure
-Cardiogenic shock
Vasodilation - distributive shock
-Sepsis
-Anaphylaxis
-Medications
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6
Q

Prerenal Labs

A 
BUN  inc – normal 10-20 mg/dl
Creatinine  inc – normal 0.5 – 1.2 mg/dl 
Urine sodium decreased to < 20 mEq/L
Normal sediment, few casts
Urine specific gravity - Increased
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7
Q

Intrarenal Cause

A

damage to the kidney parenchyma

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8
Q

Intrarenal

A 
Myoglobinurea (released into blood stream)
-Burns – tissue damage
-Trauma, crush injuries
-Rhabdomyolysis (muscle breakdown)
Hemoglobinurea
-Transfusion reaction
-Hemolytic anemia 
Nephrotoxic agents
-Medications
-Solvents and chemicals
Infectious processes
-Acute pylonephritis, glomerulonephritis
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9
Q

Acute Tubular Necrosis (ATN)

A

Most common type of intrarenal failure
ATN and ARF are not the same because ARF can occur without ATN
ATN is generally described as postischemic or nephrotoxic

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10
Q

Intrarenal Labs

A

inc BUN – normal 10-20 mg/dl
inc Creatinine – normal 0.5 – 1.2 mg/dl
Urine sodium - > 40 mEq/L
Abnormal casts, debris (kidneys are being damaged)
Urine specific gravity = low normal 1.010

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11
Q

Postrenal cause

A

obstruction, dysfunction in post renal structures

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12
Q

Postrenal

A 
Mechanical – urine cannot drain
-Calculi
-Tumors
Benign prostatic hyperplasia
-Strictures
-Blood clots
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13
Q

Postrenal Labs

A 
Inc BUN – normal 10-20 mg/dl
Inc Creatinine – normal 0.5 – 1.2 mg/dl
Urine sodium varies – often decreased
Abnormal casts, debris - varies
Urine specific gravity - varies
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14
Q

Diagnostic Tests

A

Kidney Ultrasound, EKG, Urinalysis, Blood gases – metabolic acidosis, BUN and Creatinine (Azotemia)

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15
Q

Diagnostic Evaluation

A

KUB – X-ray of kidneys/ ureters/ bladder
Bladder Catheterization – Used to rule out obstruction/ infection
Renal Ultrasound – Often used 1st-line/ identifies obstructive causes of renal failure
CT scan – Provides information regarding the size and shape of kidneys and the presence of lesions, cysts, calculi
IVP – Shows outline of the kidneys with dye
Renal Biopsy – differentiate between acute and chronic renal failure
Renal arteriogram – measures blood flow
Bladder US – noninvasive measure of bladder volume
Urodynamic studies – for evaluation of voiding problems like retention or incontinence

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16
Q

Stages of ARF

A

initiation, maintenance, recovery

17
Q

Initiation Phase

A 
Initial insult to when oliguria develops
Usually recognized in retrospect
BUN and creatinine begin to elevate
Lasts – hours to days
-might barely be at the 30mL/hr UO
18
Q

Maintenance Phase

A

Lasts 1 – 2 weeks
Increase (in the serum) of substances normally excreted by kidney: urea, creatinine, uric acid, K+
Urine output decreases to < 400 mL/day

19
Q

Recovery Phase

A

Gradual increase in urine output (may start looking like water)
Fluid loss as GFR recovers
Electrolyte imbalances
Renal function returns to normal rapidly first 5 – 25 days lasts up to 1 year
-Electrolytes return to normal

20
Q

Clin Man- Nervous System

A

Accumulation of nitrogenous waste products from impaired renal functioning and metabolic acidosis
-Uremic encephalopathy
-Cerebral edema
Signs and Symptoms: Lethargy, confusion, disorientation. Asterixis, myoclonic muscle twitching, possible seizures

21
Q

Clin Man - Cardiovascular

A

Tachycardia, Hypertension, CHF, Periorbital and Peripheral edema, Cardiac dysrhythmias

22
Q

Clin Man - Pulmonary

A 
Adventitious breath sounds
Decreased cough reflex (fluid retention)
Kussmaul breathing
Infiltrates on CXR
-Pneumonia
-Pulmonary edema
23
Q

Clin Man - GI

A

Urea decomposition in the gut results in ammonia release causing capillary fragility and GI mucosal irritation
Signs and Symptoms: N/V, GI Bleed, Impaired glucose use, Impaired protein synthesis

24
Q

Clin Man - Hematopoietic

A

Impaired renal function
Decreased erythropoietin production = decreased RBC production and impaired platelet function
Signs and Symptoms: Anemia -> Treatment = Epogen

25
Q

Clin Man - Integumentary

A

Dry, pruritic skin
Petechiae
Ecchymoses
Uremic frost - rare (looks like frost, salt coming up to skin)

26
Q

Therapeutic Management - Fluid Overload

A

Nursing diagnosis – Excess fluid volume
Interventions:Fluid Restrictions: intake = output
Diuretic Therapy = Lasix, Mannitol, Bumex
Dialysis

27
Q

Therapeutic Management - Electrolyte Imbalances

A

Collaborative diagnosis:PC Hyperkalemia – Most life threatening / GFR decreases / patient unable to excrete potassium
Nursing Interventions: Monitor K levels, Administer Meds as ordered: Kaexalate, Glucose and Insulin - Insulin given in glucose solution - facilitates movement of K from serum back into cells - until they can get pt to dialysis! Calcium gluconate

28
Q

Therapeutic Management - Diet Considerations

A

Goal: limit accumulation of nitrogenous wastes
Decrease -> Potassium, Protein – Only high biologic should be allowed (no processed meats). Sodium, Phosphorus intake
Diet should be high in: Carbohydrates, Fats, Essential amino acids

29
Q

Dialysis Issues

A

Reasons for Initiation: Volume overload, Uncontrolled hyperkalemia, Uncontrolled acidosis, Symptomatic uremia, Pericarditis

30
Q

Types of Dialysis

A

hemodialysis, peritoneal dialysis, CRRT

31
Q

Pediatric

A

ARF uncommon in children

could be initiated by: dehydration, glomerulernephritis

32
Q

Older Patient

A 
more prone to dehydration (prerenal), comordities of diabetes, hypertension (intrarenal)
BPH obstruction (postrenal)

Adult Health Test 2 (1 decks)

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