Acute Renal Failure

Question 1

Dopamine (Intropin)

Answer 1

• Administered in low doses by IV will increase renal blood flow
• Dopamine is a sympathetic neurotransmitter that improves cardiac output and dilates blood vessels of the mesentery and kidneys when given in low doses

Question 2

Diuretics: furosemide (Lasix) or mannitol

Answer 2

• Given if restoration of renal blood flow does not improve urinary output
• Purpose: wash out any present nephrotoxins, establishing urine output to prevent oliguria and reduce the degree of azotemia and F&E imbalances
• Lasix also helps manage salt and water retention

Question 3

Antihypertensives

Answer 3

Management of HTN limits renal injury; ACE inhibitors and other antihypertensives are used to control arterial pressures

Question 4

Antacids

Answer 4

Pt with ARF is at increased risk of GI bleeding: antacids are given to prevent GI hemorrhage

Question 5

Hyperkalemia Tx

Answer 5

Hyperkalemia is treated to avoid cardiac effects: give calcium chloride, bicarbonate, and insulin and glucose IV to reduce serum K+ by moving K+ into the cells

Question 6

Aluminum hydroxide

Answer 6

Used to control hyperphosphatemia in renal failure: it binds with phosphates in the GI tract, and is excreted in the feces

Question 7

Fluid Management

Answer 7

Once vascular volume and renal perfusion is restored, fluid intake is restricted: calculated by allowing 500mL for insensible losses and adding the amount excreted as urine during the previous 24 hrs

Question 8

Nutrition

Answer 8

Proteins are limited to 0.6g/kg of body weight per day to minimize the degree of azotemia; carbs are increased to maintain adequate caloric intake and provide a protein-sparing effect

Question 9

Dialysis

Answer 9

Used to remove excess fluid and metabolic waste products in renal failure; may also be used to rapidly remove nephrotoxins in ATN (acute tubular necrosis)

*Complication of dialysis: anemia, hypotension, bleeding, infection

Question 10

CRRT : Cont. Renal Replacement Therapy

Answer 10

• For pts who cannot tolerate hemodialysis and rapid fluid removal because their cardiovascular status is unstable
• Blood is cont. circulated from an artery to a vein or from a vein to a vein through a highly porous hemofilter for 12 hrs or more

Question 11

Hemodialysis

Answer 11

Blood is taken from the client via a vascular access and is pumped to the dialyzer

Question 12

Peritoneal dialysis

Answer 12

Uses the peritoneum surrounding the abdominal cavity as the dialyzing membrane; water movement is controlled using dextrose as an osmotic agent to draw it into the dialysate

Question 13

Complication of ARF

Answer 13

Hyperkalemia, edema (fluid volume excess), electrolyte imbalances, azotemia, possible cardiac arrest, metabolic acidosis, anemia, risk for infection, anorexia, oliguria