Renal Failure

Question 1

Oliguric Phase Tx

Answer 1

• Give diuretics ( to help them urinate and decrease BP)
• Limit fluids during this phase

Question 2

What Is Renal Failure?

Answer 2

The condition in which the kidneys aren’t able to get rid of metabolites from the blood, resulting in >> altered fluid, electrolyte, and acid balance

Question 3

Diuretic Phase

Answer 3

• Pt slowly starts to heal and produces more urine
• BUN & creatinine start to decrease (Still are high)
• GFR and creatinine clearance start to improve
• Mental status may improve
• Give IV fluids at this point

Question 3

What is Creatinine Clearance?

Answer 3

• Helps determine glomerular filtration rate (GFR)
• Done over a period of 24 hrs
• Urine is collected and put on ice (preserved)

Question 3

Manifestations for ARF

Answer 3

• Flank pain (lower back)
• Oliguria (>30mL/hr)
• Jugular vein distention
• SOB (increases RR)
• Lethargy
• Anemia (Kidneys are unable to produce erythropoietin)
• Hyperkalemia (monitor EKG)
• High BP

Question 3

ARF (if not treated)

Answer 3

-Can progress to CRF (end stage renal disease and hypovolemia)

No cure for CRF; pt may need dialysis for the rest of their lives or kidney transplant

Question 4

Diuretic Phase Tx

Answer 4

• Give IV fluids at this point
• Give 500mL to whatever was excreted (restoration)

–Increase carbohydrates (Provides a K+ sparing effect)

Question 7

What are the 3 different types of ARF?

Answer 7

1. ) Prerenal ARF
2. ) Intrarenal ARF
3. ) Postrenal ARF

Question 7

ARF (Nursing Implications) (part 1)

Answer 7

-Monitor Weight gain or weight loss daily, I/O

Renal and Chem labs (BUN, creatinine, Na); U/A (especially checking for proteins and blood);

• Listen to lung sounds *remember fluid retention* (listen for fine crackles or wheezing)
• Listen to heart sounds and monitor EKG

Question 9

Common causes of ARF? (2)

Answer 9

1. ) Ischemia (Not enough blood supply to the kidneys)
2. ) Nephrotoxins

Question 10

3 phases of ARF

Answer 10

1. ) Oliguric Phase
2. ) Diuretic Phase
3. ) Recovery Phase

Question 11

What is Acute Renal Failure (ARF)?

Answer 11

Rapid decline in renal function, because of the increased build up of nitrogenous waste in the blood and the fluid and electrolyte imbalances

Question 12

Postrenal (How is it caused and examples)

Answer 12

Obstructive causes. Anything that prevents urine from being excreted can lead to postrenal ARF.

Ex.) Calculi (Kidney stones), BPH

Question 13

Recovery Phase

Answer 13

• Not immediate
• Can take up to 1-2 yrs for kidneys to fully recovery
• If pt doesn’t reach the recovery phase ARF can progress to chronic renal failure (CRF)

Question 15

Intrarenal ARF (How is it caused and examples)

Answer 15

Acute damage to the kidney tissue or the nephrons

Ex.) Infection (Most common), Nephrotoxins (Aminoglycosides), Acute Tubular Necrosis (ATN) (destruction of the epithelial cells)

Side note: Primary cause of ATN is ischemia from prerenal conditions lasting more than 2 hrs can lead to ATN >> intrarenal ARF

Question 16

Oliguric Phase

Answer 16

• Pt. not producing enough urine (Below 30mL/hr)
• Lasts for 8-15 days -Fluid Retention (HTN, fluid in the lungs, electrolyte imbalances)
• Pt may show signs of decreased mental function (r/t inability to excrete toxins; can build up in the blood and affect the brain)
• Renal and chem labs will be high (BUN, creatinine, Na)

Question 17

Prerenal ARF (How is it caused and examples)

Answer 17

Any condition that affects the renal blood flow and perfusion (usually an outside source)

Ex.) Dehydration, Hemorrhage, HF, Shock, Sepsis, Ischemia

Question 18

What is azotemia?

Answer 18

The build up of nitrogenous waste in the blood.

Question 19

Nursing Imp. (Part 2)

Answer 19

• Diet should be high carb; Low -Moderate proteins (impaired kidneys have problems with proteins in excess
• Dietary restriction of na and K
• Give meds in renal doses (below average) NO NEPHROTOXIC DRUGS (aminoglycosides)
• Monitor any signs of edema