Renal Failure Flashcards
Acute Renal Failure (ARF)
- sudden cessation of renal function–leads to buildup of metabolic wastes in the body
- leading cause of death among hospitalized patients
- can result from conditions that: a)reduce blood flow to the kidneys
b) cause damage to the kidney itself, or
c) cause obstruction to the flow of urine.
Risk Factors for ARF
1) African Americans, Native Americans, and Asians have highest incidence of ESRD
2) conditions that decrease blood flow to the kidneys causing ischemia
3) conditions that cause physical, chemical or hypoxic damage to the kidney
4) conditions that cause obstruction of urine
Phases of ARF
1) Onset–begins with onset of the event and lasts for hours to days
2) Oliguria–begins with the renal insult and lasts for 1-3 wks
3) Diuresis–begins when kidneys start to recover and can last for 2-3 weeks
4) Recovery–continues until renal function is fully restored and can take up to 12 months
Prerenal Renal Failure
- renal failure that results from volume depletion or prolonged reduction of blood pressure
- most common cause of acute renal deterioration and is usually reversible with prompt intervention
Intrarenal Renal Failure
- renal failure that occurs within the kidney and the damage is usually irreversible (acute tubular necrosis)
- nephrotoxic injury can be caused by:
a) specific antibiotics
b) NSAIDS
c) organic solvents
d) contrast dye
e) heavy metals
f) hemolytic transfusion reactions
g) acute glomerulonephritis
h) acute pyelonephritis
i) toxemia of pregnancy
j) malignant hypertension
k) systemic lupus erythematosus
l) interstitial nephritis
Postrenal Renal Failure
Renal failure that occurs because of an obstruction of structures leaving the kidney:
- renal calculi
- urinary tract obstruction
- prostate cancer
- bladder cancer
- trauma
- strictures
- spinal cord disease
Nursing Care of Client with ARF
1) identify and assist with correcting the underlying cause
2) prevent prolonged episodes of hypotension and hypovolemia
3) prepare for fluid challenge and diuretics during prerenal period of azotemia if the client is showing signs of fluid volume deficit
4) restrict fluid intake during oliguric phase
5) restrict dietary intake of protein, sodium, and potassium during oliguric phase (for the client who doesn’t require dialysis)
Chronic Renal Failure (CRF)
- a progressive, irreversible kidney disease
- ESRD exists when 90% of functioning nephrons have been destroyed and are no longer able to maintain fluid, electrolyte, or acid-base homeostasis
- dialysis or kidney transplantation can maintain life, but neither is a cure
- client diagnosed with CRF may be asymptomatic except during periods of stress (infection, surgery, trauma). As renal failure progresses, clinical manifestations become apparent and dialysis or transplant become necessary.
5 Stages of CRF
1–minimal kidney damage with normal GFR
2–mild kidney damage with mildly decreased GFR
3–moderate kidney damage with moderate decrease in GFR
4–severe kidney damage with severe decrease in GFR
5–kidney failure and ESRD with little or no glomerular filtration
Risk Factors for CRF
1) acute renal failure
2) diabetes mellitus
3) chronic glomerulonephritis
4) nephrotoxic medications (gentamicin, NSAIDs) or chemicals
5) hypertension, especially if African-American
6) autoimmune disorders
7) polycystic kidney
8) renal artery stenosis
9) recurrent severe infections
Manifestations of Renal Failure
In most cases, findings of renal failure are related to fluid volume overload and include:
1) Renal–polyuria, nocturia (early), oliguria, anuria (late), proteinuria, hematuria
2) CV–hypertension, peripheral edema, pericardial effusion, heart failure, cardiomyopathy, and orthostatic hypotension
3) Respiratory–dyspnea, tachypnea, and pulmonary edema
4) Hematologic–anemia, bruising, and bleeding
5) Neurologic–lethargy, insomnia, confusion, encephalopathy, seizures, tremors, ataxia, paresthesias, and coma
6) GI–nausea, anorexia, vomiting, metallic taste, stomatitis, diarrhea, uremic halitosis, and gastritis
7) Skin–decreased skin turgor, yellow cast to skin, pruritis, bruising, and uremic frost (late)
8) Musculoskeletal–osteomalacia, muscle weakness, pathologic fractures, and muscle cramps
Laboratory Findings
1) urinalysis–hematuria, proteinuria, and alterations in specific gravity
2) serum creatinine–increases quickly in ARF; gradually in CRF
3) BUN 80-100 mg/dL within 1 wk w/ ARF, gradual increase with elevated serum creatinine over months to years in CRF
4) serum electrolytes: decreased sodium (dilutional) and calcium, increased potassium, phosphorus, and magnesium
5) CBC: decreased Hgb and Hct from anemia secondary to loss of erythropoietin in CRF
Diagnostic Procedures
- radiology
- renal ultrasound
- kidneys,ureter, and bladder (KUB)
- computerized tomography (CT)
- aortorenal angiography
- cystoscopy
- retrograde pyelography
- renal biopsy
Dietary Management
1) encourage client to follow prescribed diet, exercise, and medication regimen
2) in ARF, dietary intake of protein, sodium and potassium should be restricted during oliguric phase (for the client not requiring dialysis)
3) for clients with CRF, protein intake based on client’s stage of renal failure and type of dialysis
4) intake of sodium, potassium, phosphorus, and magnesium should be restricted
5) encourage client with diabetes mellitus to adhere to strict blood glucose control as uncontrolled diabetes is a major risk factor for renal failure
Nursing Care of Client with CRF
1) obtain detailed medication/herb hx to determine client’s risk for continued renal insult
2) control protein intake based on client’s stage of renal failure and type of dialysis
3) restrict client’s dietary sodium, potassium, phosphorus, and magnesium
4) encourage client with diabetes mellitus to adhere to strict blood glucose control as uncontrolled diabetes is a major risk factor for renal failure
