Ch71 Jen

Chapter 71: 

Chapter 71 Care of Patients with Acute Renal Failure and Chronic Kidney Disease

Acute Renal Failure: 

Acute Renal Failure Pathophysiology Types of acute renal failure include: Prerenal Intrarenal Postrenal

Phases of Acute Renal Failure: 

Phases of Acute Renal Failure Phases of rapid decrease in renal function lead to the collection of metabolic wastes in the body. Phases include: Onset phase Oliguric phase Diuretic phase Recovery phase Acute syndrome may be reversible with prompt intervention.

Health Promotion and Maintenance: 

Health Promotion and Maintenance Severe blood volume depletion can lead to renal failure even in people who have no known kidney problems Continual assessment of I&O, blood volume depletion, laboratory values, use of nephrotoxic substances

Assessment : 

Assessment History Physical assessment/clinical manifestations Laboratory assessment Imaging assessment Other diagnostic tests

Drug Therapy: 

Drug Therapy Cardioglycides Vitamins and minerals Synthetic erythropoietin Phosphate binders

Treatment : 

Treatment Nutrition therapy Dialysis therapies: Continuous renal replacement therapy Continuous arteriovenous hemofiltration (CAVH) Continuous arteriovenous hemodialysis and filtration (CAVHD) Hemodialysis Peritoneal dialysis

Chronic Kidney Disease: 

Chronic Kidney Disease Progressive, irreversible kidney injury; kidney function does not recover End-stage renal disease (ESRD) Azotemia- high BUN Uremia- high BUN (more severe than Azotemia) Uremic syndrome- Hemolytic-uremic syndrome (HUS) is a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.

Stages of Chronic Kidney Disease: 

Stages of Chronic Kidney Disease Reduced renal reserve Renal insufficiency End-stage renal disease

Calcium and Phosphate Balance: 

Calcium and Phosphate Balance

Assessments : 

Assessments Psychosocial assessment Laboratory assessment Imaging assessment

Imbalanced Nutrition: Less Than Body Requirements: 

Imbalanced Nutrition: Less Than Body Requirements Interventions include: Dietary evaluation for: Protein Fluid Potassium Sodium Phosphorus Vitamin supplementation

Excess Fluid Volume: 

Excess Fluid Volume Interventions: Monitor intake and output. Promote fluid balance. Assess for manifestations of volume excess: Crackles in the bases of the lungs Edema Distended neck veins Drug therapy includes diuretics.

Risk for Infection: 

Risk for Infection Interventions include: Meticulous skin care Preventive skin care Inspection of vascular access site for dialysis Monitoring of vital signs for manifestations of infection

Anxiety: 

Anxiety Interventions include: Health care team involvement Patient and family education Continuity of care Encouragement of patient to ask questions and discuss fears about the diagnosis of renal failure

Potential for Complications : 

Potential for Complications Interventions: Assess the patient for early signs of pulmonary edema. Monitor serum electrolyte levels, vital signs, oxygen saturation levels, hypertension.

Hemodialysis : 

Hemodialysis Patient selection Dialysis settings Procedure Anticoagulation

Subclavian Dialysis Catheters: 

Subclavian Dialysis Catheters

Hemodialysis Circuit: 

Hemodialysis Circuit

Vascular Access: 

Vascular Access Arteriovenous fistula or arteriovenous graft for long-term permanent access Hemodialysis catheter, dual or triple lumen, or arteriovenous shunt for temporary access Precautions Complications

Hemodialysis Nursing Care: 

Hemodialysis Nursing Care Drugs Post-dialysis assess for hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps or bleeding

Peritoneal Dialysis: 

Peritoneal Dialysis Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate. Types of peritoneal dialysis: Continuous ambulatory peritoneal dialysis (CAPD) Automated peritoneal dialysis Intermittent peritoneal dialysis Continuous-cycle peritoneal dialysis

Peritoneal Dialysis Exchange: 

Peritoneal Dialysis Exchange

Continuous Ambulatory Peritoneal Dialysis (CAPD): 

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated Peritoneal Dialysis: 

Automated Peritoneal Dialysis

Complications of Peritoneal Dialysis: 

Complications of Peritoneal Dialysis Peritonitis Pain Exit site and tunnel infections Poor dialysate flow Dialysate leakage Other complications

Renal Transplantation : 

Renal Transplantation Candidate selection criteria Donors Preoperative care Immunologic studies Surgical team Operative procedure

Transplanted Kidney: 

Transplanted Kidney

Postoperative Care: 

Postoperative Care Urologic management Assessment of urine output hourly for 48 hr Complications include: Rejection Acute tubular necrosis Thrombosis Renal artery stenosis Other complications Immunosuppressive drug therapy Psychosocial preparation