Module 10
If the BUN is elevated but creatinine is normal what might the problem be?
Prerenal ARF
(dehydration)
Symptoms of acute renal failure?
-Electrolyte imbalances
-Fluid imbalances: edema; monitor for heart failure and pulmonary edema
-Acid-base balance: metabolic acidosis
-N/V, constipation, anorexia
-Mental status changes (due to ammonia levels): lethargy and memory impairment
-Anemia and platelet dysfunction: fatigue and bruising
-Impaired wound healing and susceptibility to infection
What is the most common cause of chronic renal failure?
-Glomerulonephritis
-Nephrosclerosis
Complications of peritoneal dialysis?
-Peritonitis
-Pain
-Tunnel infection
-Clot
-Leakage
What tests should be reviewed for acute glomerulonephritis?
-UA
-Creatinine
-BUN
-CBC
If both BUN and creatinine are high what might the problem be?
Intrarenal ARF
Treatment of acute renal failure?
-Symptomatic treatment:
correct fluid/electrolyte imbalances
monitor for dysrhythmias; caused by hyperkalemia
manage anemia
manage hypertension
hemodialysis/peritoneal dialysis
What are the labs for chronic kidney disease?
-Increased phosphate
-Decreased calcium
-Increased mag
-Decreased H & H
-Decreased Bicarb
-Increased potassium
-Increased BUN
-Increased creatinine
What do you want to assess after dialysis?
Hypotension
What will the UA results contain if the patient has acute glomerulonephritis?
-Smokey orange color
-RBCs and proteins in the urine
-Increased specific gravity
Normal BUN level?
7-24
Nursing interventions for ARF?
-Immediately report output of less than 30mL/hr to provider
-Monitor electrolytes
-Encourage ADL's
-Hand hygiene and infection prevention
What should the nurse assess for chronic renal failure?
-Fluid overload
-Pulmonary edema
-Decreased cardiac functioning
-Weight loss
-Fatigue
-Decreased bone density
What does the nurse want to do with the patient before dialysis?
-vitals
-weight
-labs
-Bed rest until hypertension, hematuria, and proteinuria subside
-Sodium restriction
-Antihypertensive (hypertension)
-Diuretics (edema)
-Plasmapheresis and steroids (inflammation)
-Low protein, high carb diet
Normal creatinine level?
0.6-1.2
What tests are done to show kidney function?
-UA
-CBC
-BUN
-Creatinine
1- Regulate blood pressure by secreting renin
2- Increase RBC production by secreting erythropoietin
3- Metabolize vitamin D into an active form
4- Maintains acid-base balance by secreting hydrogen ions into the urine
5- Also relates electrolytes and eliminates waste
-Pain
-Respiratory effort
-Discomfort
-Dwell time
-Initiate outflow
What other therapies might help treat acute glomerulonephritis?
Plasmapheresis for autoimmune disorders
What are the signs of acute renal failure?
-Hyponatremia
-Hyperkalemia
-Hypocalcemia
-Edema
-Metabolic acidosis
-N/V
-Mental status changes
-Anemia
What can cause an elevated BUN?
-Rhabdo
-Keto diet
-Dehydration
What do you want to avoid with a dialysis fistula?
-No blood pressure
-No draws
-No IV
-Feel thrill
What are the signs of glomerulonephritis?
-Puffiness of eyes
-Hypertension
-Visual disturbances
-Fever
-Chills
-Skin lesions
-Flank pain
-Edema
What does the nurse want to monitor with acute glomerulonephritis?
Mental status changes, they could be an indication of ICP