8/14/2019 Chapter 075
1/38
Chapter 75
Interventions for Clients with
Acute and Chronic RenalFailure
8/14/2019 Chapter 075
2/38
Acute Renal Failure
Pathophysiology
Types of acute renal failure include: Prerenal
Intrarenal
Postrenal
8/14/2019 Chapter 075
3/38
Phases of Acute Renal
Failure Phases of rapid decrease in renalfunction lead to the collection of
metabolic wastes in the body.
Phases include: Onset
Oliguric
Diuretic Recovery
Acute syndrome may be reversible with
prompt intervention.
8/14/2019 Chapter 075
4/38
Assessment
History
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic assessments such as
renal biopsy
8/14/2019 Chapter 075
5/38
Drug Therapy
Cardioglycocides Vitamins and minerals Biologic response modifiers
Phosphate binders Stool softeners and laxatives Monitor fluids Diuretics Calcium channel blockers
8/14/2019 Chapter 075
6/38
Treatment
Diet therapy Protein 40 g/day if not on dialysis
Protein 1 to 1.5 g/kg per day if on dialysis
Sodium 60 to 90 mEq/day
Potassium restricted to 60 to 70 mEq/day
Fluid equal the urine output plus 500 mL
Dialysis therapies Hemodialysis
Peritoneal dialysis
8/14/2019 Chapter 075
7/38
Continuous RenalReplacement Therapy Standard treatment
Major disadvantage, bleeding caused by
anticoagulants
Dialysate solution
Vascular access Jugular or subclavian
8/14/2019 Chapter 075
8/38
Continuous RenalReplacement Therapy Continuous arteriovenous hemofiltration
Used for the hemodynamically unstable
Continuous venovenous hemofiltration Used for critically ill
8/14/2019 Chapter 075
9/38
Posthospital Care
If renal failure is resolving, follow-up care
may be required.
There may be permanent renal damage
and the need for chronic dialysis or eventransplantation.
Temporary dialysis is appropriate for
some clients.
8/14/2019 Chapter 075
10/38
Chronic Renal Failure
Progressive, irreversible kidney injury;
kidney function does not recover
Azotemia
Uremia
Uremic syndrome
8/14/2019 Chapter 075
11/38
Stages of Chronic RenalFailure Diminished renal reserve
Renal insufficiency
End-stage renal disease
8/14/2019 Chapter 075
12/38
8/14/2019 Chapter 075
13/38
8/14/2019 Chapter 075
14/38
8/14/2019 Chapter 075
15/38
8/14/2019 Chapter 075
16/38
Stages of Chronic RenalFailure
Changes Kidney Metabolic
Urea and creatinine Electrolytes
Sodium Potassium Acid-base balance Calcium and phosphorus
(Continued)
8/14/2019 Chapter 075
17/38
Stages of Chronic RenalFailure
Changes (Continued) Cardiac Hypertension
Hyperlipidemia
Congestive heart failure
Uremic pericarditis
Hematologic
Gastrointestinal
8/14/2019 Chapter 075
18/38
Clinical Manifestations(Chart 75-7) Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin
8/14/2019 Chapter 075
19/38
Imbalanced Nutrition:Less Than BodyRequirements Interventions include:
Dietary evaluation for: Protein Fluid
Potassium Sodium Phosphorus
Vitamin supplementation
8/14/2019 Chapter 075
20/38
Excess Fluid Volume
Interventions: Monitor clients 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.
8/14/2019 Chapter 075
21/38
Decreased Cardiac Output
Interventions: Control hypertension with calcium channel
blockers, ACE inhibitors, alpha- and beta-
adrenergic blockers, and vasodilators. Instruct client and family to monitor blood
pressure, clients weight, diet, and drug
therapy.
8/14/2019 Chapter 075
22/38
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
8/14/2019 Chapter 075
23/38
Risk for Injury
Interventions include: Drug therapy (chart 75-3)
Education to prevent fall or injury, pathologic
fractures, bleeding, and toxic effects ofprescribed drugs
8/14/2019 Chapter 075
24/38
Fatigue
Interventions: Assess for vitamin deficiency, anemia, and
buildup of urea.
Administer vitamin and mineral supplements. Administer erythropoietin therapy for bone
marrow production.
Give iron supplements as needed.
8/14/2019 Chapter 075
25/38
Anxiety
Interventions include: Health care team involvement
Client and family education
Continuity of care Encouragement of client to ask questions and
discuss fears about the diagnosis of renal
failure
8/14/2019 Chapter 075
26/38
Potential for PulmonaryEdema Interventions:
Assess the client for early signs of pulmonary
edema.
Monitor serum electrolyte levels, vital signs,oxygen saturation levels, hypertension.
8/14/2019 Chapter 075
27/38
Hemodialysis
Client selection
Dialysis settings
Works using passive transfer of toxins by
diffusion
Anticoagulation needed, usually heparin
treatment
8/14/2019 Chapter 075
28/38
Vascular Access
Arteriovenous fistula, or arteriovenous
graft for long-term permanent access
Hemodialysis catheter, dual or triple
lumen, or arteriovenous shunt fortemporary access
Precautions
Complications
8/14/2019 Chapter 075
29/38
Hemodialysis NursingCare Postdialysis care:
Monitor for complications such as
hypotension, headache, nausea, malaise,
vomiting, dizziness, and muscle cramps. Monitor vital signs and weight.
Avoid invasive procedures 4 to 6 hours after
dialysis.
Continually monitor for hemorrhage.
8/14/2019 Chapter 075
30/38
Complications ofHemodialysis Dialysis disequilibrium syndrome
Infectious diseases
Hepatitis B and C infections
HIV exposureposes some risk for
clients undergoing dialysis
8/14/2019 Chapter 075
31/38
Peritoneal Dialysis
Procedure involves siliconized rubber
catheter placed into the abdominal cavity
for infusion of dialysate.
Types of peritoneal dialysis: Continuous ambulatory peritoneal
Automated peritoneal
Intermittent peritoneal Continuous-cycle peritoneal
8/14/2019 Chapter 075
32/38
Complications
Peritonitis
Pain
Exit site and tunnel infections
Poor dialysate flow
Dialysate leakage
Other complications
8/14/2019 Chapter 075
33/38
Nursing Care DuringPeritoneal Dialysis Before treating, evaluate baseline vital
signs, weight, and laboratory tests.
Continually monitor the client for
respiratory distress, pain, and discomfort. Monitor prescribed dwell time and initiate
outflow.
Observe the outflow amount and patternof fluid.
8/14/2019 Chapter 075
34/38
Renal Transplantation
Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure
8/14/2019 Chapter 075
35/38
8/14/2019 Chapter 075
36/38
Postoperative Care
Urologic management
Assessment of urine output hourly for 48
hours.
Complications include: Rejection
Acute tubular necrosis
(Continued)
8/14/2019 Chapter 075
37/38
8/14/2019 Chapter 075
38/38
Postoperative Care(Continued)
Thrombosis
Renal artery stenosis
Other complications
Immunosuppressive drug therapy Psychosocial preparation