RENAL:
-Compare the pathophysiology of acute and chronic renal failure: (Pg. 1538)
ACUTE:
- Pathologic process depends on the cause of ARF (see common causes)
- A rapid decrease in kidney function, leading to the collection of metabolic wastes in the body.
- Sudden onset (hours to days)
- =50% of nephron involvement
- Usually lasts 2-4 weeks; less than 3 months
- Prognosis is good for return of kidney function with supportive care.*May be reversible*
CHRONIC:
- Progressive irreversible disorder and kidney function does not recover
- Gradual onset (months to years)
- 90%-95% of nephron involvement
- Permanent duration
- Prognosis is fatal without therapy (dialysis or transplant)
-Identify common causes of prerenal, intrarenal, and postrenal ARF: (Pg. 1538-1539)
PRERENAL:
Any condition decreasing blood flow to kidneys leading to ischemia in nephrons
- Shock (hypovolemia, hemorrhage, distributive, obstructive)
- Heart Failure
- Pulmonary Embolism
- Anaphylaxis
- Sepsis
- Pericardial tamponade
(If prolonged kidneys are severely damaged and results in intrarenal)
INTRARENAL:
Actual physical, chemical, hypoxic, or immunologic damage directly to kidney tissue
- Acute interstitial nephritis {infections }
- Exposure to nephrotoxins { NSAIDS, aminoglycoside antibiotics,}
- Vasculitis
- Acute tubular necrosis
- Renal artery or vein stenosis or vein thrombosis
- Formation of crystals or precipitates in nephron tubules
POSTRENAL:
Obstruction of urine collecting system anywhere from calyces to urethral meatus
- Ureter, bladder, or urethral cancer
- Kidney, ureter, or bladder stones
- Bladder atony
- Prostatic hyperplasia or cancer
- Urethral stricture
- Cervical cancer
, -Describe the phases and related laboratory findings of ARF:
PHASES: LABS:
- Onset: - Onset:
Begins with precipitating event. ^ in Creatinine & BUN may be noted
Continues until oliguria develops
Lasts hours to days
- Oliguric: - Oliguric:
Urine output of 100-400mL/day ^ in Creatnine & BUN
Does not respond to fluid challenge/diuretics ^ in K+ (hyperkalemia)(Tall T waves)
Lasts 1-3 weeks ^ Phosphate & Magnesium
Bicarbonate deficit (metabolic acidosis)
Decrease in Ca+ (hypocalcemia)
- Diuretic: - Diuretic:
Sudden onset 2-6 weeks after oliguric phase BUN decreases until normal or plateaus
Urine flow ^ rapidly over a several day period Kidney tubular function is re-
established
Can result in up to 10L/day of dilute urine
- Recovery: - Recovery:
Patient begins to return to normal Kidney function may never return to
Complete recovery may take up to 12 months pre-illness function (but sufficient)
Normal Lab Values:
Potassium: 3.5 -5.0 mEq/L BUN: 10-20 mg/dL
Sodium: 136 – 145 mEq/L Creatnine: 0.6 -1.2 mg/dL (M)
Magnesium: 1.3 – 2.1 mg/dL 0.5 -1.1 mg/dL (F)
Calcium: 9 – 10.5 mg/dL Serum Bicarbonate: 23-30 mEq/L
Phosphate: 3 – 4.5 mg/dL HCO-3 : 21-28 mEq/L
Hemoglobin: 12 – 16 g/dL (F) PaCO2: 35-45 mm Hg
14-18 g/dL (M) Blood Osmolarity: 285-295 mOsm/kg
Hematocrit: 37%-47% (F) pH: 7.35 – 7.45
42%-52% (M)
Identify and prioritize nursing interventions for acid-base imbalance, fluid and electrolyte imbalances associated with
chronic renal failure (ESRD).
SODIUM:
- Early: Hyponatremia due to fewer nephrons to reabsorb, so sodium is lost in urine
- Late: Hypernatremia in later due to oliguria (remember this may be a false low
on lab results r/t water retention – dilution)
POTASSIUM:
-Late: Hyperkalemia can occur quickly. Watch for tall T waves, restrict dietary potassium.
ACID-BASE:
- Bicarbonate deficit -> Metabolic acidosis occurs -> kussmaul respirations -> respiratory alkalosis
-Compare the pathophysiology of acute and chronic renal failure: (Pg. 1538)
ACUTE:
- Pathologic process depends on the cause of ARF (see common causes)
- A rapid decrease in kidney function, leading to the collection of metabolic wastes in the body.
- Sudden onset (hours to days)
- =50% of nephron involvement
- Usually lasts 2-4 weeks; less than 3 months
- Prognosis is good for return of kidney function with supportive care.*May be reversible*
CHRONIC:
- Progressive irreversible disorder and kidney function does not recover
- Gradual onset (months to years)
- 90%-95% of nephron involvement
- Permanent duration
- Prognosis is fatal without therapy (dialysis or transplant)
-Identify common causes of prerenal, intrarenal, and postrenal ARF: (Pg. 1538-1539)
PRERENAL:
Any condition decreasing blood flow to kidneys leading to ischemia in nephrons
- Shock (hypovolemia, hemorrhage, distributive, obstructive)
- Heart Failure
- Pulmonary Embolism
- Anaphylaxis
- Sepsis
- Pericardial tamponade
(If prolonged kidneys are severely damaged and results in intrarenal)
INTRARENAL:
Actual physical, chemical, hypoxic, or immunologic damage directly to kidney tissue
- Acute interstitial nephritis {infections }
- Exposure to nephrotoxins { NSAIDS, aminoglycoside antibiotics,}
- Vasculitis
- Acute tubular necrosis
- Renal artery or vein stenosis or vein thrombosis
- Formation of crystals or precipitates in nephron tubules
POSTRENAL:
Obstruction of urine collecting system anywhere from calyces to urethral meatus
- Ureter, bladder, or urethral cancer
- Kidney, ureter, or bladder stones
- Bladder atony
- Prostatic hyperplasia or cancer
- Urethral stricture
- Cervical cancer
, -Describe the phases and related laboratory findings of ARF:
PHASES: LABS:
- Onset: - Onset:
Begins with precipitating event. ^ in Creatinine & BUN may be noted
Continues until oliguria develops
Lasts hours to days
- Oliguric: - Oliguric:
Urine output of 100-400mL/day ^ in Creatnine & BUN
Does not respond to fluid challenge/diuretics ^ in K+ (hyperkalemia)(Tall T waves)
Lasts 1-3 weeks ^ Phosphate & Magnesium
Bicarbonate deficit (metabolic acidosis)
Decrease in Ca+ (hypocalcemia)
- Diuretic: - Diuretic:
Sudden onset 2-6 weeks after oliguric phase BUN decreases until normal or plateaus
Urine flow ^ rapidly over a several day period Kidney tubular function is re-
established
Can result in up to 10L/day of dilute urine
- Recovery: - Recovery:
Patient begins to return to normal Kidney function may never return to
Complete recovery may take up to 12 months pre-illness function (but sufficient)
Normal Lab Values:
Potassium: 3.5 -5.0 mEq/L BUN: 10-20 mg/dL
Sodium: 136 – 145 mEq/L Creatnine: 0.6 -1.2 mg/dL (M)
Magnesium: 1.3 – 2.1 mg/dL 0.5 -1.1 mg/dL (F)
Calcium: 9 – 10.5 mg/dL Serum Bicarbonate: 23-30 mEq/L
Phosphate: 3 – 4.5 mg/dL HCO-3 : 21-28 mEq/L
Hemoglobin: 12 – 16 g/dL (F) PaCO2: 35-45 mm Hg
14-18 g/dL (M) Blood Osmolarity: 285-295 mOsm/kg
Hematocrit: 37%-47% (F) pH: 7.35 – 7.45
42%-52% (M)
Identify and prioritize nursing interventions for acid-base imbalance, fluid and electrolyte imbalances associated with
chronic renal failure (ESRD).
SODIUM:
- Early: Hyponatremia due to fewer nephrons to reabsorb, so sodium is lost in urine
- Late: Hypernatremia in later due to oliguria (remember this may be a false low
on lab results r/t water retention – dilution)
POTASSIUM:
-Late: Hyperkalemia can occur quickly. Watch for tall T waves, restrict dietary potassium.
ACID-BASE:
- Bicarbonate deficit -> Metabolic acidosis occurs -> kussmaul respirations -> respiratory alkalosis
