more review...acute renal failure

• Acute renal review. Some…alot of work for kidneys.
  Think about the kidney…waste and water balance, acid base balance, controlling BP, controlling anemia.
• 3 f(x)= glomerular filtration, reabsorption and secretion.
• How does the kidney exrete nitrogenous waste ? Conserve electrolytes? and concentrate urine?
• Standard renal f(x) test= the GFR. Creatinine clearance test done over 24 hours. Normal rate is 80-125ml/min.
• Streptomycin--is nephrotoxic…be careful…
• Hypotension, extreme bleeding associated with pre renal failure.
• Oliguric phase--10-14 days….anticipate, urinary changes decreased output decreased GFR, cant concentrate urine. fluid volume excess, assess edema, neck vein distention, pulm. Edema, CHF, bounding pulse. Metabolic acidosis…see increased rr. Sodium balance…excreting to much Na+. Supposed to excrete K+ …but it is not. Anemia decreased platelets, RBC. Calcium deficit + Phosphate excess.
• What to expect to do….treat Hypovolemia w/ albumin IV. (remember 3rd spacing?) Treat HTN with meds, Treat hyperkalemia…R insulin IV + glucose. To help K+ into cells. Sodium bicarbonate to Tx acidosis. Calcium gluconate IV. Dialysis, to get rid of K+ for arrhythmias. Kayexalate to get rid of K+ in through stool excretion. Restrict dietary K+. to 40mEq.
• Diet
  Decrease the protein to 1gm/kg
  Increase the calories
  Decrease K+ and phosphorous (banana, citrus, coffee)
  Increase the Fe
• Hemodiaylsis
  Access = AV shunt, fistula, graft.
  Nsg Care
  Assess for change in BP, disequilibrium reaction, alterations in clotting from heparin solution.
• Transplant.
  Major concern=rejection. Rx given to immunosuppressive=Imuran, Prednisone, cyclosporin.
  Next concern is infection
  Assess for increased temp. pain. Tenderness over grafted area. Decreased output, edema, sudden weight gain. Assess for rise in serum creatinine and BUN values. in essence the s/s of ARF.