Renal Failure

Acute vs. Chronic II

Chronic Renal Failure Memory Trick

- 3 Ps
Signs & Symptoms ! P - Potassium is
! P - Priority - since it
! P - Pumps the HEART muscles
Oliguria - LOW urine output
High potassium Over 5.0
Excess waste & electrolytes in the blood - HIGH PUMPS in the heart resulting in
Broken Washing machine! Peaked T waves & ST Elevation

H+ ions (Acid) Kaplan Question:

Metabolic ACIDosis pH
below 7.35 Client with kidney disease is weak/ lethargic
Urea and bradycardic
Uremic frost
Pruritus • K+ 8.5 mEq/L lab value is suspected
HIGH Electrolytes
Sodium Na+ HIGH (norm: 135 - 145)
Sodium

Priority Treatment
Na+

Phosphorus HIGH (norm: 3.0 - 4.5)

Phosphorus

P
1. IV Calcium Gluconate for Dysrhythmias
Potassium K+ HIGH (norm: 3.5 - 5.0)
Potasssium

K+
Memory trick: Gluconate GLUEs
down heart muscles
• Peaked T waves - 6 - 7 mEq/L 2. IV 50% Dextrose + Regular INsulin
• ST elevation - 7 - 8 mEq/L 3. Kayexalate (polystyrene sulfonate)
• Wide QRS complex - OVER 8 mEq/L 4. Dialysis

Kaplan Question: Top 2 Missed NCLEX Questions

Patient with chronic kidney disease? Patient with chronic kidney disease missed 3 dialysis
• Oliguria is expected sessions… potassium level of 8.1 …
wide QRS complexes, heart rate of 58 & lethargy.
Which order should the nurse implement first?
Critical Complications
1. IV 50% Dextrose & regular insulin
Hypertensive Crisis 2. Sodium polystyrene sulfonate
Priority Key Signs! NCLEX TIPs!!! 3. Hemodialysis
1. Headache
2. Nausea & Vomiting 4. IV calcium gluconate
3. Change in mental status

End stage renal disease… potassium 7.2, BUN 35,

Signs of Fluid Volume Overload (FVO) creatinine of 3.8, and urine output of 300 ml in 24
hours. Which order is PRIORITY?
• Crackles in the lungs - wet fluid filled lungs
• JVD - jugular vein distention
• Bounding pulses from that fluid excess! 1. IV Regular insulinR & 50% Dextrose
2. IV loop diuretic
Anemia - Low RBCs, since kidneys release 3. Dialysis
Erythropoietin, the hormone that stimulates 4. Put in for vacation time?
bone marrow to produce red blood cells
 Renal Failure
Acute vs. Chronic

Acute kidney failure -- sudden short -term loss of 13

6
S

14
M

15
1

8
T

16
W

9 10

17
T

11

18
F

12

19
S

Chronic Kidney Disease

kidney function. If not stopped & reversed - can
20 21 22 23 24 25 26

27 28 29 30

lead to Chronic Renal failure (CRD).

vs Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Chronic kidney failure --long-term chronic Year 3

damage to kidneys - years & years of destruction

Year 2
Year 1

89- 59- 29-

resulting in permanent damage 90%+
90% 30% 15%

Kidney Kidney Moderate

Severe Kidney failure

Kaplan
damgage damgage to severe
loss of need treatment
normal mild loss loss of
function to live
function of function function

Acute Kidney Injury … correct understanding?

• Sudden loss of kidney function due to loss of
the renal system circulation or glomerular/ tubular 5 stages of CKD
damage
GFR - Glomerular Filtration Rate
Over 90 mL/min - normal HESI
Pathophysiology & Causes Stage 1: 90 + GFR
Polycystic kidney disease
Stage 2: 89 - 60 GFR • At risk for end stage
Acute Renal Failure: Stage 3: 59 - 60 GFR renal disease
1. Prerenal -- think decreased tissue “PRE-fusion” Stage 4: 29 - 15 GFR
• Obstruction - blocks blood flow & oxygen Stage 5: 15 or Less GFR
(emboli, clots, tumors) = End Stage Renal Disease
• Low Blood Pressure - low perfusion
(shock, hypovolemia, dehydration
- from blood or volume loss); low MAP <65 Causes of Chronic Renal failure
• Low Cardiac Output - Older age
- MOST commonly tested
2. INtrarenal - Uncontrolled Diabetes - uncontrolled HIGH sugar
INside the renal >1.3 - Uncontrolled HTN - uncontrolled HIGH blood pressure
• CT Contrast - Unchecked autoimmune disease - body attacks the kidney
CREATININE

Contrast kills the kidney!

• Antibiotics
Vancomycin
Gentamicin 220
• Creatinine over 1.3 = Bad kidney

2. Post Renal -- think Past the Renal

- Kidney stones, tumor, BPH
Key Numbers:
- Creatinine Over 1.3 = bad kidney Diagnostics
- BUN Over 20
- Urine output 30 ml/hr Less = Kidneys in distress • Creatinine - Over 1.3 = Bad Kidney
- Metabolic ACIDosis pH below 7.35 • Creatinine clearance test
• 24 hours - collect all urine in a container
• Discard the FIRST urine specimen

Kaplan
pH < 7.35

Best indicator of good renal functions

• 1500 mL urine in 24 hours

4 Phases Hesi Question

Acute Renal Failure Correct understanding of creatinine clearance test?
Save all urine samples in a container for a designated
1. Onset of injury (initiation) period after discarding the first urine
2. Oliguric phase - less than 400ml in 24 hours
LOW output = thick sticky urine
3. Diuresis phase - “Polyuric phase” - Diuresis = URINE TEST 4 URINE TEST 5 URINE TEST 6

drain urine 3-6 L per day!

URINE TEST 2 URINE TEST 3

4. Recovery phase - SLOW up to 1 year for recovery

Renal Failure
Acute vs. Chronic III

Nursing Interventions
Milk of

• Daily Weights NSAIDs Magnesia

1 kg = 1 liter of fluid retained

AVO
• Avoid: the top drugs that can cause kidney failure
NSAIDS ID
Milk of Magnesia (Anti Acid)
Antibiotics: Vancomycin + Gentamicin Vancomycin Gentamicin

CT Contrast dye! Thick cement in washers!

Procedures
Hemodialysis: the machine version of the kidney, used to wash the blood.
It is only used for a number of years until a kidney transplant is available.

Diet
• NO Sodium
No canned / packaged foods -
No processed meats -
• NO Potassium CE
CHOI
Apples = BEST choice! NCLEX TIP BEST
NO Salt Substitutes NCLEX TIP
NO Leafy veggies (spinach)
Potasssium

K+
NO Avocados, Carrots, Tomatoes
NO Strawberries, Oranges or Bananas
• Low - Phosphorus
NO Dairy: Yogurt, Pudding, Milk NCLEX TIP
• Low - Protein

HESI Questions KAPLAN Questions

Q: Best food choice for potassium of 6.5?
Rationale for low protein diet?
A: Apple slices or apple juice... low K+ levels

Q: Which statement … need for further

Answer: preserve renal function
education?
Teaching about nutrition has been
A: "I should reduce my sodium intake by
using a salt substitute."
effective when the client states:
Answer: “I will eat red bell peppers
and avoid red meats”

AVOID