CRF
chronic renal failure
- slow
- progressive
- irreversible loss in kidney function
- GFR = 60 mL/min for 3 months or longer
- occurs in stages
- results in uremia or end-stage renal disease
- hypervolemia (kidneys unable to excrete Na+ and H20)
Progression of Chronic Kidney Disease (CKD)
Stage 1: at risk, normal kidney function, GFR >90mL/min
Stage 2: mild CKD, GFR 60-89 mL/min
Stage 3: moderate CKD, GFR 30-59 mL/min
Stage 4: Severe CKD, GFR 15-29 mL/min
Stage 5: ESKD, GFR
CKD Causes
- AKI
- DM and other metabolic disorders
- chronic HTN
- chronic urinary obstruction
- recurrent infections
- renal artery occlusion
- autoimmune disorders
Activity Intolerance
- fatigue results from anemia and buildup of wastes from diseased kidneys
- provide adequate rest periods
- teach client to plan activities
- admin mild CNS depressants as prescribed to promote rest
Anemia
Decreased secretion of erythropoietin by damaged nephrons leading to decreased production of RBC’s
-Monitor for decreased HgB and HCT
-Administer:
epoetin alfa, folic acid (vit b9), iron orally, stool softeners, blood transfusions
GI bleeding
- urea broken down by intestinal bacteria leading to ammonia leading to irriated GI mucosa leading to ulceration leading to bleeding
- monitor HgB and HCT, stool for occult blood
- avoid ASA
What to monitor for Hyperkalemia
- BP
- apical HR
- serum K+ level
- continuous cardiac monitoring is highly recommended
What to Administer for Hyperkalemia
- electrolyte binding and electrolyte excreting meds (Kayexalate)
- 50% dextrose and insulin
- Calcium gluconate
- NaHCO3
- loop diuretics
What to avoid with Hyperkalemia
- High K+ foods
- K+ sparing meds
What would you potentially need to prepare the patient for with Hyperkalema
-peritoneal or hemodialysis
Hypermagnesemia Causes
Mg is Regulated by the kidneys and necessary for cardiac function
caused by renal patients receiving magnesium supplements
decreased renal excretion of magnesium
Hypermagnesemia clinical manifestations
- depresses CNS
- cardiac dysrhythmias (PVC’s and VF)
What to administer for hypermagnesemia
- loop diuretics
- calcium
What to avoid with hypermagnesemia
- antacids
- laxatives
- enemas
Phosphate
- major role in nerve, RBC, and muscle function
- maintains acid base balance
- kidneys excrete phosphate
- inverse relationship with calcium
Phosphate has an inverse relationship with…
Calcium
Hyperphosphatemia causes
chronic renal failure and/pr excessive Vit D intake
Hyperphosphatemia Effects
- decreased serum calcium levels
- Tetany
Increased phosphorus levels leads to….
decreased Ca+ levels which leads to stimulation of parathyroid hormone with leads to bone demineralization
What to administer with Hyperphosphatemia
- TUMS (phosphate binders)
- calcium acetate (PhosLo)
- Sevelamer (Renagel) with meals
- Stool softeners because phosphate binders are constipating
What to avoid with Hyperphosphatemia
-aluminum hydroxide preps
Hypocalcemia causes
- CRF
- vit D deficiency
- loop diuretics (Lasix)
- increased phosphate levels
Hypocalcemia effects
- stimulate PTH to release Ca+ from bone
- Chovstek’s sign
- Trousseau’s
- Tetany/seizures
What to administer for Hypocalemia
-calcium supplements and activated Vit D
