Chronic Renal Failure

  1. General information
    1. Progressive, irreversible destruction of the kidneys that continues until nephrons are replaced by scar tissue; loss of renal function gradual
    2. Predisposing factors: recurrent infections, exacerbations of nephritis, urinary tract obstructions, diabetes mellitus, hypertension
  2. Medical management
    1. Diet restrictions
    2. Multivitamins
    3. Hematinics
    4. Aluminum hydroxide gels
    5. Antihypertensives
  3. Assessment findings
    1. Nausea, vomiting; diarrhea or constipation; decreased urinary output; dyspnea
    2. Stomatitis, hypotension (early), hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub, CHF
    3. Diagnostic tests: urinalysis
      1. Protein, sodium, and WBC elevated
      2. Specific gravity, platelets, and calcium decreased
  4. Nursing interventions
    1. Prevent neurologic complications.
      1. Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).
      2. Assess for changes in mental functioning.
      3. Orient confused client to time, place, date, and persons; institute safety measures to protect client from falling out of bed.
      4. Monitor serum electrolytes, BUN, and creatinine as ordered.
    2. Promote optimal GI function.
      1. Assess/provide care for stomatitis
      2. Monitor nausea, vomiting, anorexia; administer antiemetics as ordered.
      3. Assess for signs of GI bleeding.
    3. Monitor/prevent alteration in fluid and electrolyte balance.
    4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel, AlternaGEL) as ordered.
    5. Promote maintenance of skin integrity.
      1. Assess/provide care for pruritus.
      2. Assess for uremic frost (urea crystallization on the skin) and bathe in plain water.
    6. Monitor for bleeding complications, prevent injury to client.
      1. Monitor Hgb, hct, platelets, RBC.
      2. Hematest all secretions.
      3. Administer hematinics as ordered.
      4. Avoid IM injections.
    7. Promote/maintain maximal cardiovascular function.
      1. Monitor blood pressure and report significant changes.
      2. Auscultate for pericardial friction rub.
      3. Perform circulation checks routinely.
      4. Administer diuretics as ordered and monitor output.
      5. Modify digitalis dose as ordered (digitalis is excreted in kidneys).
    8. Provide care for client receiving dialysis.

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