3 renal failure

8/8/2019 3 Renal Failure

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er ca on ev ew ourse

S. Renee Hill, RN BSN CNNIn-Service Education Coordinator

Central Florida Kidney Center


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Physiology

Failure ev ew o rea men o a es

Vascular Access

Renal Diet & Fluid Restrictions


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-

170 grams (size of afist

20% of Cardiac

Out ut 1 L/min of blood

120 ml/min of plasma

is filtered


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Work 24 hours 7 daysa week

Maintain a constant

balance of chemicals

Most people have 2kidne s


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Renal Anatom & Ph sioloHow Healthy Kidneys Work

Blood with waste enters theRenal Artery

Each kidney has over a millionnephrons

Filtration occurs in theGlomerulus

Urine goes to Collecting duct to

Filtered blood flows through theRenal Vein & back to the body

connecting the kidney to thebladder. Waste products leavethe kidneys via the bladder. Thewaste s ca e ur ne.


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The Ne hron The workin unit of the kidne

Filters and cleans the blood, discards

Keeps the body in balance (Homeostasis)

m on o em per ney

Made up of a Glomerulus and a tubule

Nephrons empty into collecting ducts


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capillaries heldtogether by amembrane called the

Bowmans capsule. The capillary walls

are semipermeable


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Blood enters each glomerulus from an afferent

(toward the organ) arteriole (small artery) Blood pressure forces water to filter out the

blood-through tiny slits-into the urinary space of

a glomerulus ma was es pass roug pores a ong w e

water to form a liquid called Glomerular filtrate.

u -180 liters/day.

,

substances, like protein, pass through)


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-


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Glomerulus sends filtrate into a tubule

Tubule has 4 parts: Proximal Convoluted Tubule

Loop of Henle

Distal Convoluted Tubule

Chemicals and water the body needs arereabsorbed into the blood throu h thetubules, the rest gets emptied and then flowsinto the ureters to be excreted as urine.


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a. Medulla

.

c. Calyx

.


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a. A glomerulus and a tubule

. nep ron an a capsu e

c. The Loop of Henle and a capillary bedd. The Bladder and the ureter


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-

W Water Removal

ectro yte a ance

T Toxin Removal B Blood Pressure Control

D Vitamin D Metabolism


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The kidneys maintain acid-base balance

blood plasma. a ys s e ps o res ore ac ase a ance


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Intracellular: first space. Located within tissue and muscle

ce s ns e e ce s . a es up o o a o y wa er.

Intravascular: blood inside the blood vessels. Extracellular or Interstitial: second space. Is composed of

. Whole blood is in both the intracellular and extracellular

compartment Transcellular: third s ace. Makes u a rox 1-3% of bod

water. It exists in various compartments: Cerebrospinal Pleural

Peritoneal Gastrointestinal


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intravascular fluid compartment?.

b. Blood inside the blood vesselsc. Fluid between cells

d. Fluids inside and between cells


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, ,

pass through the kidneys go back into.

Sodium, Potassium, Chloride, Calcium,.

Dialysis helps to restore electrolyte

a ance.


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-Rid the body of waste and excess fluid

astes comes rom oo s t at are

digested Wastes come from the breakdown of

tissue due to normal muscle use

Dialysis removes some waste ontreatment da s


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pressure control,

with sodium

a ys s e ps o con ro oo pressure yremoving fluid and balancing sodium on

rea men ays


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make red blood cells by producing

Antidiuretic Hormone- released by the

pressure

a ys s can ma e ery ropo e n, uerythropoietin can be given.


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Calcium and Phosphorus balance thathel s with bone metabolism

Dialysis cannot activate Vitamin D, but

Vitamin D sterols can be iven. Dialysis can change Ca levels by adjusting

Ca in dialysate and some Phosphorus can

be removed, but not as well as healthykidneys


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ron c ney sease

End Stage Renal Disease


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Sudden loss of kidne function

Causes: -

Severe Dehydration Heart Disease

- Trauma Nephrotoxic Drugs

Postrenal-blocka e causin urine back-u

Kidney Stones Kinked ureter Tumors

Lasts days, weeks, months


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,

functions over a period of months or years

glomerular filtration rate.

in blood serum.


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CKD that leads to severe illness and.


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How to Slow Kidney Disease

Progression

Blood Pressure Control

et

Blood sugar control in Diabetics Stop smoking


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Stages of Chronic Kidney Disease

Stage GFR Description

no symptoms

- ney amage w t ecreaseGFR; Anemia

3 30-59 Moderate decrease in GFR;Fatigue, Anemia, Edema

4 15-29 Severe decrease in GFR; preparept for dialysis or transplant

5


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Diabetic Nephropathy (Diabetic Kidney

1-2 main types of Diabetes cause most kidney

Type I Pancreas cant make Insulin

Type II-The body cant make enough insulin or

cant use what it makes (90% of pts)


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2nd most common cause of CKD Cause usuall unknown

Stress being overweight smoking

High salt diet heavy use of alcohol

Glomerular Disease

-

Glomerulosclerosis (narrow)-narrowing of glomeruli


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disease for adults in the US?.

b. Glomerulonephritis

.

d. Urinary Obstruction


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Genetic cysts (fluid filled)

Other Causes

Birth defects, AIDS, Sickle Cell Disease, Useof street drugs, Cancer, Large Kidney Stones

upus mmune sys em sease , rauma


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Di h Tr m n

Options for Kidney Failure

Peritoneal Dialysis

None


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e process o c ean ng e oo y

removing waste and fluid build-up whene neys a roug a sem -permea e

membrane.

Both blood and dialysate are pumpedthrough the dialyzer at the same time.

Dialysis only replace 15% of kidneyfunction.


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-

Good fluid balance

Anemia controlled

w

Blood tests in target range


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-

More energy

Has a good appetite


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membrane as the filter Membrane is inside the abdomen

(Peritoneum)

A plastic catheter is placed in theabdomen

Minor surgery


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-

Can be done alone or with a partner

-

Fits into the patients lifestyle Allows working patients to keep their jobs

Fewer Diet and fluid limits


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Inflammation of the Peritoneum

How to prevent Peritonitis? Follow the steps exactly as taught to you (the

patient)

Good Handwashing Wear Mask during exchanges


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Dialysis)

PD ( ontinous ycling PeritonealDialysis)

A machine (cycler) is used to automaticallyperform exchanges during the night


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Kidne Trans lant

person into your body.

surgery

Disease


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Kidney from a blood relative (Living Related

Kidney from a non-blood relative (spouse,

- A deceased donor kidney from a National

Trans lant List


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Why are patients tested? a e sure a oo an ssue ma c

Make sure that the donor and the recipient

mentally)

C C li ti f


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Common Complications of

Transplantation

Surgical complications

Lymphocele

Acute rejection

The immune system sees the transplant as aforeign body and attacks it.


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Anti-rejection drugs are given-known as

mmunosuppressan rugs Side effects

e g ga n

Hypertension

Increased chance of Infection Cancer

A special diet is followed, but not aslimiting as for the In-center Hemopatients


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blood.

Three Types of Accesses:

Fistula

Graft

Catheters


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a vein,

candidate

ncourage your pa en o s ar exerc s ngapproximately 1 week after surgery


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-

(wrist) and cephalic vein (elbow) Most common

Brachiacephalic- Brachial artery

connected to the ce halic vein Transposed Basilic Vein- a deep vein

brou ht closer to the surface of the skin

and the vein is moved to the front of theupper arm


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Radiocephalic Fistula Brachiacephalics u a


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Fistula

Advantages Disadvantages

Less chance of

Infection

mature (4-12 wks)

Slow to develop Stenosis may develop


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Vascular Access

ssess e ccess eac rea men

Look for si ns of infection redness or draina e

Listen for the bruit (low pitch sound)

Feel for the thrill (purring or vibrations)


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hands after access placement. -

Bruit- swooshing noise; louder if stenosis

Thrill- continuous vibration; not a strong

Aneurysm-ballooning or bulging of a blood


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Keep needles at least 1 inch from

Avoid curves, flat spots, aneurysms

Even if the vessel appears large enough

Gives it a better feel Helps to see the vessel better


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Arterial needles can be antegrade or

Venous needles should always be placean egra e owar e oo ow owarthe patient)

Bevel down-prevents coring


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you choose 2 new holes Rotate sites to revent aneur sm formation

Button Hole Techni ue or Constant Site For patients with low pain tolerance

For atients with limited access areas

Fewer missed insertions & infiltrations Fewer infections


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An artificial (synthetic) blood vessel used to connect an

Advantages Disadvantages

artery ve n

Takes less time tomature

More prone toinfection

arger areas ocannulate

Easier to cannulate

ore prone oThrombosis (clotting)

More likel to develo

Used in Diabetics

a stenosis

Older Patient

Patients with Poor

Circulation


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subcutaneous portunder the skin

Reasons for Use

Acute Renal Failure Peritonitis

Awaiting a Transplant

Refuses a permanentaccess


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Good for urgent use Can be hidden under

Leads to infection Can cause

clothing

Pt able to move more

inflammation, clotting,and stenosis

No needles used

leading to pooradequacy


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To maintain nutrition

to a minimum

Planned for every patient

n v ua ze

Can be changed based on patient needs


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Protein-aids in growth and maintains body, ,

Sodium-found naturally in foods; cant be

Potassium-controls & transmits nerveim ulses

Phosphorus-Major source from the Bones;hel s with ener , absor tion, metabolism offats


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Little or no urine is produced

Fluid must be removed through dialysis

Fluid weight varies between patient

rea men s


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restriction Limited to volume of the atients urine out ut+ 1 liter (4 cups/day)

No urine output- patient is limited to 4 c/day

Dry Weight-Post dialysis weight at which

excess fluid has been removed and thepatient is normotensive


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Teach the effects of Protein oo muc = eva e or ec s a ys s

treatment time

Teach the effects of Sodium

Too little caused by diarrhea or fluid overload

Too much=Arrhythmias


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Sources All protein foods (Meat, fish, poultry, eggs)

Avoid or limit these sources

Milk and milk products

Dried beans

Chocolate

Cola

Nuts and seed

Whole grains


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Anything that melts at room temperature is

Never guess when you are talking to yourpa en s a ou e re a e ssues-re erthem to the Dietitian or any nutritional

an ou s a m g e n your un .


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CRITICAL THINKING IS KEY!

3 renal failure

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