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Acute Renal Failure - hypertonic glucose, insulin infusions, and sodium bicarbonate to

be used to treat

ARF is the sudden cessation of renal function that occurs when blood flow tothe kidneys is significantly compromised. (ATI p787)

o Oliguric: pts who excrete < 500 milliliters per day (< 16 oz/day)o Nonoliguric: pts who excrete > 500 milliliters per day (> 16 oz/day)o In nonoliguric patients, urine is of poor quality (contains little waste)

because blood is not well filtered, despite fact that an adequate volume

of urine is excreted. (Powerpoint)

o Both kidneys are failing when ARF occurs. One normally functioningkidney can maintain adequate blood filtering.

o Also caused by stones & strictures in kidney or ureters, HF leading topoor renal perfusion

o Clinical manifestations occur abruptlyo Lab findings:

BUN serum creatinine serum potassium blood pH bicarbonate level Hct & Hgb

Complications (ATI p787) Nursing Actions

Hyperkalemia Administer sodium polystyrene

(Kayexalate) or insulin as

prescribed

HTN Administer antihypertensives &

diuretics as prescribed

Pulmonary edema Prepare client for hemodialysis

Metabolic acidosis Hemodialysis

Uremia Hemodialysiso Management:

Supportive measures: diet high in calories & low in protein,sodium, & potassium, w/ supplemental vitamins & restricted

fluids. Meticulous electrolyte monitoring is essential to detect

hyperkalemia. If hyperkalemia occurs, acute therapy may

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include dialysis, hypertonic glucose & insulin infusions, &

sodium bicarbonateall administered IV--& sodium polystyrene

sulfonate, by mouth/ enema, to remove potassium from body.

If measures fail to control uremic symptoms, hemodialysis orperitoneal dialysis may be necessary.

Nursing Interventions: (from powerpoint) Monitor S/S hypovolemia or hypervolemia because

regulating capacity of kidneys is inadequate

Monitor I & O, specific gravity, gastric secretions, stools,wound drainage, perspiration

Weigh patient daily to provide index of fluid balance;expect weight loss is to 1 lb daily

Adjust fluid to avoid volume overload & dehydration Orthostatic B/P Assess lung sounds Inspect for JVD Evaluate for S/S of hyperkalemia, monitor potassium

levels

TX of elevated K+ is bicarb, glucose, insulin- shiftspotassium into cells

o NCLEX: Nurse is caring for a client in acute renal failure (ARF). The

nurse should expect hypertonic glucose, insulin infusions, and

sodium bicarbonate to be used to treat:

A. Hypernatremia B. Hypokalemia C. Hyperkalemia D. Hypercalcemia

Rationale: Hyperkalemia is a common complication of acuterenal failure. Its life-threatening if immediate action isnt taken to

reverse it. Administration of glucose & regular insulin, with

sodium bicarbonate if necessary, can temporarily prevent

cardiac arrest by moving potassium into cells & temporarily

reducing serum potassium levels. Hypernatremia, hypokalemia,

& hypercalcemia dont usually occur with ARF & arent treated

with glucose, insulin, or sodium bicarbonate.

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