About
Inability of the kidneys to filter through and excrete wastes and by products of metabolism, usually temporary as a result of nephrotoxic medications or conditions.
Assess
Oliguria, anuria, hypotension, lethargy, tachycardia, edema, dyspnea, pulmonary edema, hypertension as it progresses, Electrolyte changes, Increased BUN and Creatinine, anemia
Complications
End stage renal disease- dialysis or transplant; hypertension; hyperkalemia
Diagnosis
- Fluid volume excess related to decreased urine output and water retention
- Ineffective coping related to diagnosis.
- Imbalanced nutrition: less than body requirements related to dietary restrictions, nausea
- Impaired urinary elimination related to effects of disease
- Fatigue related to uremia and anemia
- Knowledge deficit related to dialysis, dietary restrictions
Goals
- The client will maintain acceptable fluid balance.
- The client will have electrolytes within acceptable ranges.
- For acute renal failure, the client will have resolution of disease.
- The client will identify strategies to manage impaired kidney function ( temporary dialysis, dietary restrictions).
Interventions
- Monitor VS, Intake and outputs, daily weights, electrolytes, albumin, and BUN/ Creatinine.
- Assess lung sounds frequently to assess for pulmonary edema.
- Assess heart frequently and monitor for dysrhythmias.
- Assess shunts, dialysis catheters, vascular access devices for infection, patency, and adequate perfusion ( positive thrill/ bruit).
- Monitor for s/s of electrolyte imbalances.
- Monitor for drug accumulation and toxicity since renal clearance may be compromised.
- Administer renal replacement medications as ordered.
- Maintain a renal diet, including protein restriction, potassium restriction, and sodium restriction; sometimes fluid restriction.
- Teach client how to manage vascular access devices prior to discharge.
- Teach client how to maintain dietary restrictions, continuing care with dialysis, and s/s of complications that require immediate follow-up.
- Monitor for signs/ symptoms of complications.
- Monitor VS, Intake and outputs, daily weights, electrolytes, albumin, and BUN/ Creatinine.
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