5/30/2012 6:22:00 PM Acute Renal Failure - hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat ARF

F is the sudden cessation of renal function that occurs when blood flow to the 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 functioning kidney can maintain adequate blood filtering. o Also caused by stones & strictures in kidney or ureters, HF leading to poor renal perfusion o Clinical manifestations occur abruptly o Lab findings: BUN serum creatinine serum potassium blood pH bicarbonate level Hct & Hgb Nursing Actions Administer sodium polystyrene (Kayexalate) or insulin as prescribed Administer antihypertensives & diuretics as prescribed Prepare client for hemodialysis Hemodialysis Hemodialysis

Complications (ATI p787) Hyperkalemia

HTN Pulmonary edema Metabolic acidosis Uremia

o 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

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 or peritoneal 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- shifts potassium 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 acute renal 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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5/30/2012 6:22:00 PM