09.05 Chronic Renal Failure

Nursing Points

General

1. Chronic renal failure
   1. Decline in kidney function
   2. Stages
      1. Diminished renal reserve
         1. 50% nephron loss
      2.    Renal insufficiency
         1. 75% nephron loss
      3. End Stage Renal Disease (ESRD)
         1. 90% nephron loss
      4. Uremic Syndrome
         1. 100% nephron loss
   3. Inverse relationship
      1. As creatinine level increases GFR decreases
   4. Hyperkalemia
      1. Causes EKG changes
         1. Peak T waves
            1. High potassium level of 6.7-6.9
         2. Prolonged PR interval
            1. Potassium level 7
         3. Lose P wave
            1. Potassium level 7.5
         4. Wide complex
            1. Potassium level 7.8-7.9
         5. Biphasic
            1.    Potassium level 8
         6. Sine wave
            1. Calcium chloride IVP – treatment for EKG involvement
               1. Protects heart to allow normal conductivity
               2. Does not lower K level
         7.  Muscle weakness
      2. Treatment
         1. Insulin -hides potassium
         2. Glucose
         3. Sodium bicarb -pushes potassium into the cell
         4. K excelate –> removes potassium from cell into the bowel
   5.  Calcium and Phosphate
      1. Reciprocal relationship
2. Kidney disease
   1. Low vitamin D
   2. Low Calcium
   3. High Phosphate
   4. Treatment
      1. Amphogel –> Decreases phosphate
      2. Oscal –> Increase calcium
   5. Hyperphosphatemia
      1. Chvostek’s sign
      2. Trousseau’s sign
      3. Twitch
      4. Seizures
      5. Same as hypocalcemia
   6. Hypercalcemia
      1. Muscle weakness
      2. Apathy
      3. Diabetes
      4. Nephrogenic diabetes inspidus
      5. Same as hypophosphatemia