Restore and maintain renal perfusion IV fluid dopamine loop diuretics

Restore and maintain renal perfusion iv fluid

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Restore and maintain renal perfusion IV fluid, dopamine, loop diuretics Aggressive hypertensive management ACE inhibitors, ARBs Nutritional Needs-ARF Adequate nutrients and calories to prevent catabolism (ketones) Decrease proteins to decrease azotemia and essential Amino Acids Incresae CHO to spare proteins Decrease K Decrease Na Renal Replacement Therapy Hemodialysis o Intermittent hemodialysis Artificial kidney Cylinder encloses straw-like fibers Blood passes through these fibers Vascular access is needed for blood flow Blood flows from the dialysis catheter from femoral/internal jugular vein Blood pump on machine takes blood through dialyzer Diffusion/ Osmosis takes place in dialyzer Clean blood returns to patient DIALYSIS CATHETERS ARE NOT A CENTRAL LINE, CAN’T DRAW BLOOD THERE Have one side that has venous access and arterial access o Continuous renal replacement therapy Continuous- 24 hours Most like normal kidney Uses smaller artificial dialyzer- less blood volume Machine at bedside in ICU Slow gentle fluid and toxin removal Must turn and shift patient as appropriate but because he can’t get up o Slow low (efficiency of extended) dialysis o Peritoneal Dialysis Less recommended if not compliant o Renal Transplant Not much of a chance of getting an organ Principles of Dialysis Fluid Removal Ultrafiltration
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Osmosis Hydrostatic pressure Solute Removal Diffusion Convection o Solutes moves with water as water moves across the semipermeable membrane of the dialyzer o Also referred to as solute drag- the solutes are being dragged across the membrane with the water - Greater concentration of potassium and urea move to the dialysate across the membrane - Greater concentration of bicarbonate and calcium in dialysate move into the blood Chronic Kidney Disease Chronic Kidney Disease & Staging defined by presence of kidney damage for three or more months - Staging 1-5 based upon GFR - Stage 5 is End Stage Renal Disease (GFR <15) o Renal replacement therapies start here Stage Description GFR 1 Kidney damage with normal or increased GFR > 90 2 Kidney damage with mild decreased GFR 60-89 3 Moderately decreased GFR 30-59 4 Severely decreased GFR 15-29 5 Kidney Failure < 15 (or dialysis) Stages: Decreased renal reserve: GFR at 50% nl; BUN and creatinine is normal Renal insufficiency: GFR 20-50% nl; polyuria; creatinine 1.5-2.5; BUN 20-60 Renal failure: GFR <20% nl; oliguria; creatinine >2.5; BUN >60 ESRD: GFR <5% nl; anuria (on dialysis) o “Uremia” Cardiovascular HTN Edema Hyperlipidemia Hematology Anemia Neurology Change in LOC Restless leg syndrome o r/t hyperkalemia Muscle weakness Seizures o r/t hypernatremia Endocrine Uric acid level increased Resistance to insulin Dermatologic effects Yellowish hue skin Dry skin with poor turgor Pruritis due to metabolic waste Uremic frost GI Anorexia, N/V
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