Critical Care Nursing
A Holistic Approach
Part 6
Anatomy and Physiology of the
Renal System
Chapter 28
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Hormones
• Antidiuretic
• Renin hormone
• Aldosterone
• Calcitriol
• Erythropoietin
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Functions of the Renal System
• Renal clearance
• Regulation
– Electrolyte concentration
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Patient Assessment:
Renal System
Chapter 29
History
• Other diseases that contribute to renal failure
– Diabetes mellitus
– Systemic lupus erythematosus
– Hypertension
– Sickle-cell anemia
• Other causes of renal injury
– Recent illness including surgery or infection
– Exposure to nephrotoxic agents
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Assessment of Costovertebral Angles
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Site of Renal Bruits
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Diagnostic Tests
• Urinalysis
• Creatinine and creatinine clearance
• Blood urea nitrogen (BUN)
• Osmolality
• Radiological studies
• Renal biopsy
• Renal angiogram
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Assessment of Fluid Balance
• Daily weight
• Intake and output
• Lab studies
• Hemodynamic monitoring
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Patient Management:
Renal System
Chapter 30
Patient Access
• Vascular catheter
• A-V fistula
• Synthetic vascular graft
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Hemodialysis
• Removes urea, creatinine,
and uric acid
• Removes excess water
• Restores the body buffer
system
• Maintains appropriate levels
of electrolytes
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Complications of Dialysis
• Dysequilibrium – Removal of uric acid too quickly
• Hypovolemia
• Hypotension/Hypertension
• Muscle cramps – Removal of fluid too quickly
• Dysrhythmias
• Angina
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Continuous Renal Replacement Therapies
(CRRT)
• Similar to hemodialysis
• Removes waste product slowly
• Requires more time
• Used when uric acid needs to be aggressively managed
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Peritoneal Dialysis
• The peritoneum is used as the semipermeable membrane
• Osmosis is used to remove fluid
• Peritoneal catheter is placed in surgery
• Used for patients who do not live close to a dialysis
center
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Peritoneal Dialysis
• Advantages
– Less complicated
equipment and supplies
– Less adverse effects
because fluid and
electrolyte change is
slower
• Disadvantages
– Requires more time
– Peritonitis
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Renal Failure
Chapter 31
Causes of Acute Renal Failure
• Prerenal
– Physiological event causing hypoperfusion
• Intrarenal
– Acute damage to renal parenchyma
• Postrenal
– Obstruction to flow of urine out of the kidney
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Chronic Renal Failure
• Slow, progressive, irreversible
• Progressive destruction of nephrons
• Diabetes mellitus and hypertension are the most
common causes
• More common in African Americans, Hispanics, and
Native Americans
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Chronic Renal Failure
• Slow the rate of nephron damage
– Avoid nephrotoxins
• Aminoglycosides
• IV contrast agents
– Strict blood glucose control
– Reduction in hyperlipidemia
– Control of hypertension
• Use of ACE inhibitors
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.