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Cleansweep RN

A. General Information:

  • Progressive, irreversible destruction of the kidneys that continues until nephrons are replaced by a scar tissue; loss of renal function is gradual
  • It occurs in stages and results in uremia or end stage renal disease.
  • Affects all major body systems and requires dialysis or kidney transplantation to maintain life.
  • Hypervolemia may occur due to kidney’s inability to excrete sodium and water, and hypovolemia occurs due to kindneys inability to conserve sodium and water.

B. Stages of Chronic Renal Failure:

STAGE 1: Diminished Renal Reserve

  • Renal function reduced
  • No accumulation of metabolic wastes
  • Healthier kidney compensates
  • Decrease ability to concentrate urine
  • Nocturia and polyuria occurs

STAGE 2: Renal Insufficiency

  • Metabolic wastes begin to accumulate
  • Decrease ability healthier kidney to compensates
  • Oliguria and edema occurs
  • Decreased response to diuretics

STAGE 3: End Stage

  • Excessive accumulation of metabolic wastes
  • Kidneys unable to maintain homeostasis
  • Dialysis or other renal replacement is required

C. Primary Causes:

  • Acute Renal Failure
  • Diabetes Mellitus
  • Hypertension
  • Chronic urinary obstruction
  • Recurrent infections
  • Renal artery occlusions
  • Autoimmune disorders

D. Assessment Findings:

  • Neurologic: Lethargy, daytime drowsiness, decreased attention span and concentration, seizure, coma, slurred speech, asterixis, tremors, twitching or jerking movements, myoclonus, ataxia and paresthesis
  • Cardiovascular: Cardiomyopathy, peripheral edema, hypertension, heart failure, uremic pericarditis, pericardial effusion, pericardial friction rub and cardiac tamponade.
  • Respiratory: Crackles, depressed cough reflex, uremic halitosis, tachypnea, pleural effusion, shortness or breath, pulmonary edema, deep sighing, Kussmaul’s respiration, yawning, uremin pneumonia
  • Hematologic: Abnormal bruising or bleeding and anemia
  • Gastrointestinal: Nausea, anorexia, vomiting, metallic taste diarrhea (uremic colitis), constipation, uremic fetor, stomatitis, GI bleeding ( Uremic gastritis)
  • Genito-Urinary: Decreased fertility, absence of menses, decreased libido, impotence, polyuria, nocturia (early), oliguria (later), proteinuria, hematuria, straw like diluted urine
  • Integumentary: Yellow gray pallor, decreased skin turgor, Pruritus, ecchymosis, purpura, soft tissue calcifications, uremic frost
  • Musculoskeletal: Muscle weakness and cramping, bone pain, pathologic fractures, renal osteodystrophy
  • Diagnostic tests: Urinalysis may reveal decreases specific gravity, platelets and calcium levels, elevated WBC, protein and sodium

E. Nursing Interventions:

Prevent Neurologic complications:

  • Assess and monitor neurologic and vital signs
  • Orient confused client to time, place, date and person
  • Monitor Serum electrolytes, BUN and creatinine

Promote optimal GI function:

  • Asses and provide oral care for stomatitis
  • Monitor for nausea and vomiting, anorexia, administer anti-emetics as ordered
  • Assess signs of GI bleeding
  • Administer stool softeners as prescribed because of constipating effects of iron

Monitor and prevent alteration in fluids and electrolytes:

  • Teach the client about fluid and dietary restrictions and importance of daily weights.
  • Assess for hyperphosphatemia (muscle cramps, seizures and abnormal reflexes) and administer aluminium hydroxide gels (Amphojel) as ordered.

Promote maintenance of skin integrity:

  • Assess and provide care for pruritus and uremic frost
  • Avoid the use of soaps
  • Provide meticulous skin care and oral hygiene

Monitor bleeding complications and prevent injury:

  • Monitor laboratory values (Hgb, Hct, platelets, RBC, Stool for occult blood)
  • Avoid intramuscular injections
  • Administer epoetin alfa (Epogen), hematopoietics, as prescribed to stimulate the production of RBC
  • Avoid administering acetylsalicylic acid (Aspirin) because it is secreted in the kidneys that can cause prolonged bleeding time

Provide safe and calm environment

  • Monitor and maintain maximal cardiovascular function:
  • Monitor blood pressure and report significant changes
  • Auscultate for pericardial friction rub
  • Administer diuretics as ordered and monitor output

F. Medical Management:

  • Diet restrictions
  • Multivitamins
  • Aluminium hydroxide gels
  • Antihypertensive drugs
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