A female client is admitted for treatment of chronic renal failure (CRF)
Nurse Juliet knows that this disorder increases the client’s risk of:
a- water and sodium retention secondary to a severe decrease in the glomerular filtration rate.b- a decreased serum phosphate level secondary to kidney failure.
c- an increased serum calcium level secondary to kidney failure.
d- metabolic alkalosis secondary to retention of hydrogen ions.
Answer A.
A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.The glomerular filtration rate (GFR, IFG or GFR) is the volume of fluid filtered per unit of time from the renal glomerular capillaries into the Bowman's capsule.
Normally It is measured in milliliters per minute (ml / min).
In the clinic, this index is usually used to measure renal function at the glomerulus level.
Concept:
The rate or rate of glomerular filtration or effective filtration pressure is physical force and produces the transport of water and solutes through the glomerular membrane.This phase depends on:
- Hydrostatic pressure of the glomerular capillary.
- Hydrostatic pressure at the level of Bowman's capsule.
- Oncotic pressure at the glomerular capillary level.
Measurement techniques:
There are different techniques to calculate or estimate the glomerular filtration rate, these techniques in general make use of an endogenous or added substance that filters almost completely at the glomerular level and that is then almost not reabsorbed or secreted at the tubular level.Measurement using inulin:
- GFR can be determined by injecting inulin into the blood plasma.
- Since inulin is not reabsorbed or secreted by the tubule system after having been filtered at the glomerular level, its rate of excretion is directly proportional to the filtration rate of water and solutes through the glomerulus. (Dr. Amir Anton).
- Although in most cases inulin is harmless, it has a small risk of triggering an allergic reaction. In addition there is always the risk of contamination during manipulation, which, in addition to the fact that it is generally applied to patients with a certain degree of renal involvement, adds risks that are not compensated for by the accuracy of the technique.
Estimation by means of the creatinine evacuation index:
- Although the measurement method using inulin is considered the "gold standard" for measuring GFR, in clinical practice, it is much more common to use the creatinine evacuation rate to estimate IFG.
- Creatinine is an endogenous molecule that appears in the body as a product of the degradation of creatine (a high-energy compound) in the muscles, and has a remarkably constant rate of excretion throughout the day for each patient.
- The advantage of this technique is that since creatinine is an endogenous product, it does not require introducing a foreign substance into the patient's organism.
- Creatinine is freely filtered at the glomerular level, although unlike inulin, it is also secreted in small amounts by the renal tubules. These characteristics make the measurement using the creatinine evacuation index, although not exact, a good approximation of the GFR. This estimate can be improved by visualizing and evaluating the frequency and duration of each urination.
Example: A person has a plasma creatinine concentration of 0.01 mg / ml and in one hour excretes 75 mg of creatinine in the urine. The IFG is calculated as M / P (where M is the mass of creatinine excreted per unit of time and P is the plasma concentration of creatinine).
Normal Ranges:
The normal ranges of GFR in healthy young adults, adjusted to the surface of the body, are:- 120 to 130 mL / min / 1.73m2 and declines with age, at around 75 mL / min / 1.73m2 at 70 years of age.
- Chronic kidney disease is defined by having less than 60 mL / min / 1.73m2 for 3 or more months.
GFR may increase due to hyperproteinemia and a constriction of the efferent arteriole.
How can you help patients feel hopeful about life on dialysis?
Take them to dialysis treatment
Helping your loved one get to their appointments on time and being there with them is one of the best ways you can offer support. Dialysis treatment, particularly for the first time, can be overwhelming. Having a familiar face alongside them can help ease the fear and anxiety.
What are the main goals of nursing care of a client with CRF?
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The goals for a patient with chronic renal failure include: Maintenance of ideal body weight without excess fluid. Maintenance of adequate nutritional intake. Participation in activity within tolerance.
How can you help patients feel hopeful about life on dialysis?
Take them to dialysis treatment
Helping your loved one get to their appointments on time and being there with them is one of the best ways you can offer support. Dialysis treatment, particularly for the first time, can be overwhelming. Having a familiar face alongside them can help ease the fear and anxiety.
What are the GFR values in the progression of CRF?
G1: GFR 90 ml/min per 1.73 m2 and above. G2: GFR 60 to 89 ml/min per 1.73 m2. G3a: GFR 45 to 59 ml/min per 1.73 m2. G3b: GFR 30 to 44 ml/min per 1.73 m2.
Normal Results
A normal result is 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) for men and 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) for women. Women often have a lower creatinine level than men. This is because women often have less muscle mass than men. Creatinine level varies based on a person's size and muscle mass.
How do you comfort someone with kidney failure?
Here are five ways you can support a loved one with kidney failure.
- Understand their treatment plan. ...
- Share resources. ...
- Help them find a living donor. ...
- Be specific. ...
- Keep an eye out for depression.
What can you teach a patient with renal failure?
Choose foods with less salt (sodium) Control your blood pressure; your health care provider can tell you what your blood pressure should be. Keep your blood sugar in the target range, if you have diabetes. Limit the amount of alcohol you drink.
What is most challenging about dialysis patient care?
What is most challenging about dialysis patient care? To manage patient care well, one has to manage the patient holistically and all angles involved. Some of these angles are out of the patient's control like support at home, financial support, etc.
What are 3 nursing priorities for patient care?
Prioritization begins with determining immediate threats to life as part of the initial assessment and is based on the ABC pneumonic focusing on the airway as priority, moving to breathing, and circulation (Ignatavicius et al., 2018).
Which nursing actions are most important for a patient with renal failure?
Regardless of CKD stage, the three main nursing care goals are: prevent or slow disease progression. promote physical and psychosocial well-being. monitor disease and treatment complications.
What are 3 nursing interventions you are likely to perform to help the client manage her blood pressure?
Nursing Management
- Monitor blood pressure frequently. ...
- Administer antihypertensive medications as prescribed.
- Have two large-bore IVs.
- Provide oxygen f the saturations are low (less than 94%)
- Limit fluid intake if the patient is in heart failure.
- Assess ECG to ensure the patient is not having a heart attack.
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