Page 374 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 359

the afferent arteriole. Blood leaves the kidney through the renal veins, which
return blood to the left side of the heart through the inferior vena cava.

NURSING ALERT

Any surgery that involves decreasing blood supply to the kidney can potentially
cause renal failure. Types of surgeries notorious for doing this are abdominal aortic
aneurysm repair and open-heart surgeries.

Assessment Skills

1 Failing kidneys can affect all body systems, making a thorough history and
physical of the patient important in determining the presence, extent, and com-
plications of renal failure. The correct order of performing this assessment should
proceed from inspection and auscultation to percussion and then palpation.

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A patient history should include height and weight patterns and past medical
history for ureteral calculi, tumor, glomerulonephritis, cystic kidney disease,
heart problems, diabetes, and hypertension. Patients at highest risk for renal
failure are those with diabetes, hypertension, glomerulonephritis, and cystic
kidney disease.
A nutritional assessment should obtain information about the patient’s
weight history and previous diets; food intake patterns; social economic status;
and living arrangements. This information becomes important if the patient
needs to be placed on special diets like protein sparing and potassium-sodium
limiting to control edema and uremia. Inquire about weight gain and voiding
patterns, which can develop if fluid is retained. Patients who develop uremia
often describe having little appetite, nausea, and vomiting, which leads to
impaired nutrition and fluid/electrolyte issues.
Ask the patient what medications he or she is taking and if they are nephro-
toxic. Medications that can cause nephrotoxicity include aminoglycoside anti-
biotics, cephalosporins, sulfonamides, thiazide diuretics, and phenytoin.
Has the patient had recent tests where potentially nephrotoxic dye was
injected like a cardiac catheterization or renal arteriogram? Dyes used in these
tests are frequent causes of acute tubular necrosis (ATN) leading to kidney
failure.