Page 398 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 383

Predialysis nursing care is similar to that for HD external access sites. During
dialysis, the nurse is responsible for:
Monitoring the patient’s vital signs and cardiac rhythm.
Checking for hypothermia from blood removal from the body.

Evaluating hemodynamic and perfusion status via a pulmonary artery cath-
eter with readings including central venous pressure, pulmonary artery pres-
sure, and pulmonary artery occlusion pressure.

Monitoring fluid volume status and laboratory values to confirm this.
Administering anticoagulants (heparin) if needed to prevent clotting of the
hemofilter.
Assessing for signs of bleeding or clotting.
Checking the system for patency, alarms, flow rates.

Calculating hourly intake and outputs with replacement solutions as indi-
cated by the type of CRRT.

Looking for indications of infection at the access site; dialysate should be
clear and not cloudy.

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the hemofilter; this should be preceded by an alarm as bacterial invasion can
contaminate the patient’s blood.

Calculating weight gain or loss from pre- and post-dialysis weights.

Acute and Chronic Renal Failure

Acute Renal Failure

What Went Wrong?
5 Acute renal failure (ARF) is the sudden, reversible loss of partial kidney
function. ARF has three types: prerenal, intrarenal, and postrenal failure
(see Table 8–7). Prerenal failure involves a decreased blood supply or perfusion
to the kidney. The most common causes are decreased cardiac output, dehydra-
tion, renal artery stenosis, and shock. All of these have in common that blood
supply is not getting to the kidney, which stimulates the RAAS to conserve
sodium and water. This leads to an increased intravascular volume, which
increases the BP and decreases urinary output.
Intrarenal failure is caused when something injures the kidney tubules or
nephrons directly. The most common cause of intrarenal failure is acute tubular