Page 402 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 387

Monitor the patient’s heart and lung sounds for signs of failure like S3, peri-
cardial friction rub, and crackles
Assess the patient’s SaO and/or ABGs to determine if pulmonary edema is a
2
result of retained fluid.
Monitor the urinary output to keep it above 30 cc/hr and 400 mL/day, which
is the minimal amount of renal output required to prevent ARF.
Perform neurological checks looking for signs of uremic toxicity signified by changes
in the level of consciousness, tremors, numbness, and tingling and can lead to coma.
Check the patient’s ECG for rhythm changes due to metabolic acidosis and
signs of hyperkalemia (see section on hyperkalemia).
Maintain daily weights, which is the most critical indicator of fluid status.
Maintain intake and output hourly to detect fluid deficit or overload.
Monitor the patient’s electrolyte status with close attention to sodium, potas-
sium, chloride, and magnesium levels, which will change with phases of ARF.
Closely observe patients who require PEEP during mechanical ventilation.
Evidence-based research shows that decreased venous return leads to low CO,
which can cause prerenal failure in patients with normal renal functioning.
Prepare to insert a pulmonary artery catheter to measure the heart’s ability to Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
handle preload and afterload.
Observe strict aseptic techniques as the patient is at high risk for infection.
Prepare to insert an indwelling urinary catheter for strict measurement of output.
Administer diuretics to decrease hypertension and excrete excess fluid.
Monitor Hgb and Hct and prepare to administer Procrit or red blood cells
according to protocols to increase oxygenation.
Institute safety measures to prevent injury or falls due to uremic changes in
brain functioning.
Teach and maintain renal diets, which include low-potassium, low-sodium, high-
calorie, and low-protein foods to prevent azotemia, hyperkalemia, and fluid overload.
Prepare the patient and significant other for dialysis or CRRT if the patient
fails to recover.

NURSING ALERT

Recent evidence-based research shows that the use of low-dose dopamine does not
prevent/treat renal dysfunction. It may cause more harm by worsening splanchnic
oxygen need, decreasing GI motility, increasing tachyarrhythmias, and decreasing

pulmonary response to hypercarbia. Dopamine is beneficial for inotropic and vaso-
active effects in heart failure and septic shock.