Page 406 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 391

Nursing Interventions
The care of the patient in CRF is very similar to that of the patient with ARF
with the following additions:
Monitoring vital signs, especially temperature and BP, for infection and
hypertension.
Assess for signs and symptoms of worsening uremia to prevent complications
like confusion, pericarditis, hyperkalemia, and bone changes.

Limit fluid volume intake to decrease amount of fluid removed by diuretics or
dialysis. Usual amount is calculated to be 500 to 600 mL from previous 24-hour
urine output.
Calculate the amount of fluid the patient is receiving including orally and
through medications and irrigations as considerable amounts may add to fluid
intake from these sources.
Administer antihypertensive medications to lessen the workload of the heart
and prevent heart failure.

Monitoring for sodium and water retention by checking laboratory values to
reduce the edema. 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.

Observe the patient for twitching, headache, change in the level of conscious-
ness, or seizure activity, which can be caused by neurologic changes due to uremia.

Administer vitamin D and calcium to prevent renal osteodystrophy (removal of
calcium from the bone, causing them to become brittle and break) and lower
phosphate levels.

Observe for pericarditis, which can lead to pericardial tamponade caused by
uremic wastes and inadequate dialysis.

Assess the potassium level for hyperkalemia, which can elevate in the blood
when the kidneys cannot excrete it.
Check the Hct (less than 30%) and Hgb (less than 12 g/dL) levels to observe for
anemia secondary to the absence of erythropoietin usually formed in the kidney.
Administer synthetic erythropoietin after dialysis to increase formation of red
blood cells and prevent anemia.
Monitor for range of motion (ROM) and functional abilities as low serum cal-
cium and high phosphate levels cause removal and weakness of bone structure.
Check all medications for magnesium-containing compounds. Patients with
chronic renal failure cannot excrete magnesium. Giving magnesium-containing
compounds like antacids can lead to magnesium toxicity.