Page 140 - Critical Care Notes

4223_Tab04_131-140 29/08/14 8:28 AM Page 134

GU
■ GFR rate
■ Kidney-ureters-bladder (KUB) x-ray, intravenous pyelogram (IVP), excretory
urography, nephrotomography
■ CT scan or MRI of kidneys
■ Renal angiography
Management
■ Monitor and correct fluid and electrolyte imbalances.
■ Assess and correct acid-base imbalances.
■ Assess respiratory status and monitor oxygenation. Administer O 2 as
indicated.
■ Institute cardiac monitor, and observe for arrhythmias.
■ Restrict fluid intake, and measure intake and output strictly. Assess for
edema.
■ Assess color and clarity of urine output. Check specific gravity.
+
+
■ Institute renal diet with adequate protein and low K , Na , and phosphorus.
Protein may be restricted if BUN and creatinine greatly elevated. Dietary
consult.
■ Treat anorexia, nausea, and vomiting.
■ Monitor daily weight.
■ Insert a large-bore central line.
■ Administer medications, including antihypertensives, calcium channel
blockers, beta blockers, and diuretics such as bumetanide (Bumex) and
furosemide (Lasix). Administer meds cautiously in patients with impaired
renal function.
■ Administer iron supplement or recombinant human erythropoietin
(Epogen).
■ Monitor hemoglobin and hematocrit levels for anemia and O 2 -carrying
capacity of hemoglobin. Administer blood products as needed.
■ Maintain meticulous skin care to prevent skin breakdown.
■ Ensure prevention of secondary infections.
■ Assess for gastrointestinal and cutaneous bleeding.
■ Assess neurological status for changes in LOC and confusion.
■ Administer dialysis (hemodialysis, peritoneal dialysis, or continuous renal
replacement therapy [CRRT]).
■ Provide patient and family support.

134