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Differentiating Low Urine Output

Differentiating Low Urine Output. Test Yourself on Renal Nursing. Which of the following conditions is a common cause of prerenal ARF? Atherosclerosis Decreased cardiac output Benign prostatic hyperplasia Rhabdomyolysis.

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Differentiating Low Urine Output

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  1. Differentiating Low Urine Output

  2. Test Yourself on Renal Nursing • Which of the following conditions is a common cause of prerenal ARF? • Atherosclerosis • Decreased cardiac output • Benign prostatic hyperplasia • Rhabdomyolysis

  3. 2. A patient is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following should you do? • Take vital signs every 8 hours • Weigh the patient every other day • Assess urine output every shift • Monitor the patient’s electrolyte levels.

  4. 3. Serum creatinine levels provide the most accurate picture of renal function because: • Serum creatinine is rapidly absorbed by the renal tubules • A slow urine flow through the kidneys increases creatinine levels • Elevated serum creatinine levels indicate a decrease in glomerular function • Serum creatinine levels are related to the rate of urine flow through the kidneys

  5. 4. Which of the following causes the nausea associated with renal failure? • Oliguria • Gastric ulcers • Electrolyte imbalance • Accumulation of metabolic wastes

  6. 5. Which of the following patients is at greatest risk for developing acute renal failure? • A dialysis patient who gets influenza • A teenager who has an appendectomy • A pregnant woman who has a fractured femur • A patient with diabetes who has a heart catheterization

  7. So what’s the big deal about low urine output?

  8. Glomerular Filtration Rate (GFR)

  9. This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

  10. So What’s the Problem?Top Three Questions • Are they dry? 60-70% 2. Are they obstructed? 5-10% 3. Is it the kidneys? 30%

  11. What is it about BUN and Creatinine? BUN • state of renal perfusion Creatinine • actual tubular function Creatinine Clearance • direct indicator of GFR

  12. Jugular Vein Distention

  13. Nursing Management Goal: Get the blood flowing to the kidneys again! • Patient safety • IVF • Diuretics (furosemide, mannitol) • Put in a foley • I&O • Daily weight • Keep MAP >60 • Monitor the labs • Anticipate CRRT or dialysis

  14. Hemodialysis AV Shunt Do’s & Don’ts • Never take a blood pressure in the arm with the AV shunt. Use the opposite arm. • Do not draw blood or insert needles of any kind in the arm with the AV Shunt. Use the opposite arm. • If you touch one of the veins near the wrist, you will feel a rhythmic pulsation called a “thrill”. This normal. • Protect the arm from injury. Any banging, crushing or minor cuts can become very serious especially if bleeding occurs. • Any bleeding from the arm with the AV shunt is an arterial bleed! If bleeding occurs or if one of the veins is ruptured under the skin from trauma, apply direct pressure to the site immediately.

  15. So…what’s the big deal about low urine output?

  16. Case Study - E.B. 160 ml. • Abnormalities and causes • ARF category • Next action • Oliguria and anuria • Explanation for increase in BUN and creatinine • Nursing interventions and priorities in ARF • “Am I going to die?”

  17. Case Study - F.F. • Priorities • Hydronephrosis • ARF category • Relationship between creatinine and GFR

  18. Case Study - F.F. Staghorn stone in the renal pelvis

  19. Case Study - C.W. • Signs and symptoms • Elevated K+ • Elevated BUN and creatinine • ARF category • Monitor fluid status • 6 assessments of fluid balance

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