CCRN Review - Renal. CCRN Review - Renal 10/16/2014. CCRN Review Renal. Sodium Critical Value < 120 meq/l > 160 meq/l

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1 CCRN Review Renal Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Sodium Critical Value < 120 meq/l > 160 meq/l Sodium Etiology of Hypernatremia water intake hypertonic IV fluids/ tube feedings fluid losses osmotic diuresis (HHNC) diabetes insipidus 1

2 Sodium Etiology of Hyponatremia diuretic therapy diaphoresis GI losses hypotonic solutions SIADH Potassium meq/l Critical Values < 2.5 meq/l > 6.5 meq/l Potassium Etiology of Hyperkalemia intake trauma acidosis renal failure 2

3 Potassium Etiology of Hypokalemia intake intracellular shift GI loss urinary loss aldosterone excess Calcium mg/dl Ionized: Critical Value < 7.0 mg/dl > 14.0 mg/dl Calcium Etiology of Hypercalcemia bone release hyperparathyroidism acidosis - albumin excessive vitamin D renal excretion 3

4 Calcium Etiology of Hypocalcemia hypoparathyroidism chronic renal failure intestinal absorption binding alkalosis Magnesium meq/l Critical Value < 1.0 meq/l > 4.0 meq/l Magnesium Etiology of Hypermagnesemia intake / absorption parenteral administration excretion oliguric renal failure 4

5 Magnesium Etiology of Hypomagnesemia intake / absorption excretion alcoholism hyperaldosteronism hyperparathyroidism Phosphate meq/l Critical Value < 1.0 meq/l Phosphate Etiology of Hyperphosphatemia hypoparathyroidism renal failure acute acidosis cytotoxic drugs 5

6 Phosphate Etiology of Hypophosphatemia GI loss urinary loss intake alcoholism movement into cell Definition sudden decline in renal function increase in BUN & creatinine oliguria (<400 ml/24 hours) hyperkalemia & sodium retention Pathophysiology Prerenal hypovolemia shock hemorrhage burns cardiac dysfunction 6

7 Pathophysiology Intrarenal intrarenal ischemia toxins immunologic processes Pathophysiology Postrenal renal calculi urinary tract infection enlarged prostate trauma to plumbing Clinical Presentation Prerenal: decreased skin turgor, dryness of mucous membrane, weight loss, oliguria, hypotension, flat neck veins, tachycardia Intrarenal: usually edema Postrenal: often anuria 7

8 Diagnostics urinalysis: proteinuria, hematuria, casts rising serum BUN & creatinine renal ultrasonography Management preventive patients at risk adequate hydration avoid nephrotoxins prevent & treat shock monitor suspected patients avoid infection Management corrective & supportive correct reversible causes correct fluid excess or deficit monitor for electrolyte imbalance restore/maintain BP maintain nutrition assist with RRT 8

9 Complications infection dysrhythmias GI bleed multiple organ failure electrolyte abnormalities Definition progressive deterioration uremia & its complications dialysis, transplantation Etiology prolonged, severe hypertension diabetes mellitus glomerulopathies interstitial nephritis 9

10 Pathophysiology ESRD increased BP metabolic acidosis phosphate increases decreased erythropoietin Clinical Presentation GI: anorexia, N&V, GI bleed CV: ECG changes, hypertension, pericarditis Respiratory: pulmonary edema, pleural effusion, pleural rub Clinical Presentation Neuro: fatigue, sleep problems, headaches, lethargy, seizures, coma Metabolic: glucose intolerance, hyperlipidemia 10

11 Clinical Presentation Fluid & Lytes:acidosis, K, Na, Mg, PO 4, Ca Dermatologic: pallor, pruritus, uremic frost Hematologic: anemia, platelet dysfunction Diagnostics Anemia creatinine, BUN, phosphorus calcium, bicarbonate & proteins ph, pco 2, HCO 3 Management dietary regulation treat anemia treat acidosis detect & treat reversible causes 11

12 Management manage hyperkalemia dialysis reduce phosphate retention 12

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