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Chapter 75: Interventions for Clients with Acute and Chronic Renal
Failure
Suggested Responses
1. For what type(s) of acute renal failure is she at risk? Why?
She is most at risk for prerenal renal failure (ATN) as a result of prolonged hypovolemia.
She was exercising heavily for an hour in the heat, which probably caused her to be
dehydrated. Her injuries caused some external bleeding and could very well have caused
internal bleeding, both of which increase the degree of hypovolemia. If her injuries also
resulted in muscle damage she could be at risk for intrarenal renal failure from precipitation
of myoglobin in the kidney tubules. She may have sustained some direct damage to her left
kidney as a result of trauma.
2. Do any of her usual drugs increase her risk for ARF? Which one(s) and why?
The drug that increases her risk for ARF is the ibuprofen. This nonsteroidal anti-
inflammatory agent inhibits the synthesis of prostaglandins. The result of this
inhibition is reduced renal blood flow. In addition, the ibuprofen frequently causes a chronic
interstitial nephritis. The decreased blood flow makes any renal hypoperfusion worse, as
does the interstitial nephritis.
Suggested Responses
1. What other assessment data should you obtain?
Take her blood pressure and other vital signs, especially heart rate. If possible, obtain an
ECG strip. Listen to her lungs. Do a "spot" check of her blood glucose level. Weigh her. Ask
her to show you her prescription bottles or name the drugs she is taking. Ask her when she
last took her antidiabetic drug. Assess her for the presence of pitting or nonpitting edema.
Ask her how much fluid and what types of fluid she usually drinks in a typical day. If she
urinates, measure the volume and examine the urine for color, specific gravity, and the
presence of blood or protein.
2. What risk factors for the development of CRF are noted in her past medical history?
Provide a rationale for your choices.
Suggested Responses
1. What instructions should you provide regarding the dietary and fluid needs for this
client?
This client will have to follow significant fluid, protein, sodium and potassium restrictions
on the days between dialysis. Fluid limits are usually placed at whatever her output for a
given day is plus an additional 500 to 700 mL. She will need between 1.0 and 1.5 g/kg body
weight of protein each day. For example, a woman who weighs 150 pounds should have
between 70 and 100 g of protein daily (280 to 400 calories of protein). Sodium is restricted
to 2 to 4 g/day and potassium is restricted to 70 mEq/day. (See Chapter 14 for charts
showing sodium and potassium content of various foods.) Often the client is permitted to
have foods rich in sodium or potassium during the first 1 hour of dialysis.
2. How will you explain to the client and her family that HD, rather than transplantation,
is the best choice of renal replacement therapy for her?
Renal transplantation is governed by availability of transplantable kidneys and meeting
specific criteria for being a recipient. In addition, there is a lengthy waiting list for
transplantation. Even if this client qualified for a renal transplant, she would need regularly
scheduled dialysis for months to years. It is unlikely that this client would qualify as a renal
transplant recipient in any state. First, she has two major chronic diseases that in themselves