Renal Failure: Chronic (CRF)

Renal Failure: Chronic (CRF)

Definition: Gradual and progressive loss of ability of kidneys to excrete wastes, concentrate urine, and conserve electrolytes. In contrast, acute renal failure occurs suddenly. Incidence: Affects >2 out of 1000 people in the U.S. annually. Onset: Gradual, over many years. Etiology: Diabetes and HTN are primary causes of CRF, accounting for 40% and 25%, respectively, of all cases. Other causes include trauma, autoimmune disorders, birth defects, drug OD, and genetic diseases. Clinical Findings: Edema throughout the body, shortness of breath, fatigue, flank pain, oliguria (progressing to anuria), elevated BP, and pale skin. Nursing Focus ■ Never measure BP or perform venipuncture on an arm with a dialysis shunt. ■ Help minimize discomfort from frustrations with fluid restrictions by offering ice chips, frozen lemon swabs, diversional activities, and hard candies. ■ Provide routine skin care; uremia causes itching and dryness of skin. ■ Monitor BUN and serum creatinine levels. ■ Monitor strict fluid intake and output; fluids are typically restricted to an amount equal to previous day’s urine output plus 500–600 mL. ■ Perform frequent turning and ROM exercises to minimize skin breakdown. Patient Teaching ■ Provide Pt and family with literature on CRF and/or dialysis. ■ Restrict sodium, water, potassium, phosphate, and protein intake as ordered. ■ Encourage compliance with secondary preventive measures. ■ Explain actions, dosages, side effects, and adverse reactions of meds.