Which aspect of a patients renal function is most important for the nurse to assess?
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What is Kidney Failure?Kidney failure does not happen overnight. In the early stages of kidney disease, there are few, if any, symptoms. Symptoms usually show up late in the process. Kidney failure is the end result of a typically gradual loss of kidney function. The most common causes of kidney failure are diabetes and high blood pressure. Kidney failure happens when:
As your kidneys failed, the level of creatinine in your blood rose. The amount of creatinine in your blood is a factor used in calculating your GFR (glomerular filtration rate, a measure of kidney function). As creatinine goes up, GFR goes down. In kidney failure some of you may have nausea, vomiting, a loss of appetite, weakness, increasing tiredness, itching, muscle cramps (especially in the legs) and anemia (a low blood count). With treatment for kidney failure, these symptoms will improve and you will begin to feel much better. There is no cure for kidney failure, but with treatment it is possible to live a long, fulfilling life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love. Treatments for Kidney FailureThe two treatments for kidney failure are kidney transplantation and dialysis. Two different types of dialysis can be done - hemodialysis and peritoneal dialysis.
To learn more about each type of treatment, see "Choosing a Treatment for Kidney Failure" in the A-to-Z Guide. Choosing DialysisThere are advantages and disadvantages to each type of dialysis treatment. (If you think one type of dialysis may be better for you than the type you are now on, it may be possible to change.) You don't have to feel "locked in" to any one type of dialysis. You should start by knowing the advantages and disadvantages for each one, and speak to your healthcare professional. The charts below will help you to compare some of the pros and cons of the different types of dialysis. Peritoneal Dialysis
Home Hemodialysis
In-Center Hemodialysis
Self-ManagementGood self-management will help you to live a longer, more active life and continue to do the things you love. It will also help you to preserve the remaining kidney function you have left. Even after kidneys fail, you will still have some remaining kidney function left. It is important to keep as much of this as you can. This will help improve your health and enable you to live longer and better. Good self-management starts with:
Getting Enough DialysisIt is important that you get enough dialysis. Studies have shown that getting the right amount of dialysis improves your overall health, makes you feel better, keeps you out of the hospital, and enables you to live longer. Your healthcare professional will give you a "dialysis prescription" to make sure you get the right amount of treatment. It depends on:
Your dialysis care team will monitor your treatment with monthly lab tests to measure the amount of dialysis you receive. This is called your "delivered dose of dialysis." The number that tells your delivered dose of dialysis is your Kt/V (pronounced "kay tee over vee"). The goal for your Kt/V number may vary depending on how often you have dialysis and on how much remaining kidney function you have left. For many hemodialysis patients who have three treatments weekly, Kt/V should be at least 1.2 for each treatment. For people receiving peritoneal dialysis, it should not be less than 1.7 per week. Other methods are sometimes used to measure delivered dose of dialysis. For example, some dialysis centers may use the urea reduction ratio (URR). If this ratio is used to measure your delivered dose of dialysis, your URR should be at least 65 percent for each treatment. Caring for Your AccessAnother part of good self-management is caring for your fistula, graft, or catheter. To protect and care for your hemodialysis fistula or graft:
To protect and care for your hemodialysis catheter, you should:
To protect and care for your peritoneal catheter, you should:
Managing Other Health ProblemsChronic kidney disease can cause other problems throughout your body including:
Kidney disease does not happen overnight. You may have been experiencing some of these problems for many years before your kidneys failed. Your healthcare professional will work with you to develop a treatment plan to help you manage these problems and keep them from getting worse. Treatment usually includes diet, exercise, and medications. It is very important that you follow your treatment plan because it can greatly improve your quality of life and how long you live. It can also help to protect the remaining kidney function you have left. To learn more about the treatments for the problems listed above, see the A-to-Z guide. Tools to HelpTo Learn MoreYou can learn more about kidney failure in the A-to-Z guide:
What is the most important indicator of kidney function?Glomerular filtration rate is the best overall indicator of kidney function. It is superior to the serum creatinine level, which varies with age, sex, and race and often does not reflect kidney function accurately.
What is the most accurate assessment of kidney function?The GFR is considered the best overall measure of the kidney's ability to carry out these various functions, and therefore estimation of the GFR is used clinically to assess the degree of kidney impairment and to follow the course of the disease.
What should you assess for a patient with renal failure?Pulse oximetry, blood pressure, pulse, respirations and temperature should all be assessed and recorded. Ask if the patient has been diagnosed with renal failure.
Why is it important to measure renal function?Importance of renal function tests
Renal function tests are important for: Early detection of renal disease. Calibrating dosage of several drugs which are excreted or metabolized in the kidneys. Indicating the appropriate time for the start of dialysis.
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