Info

meals tid

(Basajel, Amphojel)

phosphorus

Other Therapy: Sodium polystyrene sulfonate (Kayexelate) can be administered orally or rectally to reduce potassium. Sodium bicarbonate may be ordered to correct metabolic acidosis. If the patient is receiving hemodialysis, supplements of water-soluble vitamins are needed because they are removed during dialysis. Other medications include antihypertensives to control blood pressure, antibiotics to manage secondary infections, diphenhydramine (Benadryl) to manage itching, and recombinant human erythropoietin to increase red blood cell production.

Independent

Rest and recovery are important nursing goals. By limiting an increased metabolic rate, the nurse limits tissue breakdown and decreases nitrogenous waste production. A quiet, well-organized environment at a temperature comfortable for the patient ensures rest and recovery. To help the patient deal with fluid restrictions, use creative strategies to increase the patient's comfort and compliance. Give medications with meals or in minimal IV volumes to maximize the amount of fluid available for patient use.

Several factors place the patient with ARF at risk for impaired skin integrity. Uremia results in itching and dryness of the skin. If the patient experiences pruritus, help the patient clip the fingernails short and keep the nail tips smooth. Use skin emollients liberally, avoid harsh soaps, and bathe the patient only when necessary. Frequent turning and range-of-motion exercises assist in preventing skin breakdown. If the patient is taking medications that cause frequent stools, clean the perineum and buttocks frequently to maintain skin integrity.

Note that one of the most common sources of postrenal ARF is an obstructed urinary catheter drainage system. Before contacting the physician about a decreasing urinary output in an acutely or critically ill patient, make sure that the catheter is patent. If institutional policy permits, irrigate the Foley catheter using sterile technique with 30 mL of normal saline to check for obstruction. Note any kinks in the collecting system. If institutional policy permits, replace the indwelling Foley catheter with a new catheter and urinary drainage system to ensure it is functioning adequately. Signs that postrenal ARF is caused by obstruction in the urinary catheter include a sudden cessation of urinary output in a patient whose urinary output has previously been high or average and a urinary output with normal specific gravity and normal urinary sodium.

The patient with ARF is often irritable and confused. Recognize that the irritability is part of the disease process. Keep the environment free of unnecessary clutter to reduce the chance of falls. If the patient is on bedrest, maintain the bed in the low position and keep the side rails up. Keep the patient's call light within easy reach and the patient's belongings on a bedside table close to the bed. The patient with ARF is anxious, not only because of the ambiguity of the prognosis but also because he or she may be in an acute care environment for treatment. Provide the patient with ongoing, repeated information about what is happening and why. Ongoing reassurance for both the patient and the significant others is essential.

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