Critical Care Nursing

Renal Outline: Introduction and Assessment

Critical Care Nursing, The University of Iowa
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I. Introduction and Assessment

The composition of the blood is determined not so much by what the mouth takes in, but by what the kidneys keep. Each kidney is smaller than a man's hand, yet in one day, they filter about 1700 liters of blood and combine its waste products into about 1 liter of urine. The kidneys filter dissolved particles from the blood and selectively reabsorb those that are needed to maintain the normal composition of the internal body fluids. Substances not needed for this purpose pass into the urine. In regulating volume and composition of body fluids, the kidneys perform both excretory and endocrine functions.

A. The History, Presence, and Nature of Renal Failure

(Assess baseline renal function and risk of developing ARF):

1. Chronic Renal Disease
2. Previous Radiation Therapy
3. UTI
4. Circulatory Diseases associated with low renal perfusion: aorta aneurysm, ASCVD, PVD, cardiac disease, hypertension
5. Use of nephrotoxic agents.
6. Recent allergic response
7. Metabolic diseases: Diabetes
8. Changes in urinary elimination pattern
9. Hemorrhage or trauma
10. Pulmonary Insufficiency
11. Hepatomegaly, jaundice, ascites
12. Radiologic procedures with contrast media.

B. Signs and Symptoms

1. General Appearance:

1. Anemia, pallor
2. Edema: lumbosacral, periorbital, extremities
3. Pruritis
4. Poor skin turgor
5. Dry mucous membranes
6. Pain: assess degree and location. Check for CVA tenderness

2. Cardiovascular

1. Pericarditis
2. Hypertension
3. Retinopathy

3. Respiratory

1. Pattern: Kussmaul, indicates acidosis
2. Urine odor to breath
3. Ausculatory changes: diminished, rales

4. Urinary: note elimination patterns; color, quality, and odor of urine

5. Gastrointestinal: Hiccups, anorexia, nausea, vomiting, coated tongue, patient complaint of ammonia taste.

6. CNS: Headache, lassiturde, confusion, disorientation, drowsiness, insomnia, muscle twitching, weakness.

C. Vital Signs

1. BP and Pulse, noting any orthostatic changes.
2. Skin color
3. LOC: may present a confusing picture when the extent of CNS damage is known and does not justify the extent of alteration in LOC
4. Urinary elimination pattern, volume, specific gravity, state of hydration
5. Weight

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Last Modified: January 22, 1997