Renal Failure 79

BUY THE CHEAPEST DRUGS ONLINE FROM: DrugstoreOnlineShop.com Nephrologic Disorders Renal Failure 1. Admit to: 2. Diagnosis: Renal Failure 3. Condition: 4. Vital signs: q8h. Call physician if QRS complex >0.14 sec; urine output <20 cc/hr; BP >160/90, <90/60; P >120, <50; R>25, <10; T >38.5 C 5. Allergies: Avoid magnesium containing antacids, salt substitutes, NSAIDS, and other nephrotoxins. Discontinue phosphate or potassium supplements unless depleted. 6. Activity: Bed rest. 7. Nursing: Daily weights, inputs and outputs, chart urine output. If no urine output for 4h, inputs and outputs catheterize. Guaiac stools. 8. Diet: Renal diet of high biologic value protein of 0.6-0.8 g/kg, sodium 2 g, potassium 1 mEq/kg, and at least 35 kcal/kg of nonprotein calories. In oliguric patients, daily fluid intake should be restricted to less than 1 L after volume has been normalized. 9. IV Fluids: D5W at TKO. 10. Special Medications: -Consider fluid challenge (to rule out pre-renal azotemia if not fluid overloaded) with 500-1000 mL NS IV over 30 min. In acute renal failure, inputs and outputs catheterize and check postvoid residual to rule out obstruction. -Furosemide (Lasix) 80-320 mg IV bolus over 10-60 min, double the dose if no response after 2 hours to total max 1000 mg/24h, or furosemide 1000 mg in 250 mL D5W at 20-40 mg/hr continuous IV infusion OR -Torsemide (Demadex) 20-40 mg IV bolus over 5-10 min, double the dose up to max 200 mg/day. -Bumetanide (Bumex) 1-2 mg IV bolus over 1-20 min; double the dose if no response in 1-2 h to total max 10 mg/day. -Metolazone (Zaroxolyn) 5-10 mg PO (max 20 mg/24h) 30 min before a loop diuretic. -Dopamine (Intropin) 1-3 mcg/kg per minute IV. -Hyperkalemia is treated with sodium polystyrene sulfonate (Kayexalate), 15- 30 g PO/NG/PR q4-6h. -Hyperphosphatemia is controlled with calcium acetate (Phoslo), 2-3 tabs with meals. -Metabolic acidosis is treated with sodium bicarbonate to maintain the serum pH >7.2 and the bicarbonate level >20 mEq/L. 1-2 amps (50-100 mEq) IV push, followed by infusion of 2-3 amps in 1000 mL of D5W at 150 mL/hr. -Adjust all medications to creatinine clearance, and remove potassium phosphate and magnesium from IV. Avoid NSAIDs and nephrotoxic drugs. 11. Extras: CXR, ECG, renal ultrasound, nephrology and dietetics consults.