RENAL CARE

PROF. LUCELLE M. LUMBRES, R.N 

 RENAL ASSESSMENT
GLOMERULAR FILTRATION RATE
• is a test used to check how well the kidneys are
working. 
• Lab Test: Crea, BUN & Creatinine clearance test
• NORMAL RESULT: 90 to 120 mL/min
• BELOW 60 mL/min:  is a sign of chronic kidney
disease
• LOWER THAN 15 mL/min: is a sign of kidney
failure 
 D I A LY S I S
B Y : P R O F. L U C E L L E L U M B R E S R . N M A N
 DIALYSIS
is a procedure to remove waste 
products and excess fluid from the 
blood when the kidneys stop working
properly. It often involves diverting blood to
a machine to be cleaned. ​

Normally, the kidneys filter the blood,
removing harmful waste products an
excess fluid and turning these into
urine to be passed out of the body. ​
​
 METABOLIC ACIDOSIS
Acid-base disorders, including metabolic acidosis, are
disturbances in the homeostasis of plasma acidity. Any
process that increases the serum hydrogen ion
concentration is a distinct acidosis.

Metabolic acidosis is characterized by an increase in the

hydrogen ion concentration in the systemic circulation
resulting in a serum HCO3 less than 24 mEq/L.
 ARTERIAL BLOOD GAS
An arterial blood gas (ABG) test measures NORMAL VALUES
ph 7.35-7.45
oxygen and carbon dioxide levels in your PO2 75 –
100mmHg
blood. It also measures your body’s acid- PCO2 35-45mmhg
base (pH) level
HCO3 22-26mEq/L

O2 SAT 94-100%
Interpret an ABG 
The first value a nurse should look at is the
pH to determine if the patient is in the
normal range, above, or below. If a
patient’s pH > 7.45, the patient is in
alkalosis. If the pH < 7.35, then the patient
is acidosis. 

Examine the PaCO2. This will determine if

the changes in the blood gas are due to the
respiratory system or metabolically driven. 
R-O-M-E
Respiratory Opposite -- In respiratory
disorders, the pH and CO2 arrows move in opposite
directions.
Metabolic Equal -- In metabolic disorders, the
PH and CO2 arrows will move in the same
direction.
ELECTROLYTES 
• High potassium (called “hyperkalemia”) is a medical
problem in which you have too much potassium in your
blood. Potassium helps your nerves and muscles, including
your heart, work the right way. But too much potassium in
your blood can be dangerous. It can cause serious heart
problems.
• Normal level: 3.5-5.5mmol/L. If the potassium level is
increased above 6.0 mmol/L patient requires medical
intervention.
INTOXICATIONS / INGESTIONS Normal Values: 
Toxic alcohols Creatinine
Male: 0.8–1.3
OVERLOAD mg/dL  
CHF – Congestive Heart Failure
Female: 0.6–1.1
UREMIA​ mg/dL  
is a buildup of toxins in your blood. It occurs when the kidneys
BUN (Blood
stop filtering toxins out through your urine. It  is a dangerous Urea Nitrogen)
condition that occurs when waste products associated with Male: 8 to 24
decreased kidney function build up in your blood. ​ mg/dL  
-is the condition of having high levels of urea in the blood. Urea
is one of the primary components of urine. It can be defined as Female: 6 to 21
an excess of amino acid and protein metabolism end products, mg/dL  
such as urea and creatinine.
 MAIN TYPES OF DIALYSIS

Hemodialysis

Peritoneal Dialysis
 Hemodialysis
• is the most common type of dialysis,
• Blood passes along the tube and into
an external machine that filters it,
before it's passed back into the arm
along another tube. 
• At dialysis center, this is usually
carried out 3 days a week, with each
session lasting around 4 hours. 
Preparing for Hemodialysis 
• Prior to undergoing hemodialysis, patients need first to
have a surgical procedure to prepare them for ongoing
treatment. 
• To allow for easy access to the bloodstream, a surgeon
will create a vascular access. The access provides a
mechanism for blood to be safely removed from
circulation, filtered, and then returned to the body. 
There are several types of accesses that can be created for dialysis. 

AV grafts Intrajugular Catheter

Arteriovenous (AV) Fistulas (IJ CATH)
CENTRAL VENOUS CATHETER INSERTION 
• Cap and Mask
• Sterile gloves
• Sterile gown
• Sterile field (procedure pack with gauze, cotton balls)
• Utz machine (With sterile ultrasound probe cover and
gel)
• Decontaminant (Chlorhexidine)
• Sterile drapes (Large drape to cover the entire patient)
• Central line kit (With needle, guidewire, dilator and
CVC) 
• Bungs (For each lumen of the CVC)
• 10mL syringes x 2 (For insertion and flushing lines)
• 5mL syringe (For local anaesthetic)
• Drawing up needle
• 0.9% sodium chloride (To flush lumens)
• Local anaesthetic (1% lidocaine)
• Suture kit (Suture material, scissors, forceps)
• Bin and sharps bin nearby
IDENTIFY A VEIN
•Internal Jugular Vein
Between the two heads of the sternocleidomastoid
muscle - ask the patient to turn their head.

•Subclavian Vein
Identify the junction of the medial third and lateral
two-thirds of the clavicle. 

•Femoral Vein
To identify the vein using ultrasound, place the probe
in the groin over the femoral triangle, below the
inguinal ligament. Look for a large-bore, non-
pulsating, collapsible vessel medial to the femoral
artery.
PERITONEAL
DIALYSIS
 Peritoneal Dialysis
• Peritoneal dialysis uses the inside lining of your abdomen
(the peritoneum) as the filter, rather than a machine. 
• Like the kidneys, the peritoneum contains thousands of
tiny blood vessels, making it a useful filtering device. 
• Before treatment starts, a cut (incision) is made near your
belly button and a thin tube called a catheter is inserted
through the incision and into the space inside your
abdomen (the peritoneal cavity). This is left in place
permanently.
 Peritoneal dialysis
uses the inside lining
of your abdomen
(the peritoneum) as
the filter, rather than
a machine. 
 Continuous Ambulatory Peritoneal Dialysis (CAPD)

• CAPD doesn’t use a machine. You do the exchanges

during the day by hand. 
• You can do exchanges by hand in any clean, well-lit
place. Each exchange takes about 30 to 40 minutes.
During an exchange, you can read, talk, watch
television, or sleep. With CAPD, you keep the solution
in your belly for 4 to 6 hours or more. The time that the
dialysis solution is in your belly is called the dwell time.
Usually, you change the solution at least four times a
day and sleep with solution in your belly at night. You
do not have to wake up at night to do an exchange. 
 Automated Peritoneal Dialysis 
• With automated peritoneal dialysis, a machine called a cycler fills and empties
your belly three to five times during the night. In the morning, you begin the day
with fresh solution in your belly.  
 HEMOPERFUSION

• is a method of filtering
the blood extracorporeally  to remove a toxin. As
with other extracorporeal methods, such
as hemodialysis (HD), the blood travels from the
patient into a machine, gets filtered, and then
travels back into the patient, typically
by central venous access.
THANK
YOU!!

P R O F. L U C E L L E
LUMBRES