Transcript Creatinine
THE RENAL SYSTEM AT A GLANCE Julie, Ashley, Christen, Candace, Jennifer, Sarah, & Cindy Objectives BUN • When is it used • Nursing implications • Normal values • Abnormal result Creatinine • When it is used • Nursing implications • Normal values • Abnormal result Creatinine Clearance • When it is used • Nursing implications normal values • Abnormal result Tests for BUN/Creatinine Renal Diseases/Illnesses Dialysis Methods Blood Urea Nitrogen • Measures the amount of urea nitrogen in the blood • Urea is formed in the liver as the end product of protein metabolism and digestion • Protein is broken down into amino acids during ingestion, once in the liver, these amino acids are catabolized and free ammonia is formed. • Ammonia molecules are combined to form urea, which is then transported by the blood to the kidneys for excretion. When is BUN Used? • Used to assess kidney function and liver function as well as glomerular filtration rate. • Levels reflect the balance between the production and excretion of urea. • It may also be used to determine if body fluids are urine or not. Nursing Implications • Explain procedure to the patient • Provide teaching regarding what the test will be measuring. • Inform the patient that no fasting is required with this test. • Monitor puncture site for bleeding Normal Values • Normal values for an adult under the age of 90 years old are 2.9-7.5 mmol/L • For patients over the age of 90, levels are 3.611.1 mmol/L BUN • Cardiac Patients – Reduced Renal Perfusion – Intravascular Fluid Volume Deficit • Increase as GFR decreases – ARF – CRF – Dehydration • Altered Protein intake • Protein Catabolism Creatinine • End product of creatine metabolism. • Creatine is an energy-requiring metabolite of the skeletal muscle. • Creatine is converted to creatinine during metabolism where it is filtered through the kidney’s and excreted. • Only a small amount of creatine is converted to creatinine, this level remains stable except when there is damage to skeletal muscle. • The measuring of creatinine is an indicator of renal function Indications • Before administration of nephrotoxix medications, to assess renal function • Check glomerular function • Monitor effectiveness of renal treatment • Check accuracy of 24 hour urine collection • Assess level of nephron damage Normal Values Age SI Units Adult male 124-230 umol/kg/24hr Adult female 97-177 umol/kg/24hr Nursing Implications • Inform patient the test if used to assess renal function • Obtain a detailed history, including medications • Discuss procedure with patient • Instruct patient as to proper procedure for urine collection. • Discuss with patient the process of a 24 hour urine collection. Factors effecting levels • • • • • • • Creatinine Extremes of age and body size Severe malnutrition or obesity Disease of skeletal muscle Paraplegia or quadriplegia Vegetarian diet Rapidly changing kidney function Pregnancy Creatinine • Increased In: – Nephritis – Chronic Renal Disease • Decreased In: – Muscular Atrophy – Anemia – Advanced Degeneration of the Kidneys Creatinine Clearance • Diagnostic test of renal function • Compares the amount of creatinine in a blood sample and urine sample to determine rate the kidneys are clearing creatinine from the blood • Measure of glomerular filtration rate Indications • Determine extent of nephron damage in known renal disease • Before administering nephrotoxic drugs • Accuracy of 24-hr urine collection • Assess glomerular function • Effectiveness renal disease treatment Normal Values • Adult male 85-125mL/min/1.73 m • Adult female 75-115mL/min/1.73 m • Each decade after 40 y decrease of 6-7 mL/min/m (conventional units x 0.0167) abnormal result • Degree of impairment: – Borderline: 62.5-80 mL/min/m – Slight: 52-62.5 mL/min/m – Mild: 42-52 mL/min/m – Moderate: 28-42 mL/min/m 2 – Marked: Less than 28 mL/min/m Nursing Implications • Inform patient of test • Obtain pt. genitourinary history & results of related tests/procedures • Obtain list of medications pt. taking • Review procedure • Inform pt. urine timeframe of urine collection & to void all urine in collection device • Sensitivity to social & cultural issues Creatinine Clearance • Decreased In: – Kidney Diseases • Acute Renal Failure • Chronic Renal Failure • Increased In: – – – – – Diabetes Renal Artery Obstruction Renal Vein Thrombosis Glomularulonephritis Nephritis Tests For... Creatinine • Blood/serum: – Serum (about 1mL) collected in a red or tiger- top tube. Or – Plasma collected in greentop (heparin) tube is also acceptable • Urine: – Urine (5mL) collected from an unpreserved random or timed specimen – needs to be collected in a clean plastic collection container BUN • Blood/serum: – Serum (about 1mL) collected in a red or tiger- top tube. Or – Plasma collected in green- top (heparin) tube is also acceptable How to Test... Blood Urine Random Specimen Clean Catch • Female client procedure • Male client procedure Timed • Obtain a 3L urine specimen container, toilet-mounted collection device and a plastic bag for transporting the specimen container Dialysis • When your kidney’s cannot adequately remove waste from your body dialysis may be implemented • Pts can survive on dialysis for years • The only way to stop dialysis (and still survive) is to have a kidney transplant Why Have Dialysis? Because it treats: • Renal Failure • Edema • Hepatic coma • Hyperkalemia • Hypercalcemia • Hypertension • Uremia • Fluid overload • Pulmonary edema • Acidosis • Pericarditis • Severe confusion There are 2 Types of Dialysis Hemodialysis Periotoneal Dialysis Hemodialysis • Hemodialysis works to – remove toxins (N) & excess water from the blood stream – maintain and restore the electrolyte balance & acid-base buffer system (done in the dialyzer) – have ‘clean’ or filtered blood re enter the body as it would when leaving the kidney Dialyzer The blood filtering device • Filtration through: • Diffusion – how the toxins are removed • Osmosis – takes away extra water • Ultrafiltration – takes away extra water Complications • Artheriosclerotic cardiovascular disease • Hypertriglyceridema • Amemia • Fatigue • Gastric ulcer • Fluid overload • Exsangulation • Hypotension • Muscle cramping • Air emboli • Dysrythmia • Chest pain • Cerebral fluid shifts Peritoneal Dialysis • Peritoneal dialysis is implemented to... – Remove the toxic fluids – Remove metabolic wastes – Re-establish normal fluid and electrolyte balance. Who needs treatment? Who should not receive this treatment? How to patients receive this treatment? How does this effect a patient receiving this treatment? Complications • • • • • • • Peritonitis Leakage Bleeding Hypertriglyceridemia Abdominal hernias Clot Formation Constipation References • Day, R.A., Paul, P., Williams, B., Smeltzer, S.C. & Bare, B. (2006). Textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams and Wilkins. • McCance, K.L. & Huether, S.E (2006). Pathophysiology: The biological basis for disease in adults and children. St. Louis, MO: Elsevier Mosby. • Myers, T. (Ed.). (2006). Mosby’s dictionary of medicine, nursing and health professions (7th ed.). St. Louis, MO: Mosby Elsevier. • Pagana, K.D. & Pagana, T.J. (2010). Mosby’s manual of diagnostic and laboratory tests (4th ed.) St. Louis, MO: Mosby’s Elsevier Inc. • Van Leeuwen, A.M, Kranpitz, T.R and Smith, L. (2006). Davis’s comprehensive handbook of laboratory and diagnostic tests with nursing implications (2nd ed.). Philadelphia, PA: F.A Davis Company.