Lab Values: Renal Dysfunction 

There is a broad range of dysfunction which can occur with the kidneys. Renal insufficiency is frequently seen in the elderly and in those with hypertension and is evidenced by a glomerular filtration rate (GFR) of < 30%. Renal failure can be acute, chronic, or end stage. End-stage is a GFR of < 15% and dialysis is required to live. There are numerous causes of chronic renal failure including diabetes and hypertension. While these conditions cause renal failure, renal failure also leads to diabetes because of the insulin resistance that develops, and it also leads to hypertension. 

Renal insufficiency

In renal insufficiency, the kidneys lose the ability to hold onto sodium and water. Thus, urine output is increased. ACE inhibitors or angiotensin receptor blockers will be started to preserve renal function. If the GFR falls, these drugs will be stopped due to associated hyperkalemia in the presence of renal dysfunction. The urine will...

Dermatology is a challenging field because of all the different types of lesions and conditions which may develop. Often, a biopsy is needed for a definitive diagnosis. Repeated sun exposure is a risk factor for actinic keratosis and basal and squamous cell cancer.

Nevi

One of the most common growths which can be present at birth or develop over the lifetime. They can become dysplastic and have atypical features and growth pattern between the spectrum of a benign mole to melanoma but not be cancerous. Dysplastic moles can be removed with laser.

Seborrheic keratosis

Benign skin growth that originates in the keratinocytes. They tend to be darker in color and occur later in life and may be mistaken for cancerous lesions. Treatment is local incision.

Actinic keratosis

Precancerous lesions which present as a yellow or brown scale, primarily on sun exposed area and increase with aging. They are surgically removed or may be treated by freezing the area. 

Basal cell

Type of cancer...

We often see anion gap reported on patient charts. The gap defines the type and cause of acidosis. Normal is 8-16 mEq/L. The formula is Na+ + K+ - (Cl- + HCO3-) and luckily the computer generates the reading for us!

Only in select clinical situations, does the reading have significance from a nursing perspective. We will discuss two of the most common in this “Pearls of Knowledge”, utilizing our Memory Hint.

#1 When to give sodium bicarbonate based on the anion gap.

#2 The implication the anion gap has in a patient in diabetic ketoacidosis and insulin administration.

Anion gap and sodium bicarbonate

When a patient presents in metabolic acidosis, nurses are anticipating the administration of sodium bicarbonate. However, this may or may not be appropriate. When the anion gap is normal, sodium bicarbonate is the appropriate treatment. When the anion gap is high, the underlying condition needs to be treated, such as insulin administration in diabetic ketoacidosis.

Look at...

You are invited to check out a quick review of Breath Sounds to incorporate in the assessments you make as a professional.

Crackles

• Heard on inspiration and indicate fluid, atelectasis, or pneumonia
• In left sided heart failure and pulmonary edema, crackles will be persistent
• When heard in post-operative conditions and pulmonary or fat emboli, they are most often due to atelectasis and will clear with cough and deep breathing exercises
• Will be heard in bacterial pneumonia, along with bronchial (loud) breath sounds, but are often absent in viral pneumonia

Rhonchi

• Primarily heard on expiration and indicates movement of air through mucus
• Will be heard when the patient needs to be suctioned and should clear when suctioning is successful

Wheezing

• Indicates air movement through narrowed airways or a blockage in the vocal cords
• Expiratory wheezing indicates a mild obstruction
• Inspiratory wheezing is heard in chronic asthma
• Inspiratory and expiratory wheezing is heard in acute asthma...

Check out the simplest ABG interpretation ever!

There is a lot of information available about ABG analysis. It is all important, but as a nurse at the bedside, you may be looking for a “quick and dirty” way to get to the interpretation. As I have presented this method in numerous seminars throughout the years, I frequently hear…”where have you been all my career? I have always struggled with interpretation…and this makes sense!”

Your memory hint for ABG interpretation is “If the pH and Bicarbonate are Both in the same direction, it is a metabolic disturbance”. This is similar to “R-O-M-E” which you may have learned in nursing school. But, as a practicing nurse, you may have learned it a long time ago.

As you click on the image below, check out the three examples using this method. Note the way the arrows are going with the pH and HCO₃ to lead you to the correct interpretation. Patient example #3 is a septic patient....