Ineffective Renal Tissue Perfusion

Definition: Decrease in oxygen resulting in the failure to nourish the tissues at the capillary
level
Ineffective Renal Tissue Perfusion Related to Decreased Renal Blood Flow
Defining Characteristics
Anuria or oliguria
Decreased urinary creatinine clearance
Increased serum creatinine
Increased blood urea nitrogen (BUN)
Electrolyte abnormalities: potassium, sodium
Increased MAP, pulmonary artery occlusion pressure (PAOP), pulmonary artery
diastolic (PAD) pressure, central venous pressure (CVP) secondary to fluid overload
Sinus tachycardia
Metabolic acidosis
Crackles on lung auscultation
Engorged neck veins
Fluid weight gain
Pitting edema
Mental status changes
Anemia
1626
Outcome Criteria
CO is >4.0 L /min.
CI is >2.2 L /min/m2.
MAP, PAOP, PAD, and CVP are within normal limits for patient.
Electrolytes are within normal range.
Serum creatinine and BUN are within normal range.
Normal acid-base balance.
Level of consciousness is normal.
Lungs are clear on auscultation.
Urinary output is within normal limits, or patient is stable on dialysis.
Hemoglobin and hematocrit values are stable.
Nursing Interventions and Rationale
1. Monitor intake and output, urine output, and patient weight.
2. Collaborate with physician regarding the administration of crystalloids, colloids, blood, gand blood
products to increase circulating volume and maintain MAP >70 mm Hg.
3. Collaborate with physician regarding the administration of inotropes to enhance myocardial
contractility and increase CI to >2.5 L /min.
4. Collaborate with physician regarding the administration of diuretics to the oliguric patient to flush
out cellular debris and increase urine output.
5. Minimize the patient's exposure to nephrotoxic drugs to decrease damage to kidneys.
6. Monitor blood levels of drugs cleared by kidneys to avoid accumulation.
7. Monitor patient for signs of electrolyte imbalance due to impaired electrolyte regulation.
8. Maintain surveillance for signs and symptoms of fluid overload.
9. Monitor patient's clinical status and response to dialysis therapy to ensure the patient is receiving
safe and effective dialytic therapy.


Definition : at risk for a decrease in blood circulation to the kidney that many compromise health