3. Introduction of the Disease Acute renal failure (ARF) refers to the abrupt lost of kidney function. Over a period of hours to a few days, the GFR drops. This rapid breakdown occurs when high levels of uremic toxins accumulate in the blood due to inability of the kidney to excrete metabolic wastes thru the urine. Types: Oliguric ARF Non-Oliguric or Diuretic ARF
9. Ineffective Tissue Perfusion related to decreased Blood Flow Nursing Intervention: 1. Monitor and report signs of hypokalemia, hyponatremia, or acidosis during oliguric phase, and hypokalemia during diuretic phase. 2. Assess for and report signs of gastrointestinal bleeding 3. During oliguric phase, provide bedrest and assist with ADL. Nursing Care
10. Ineffective Tissue Perfusion related to decreased Blood Flow 4. During diuretic phase, encourage independence in ADL and early ambulation as tolerated. 5. Provide protein sparing diet Medical Management: Administer Cations exchange resins,Sorbitol Nursing Care
11. Deficient fluid volume related to fluid loss from a variety of causes Nursing Intervention: 1. Monitor weight, intake and output and vital signs 2. Assess neck veins,skin turgor and mucous membranes 3. Keep accurate fluid balance records Nursing Care
12. Deficient fluid volume related to fluid loss from a variety of causes Medical: 1. Administer cation exchange resins 2. Administer Sodium Bicarbonate or glucose and insulin Nursing Care
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15. Chronic renal failure (CRF) is the progressive loss of kidney function. The kidneys attempt to compensate for renal damage by hyperfiltration (excessive straining of the blood) within the remaining functional nephrons (filtering units that consist of a glomerulus and corresponding tubule). Over time, hyperfiltration causes further loss of function. Introduction of Disease Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure.
16. The cause of chronic renal failure are numerous. There are various injuries and disease processes that may potentially end in renal failure. Chronic glomerulonephritis, acute renal failure, polycystic kidney disease, obstruction, repeated bouts of pyelonephritis, and nephrotoxins are examples. Systemic diseases such as diabetes mellitus, hypertension, lupus erythematosus, polyarteritis, sickle cell Etiology disease, and amyloid disease, may also produce renal failure. Lazarus reports the following distribution of causes of chronic renal failure among people presenting for dialysis: glomerulonephritis, 44%; diabetic nephropathy, 13%; nephrosclerosis and renal vascular disease, 12%; congenital or hereditary kidney disease, 10%; chronic pyelonephritis, 6%; and others, 15%.
17. Pathophysiology Dilute polyuria Legend: Disease Process: S/Sx : Deterioration & destruction of renal nephrons ↓ GFR ↑ BUN ↑ serum creatinine Hypertrophy of remaining nephrons Inability to concentrate urine Dehydration Further loss of nephron function Loss of Na in urine hyponatremia Loss of nonexcretory renal function Disturbance in reproduction ↓ Libido, Infertility Immune disturbances ↓ Wound Healing, Infection ↑ Production of Lipids Advanced atherosclerosis Impaired Insulin action Erratic blood glucose level (-) erythropoetin production (-) Inactive calcium concertion Anemia, Pallor ↓ Calcium Absorption
18. Pathophysiology Legend: Disease Process: S/Sx : Loss of excretpry renal function ↓ Hydrogen excretion ↓ Phosphate excretion ↓ Potassium excretion ↓ Na reabsorption in tubules ↓ Excretion of nitrogenous waste Metabolic acidosis Hyperphosphatemia ↓ Ca absorption Hyperkalemia H2O retention HPN, HF, edema Uremia ↑ Uric acid Peripheral nerve changes CNS changes ↑ Creatinine ↑ BUN (+) Bleeding Proteinuria Pericarditis Pruritus Altered taste
19. Assessment Systemic signs: Malaise, weakness, and fatigue are very common. Gastrointestinal signs: GI disturbances include anorexia, nausea, vomiting, and hiccups. Peptic ulcer disease and symptomatic diverticular disease are common in patients with CRF. Neurological signs: Peripheral neuropathy and restless legs syndrome, seizures may occur Hematologic signs: Anemia, abnormalities in white cell and platelet functions lead to increased susceptibility to infection and easy bruising. Dermatologic signs: Pruritus is a common dermatologic complication Cardiac signs: Volume overload may cause CHF and pulmonary edema. Hypertension contributes to cardiovascular disease. Dyslipidemia is a primary risk factor for cardiovascular disease and a common complication of ESRD. Uremia may also lead to pericardial effusion and, in rare cases, pericardial tamponade. Metabolic/endocrine signs: Volume overload occurs when salt and water intake exceeds losses and excretion. This causes congestive heart failure (CHF) and exacerbates hypertension. Hyperkalemia. Anion gap acidosis, Hypocalcemia, Hypermagnesemia also may occur.
23. 1. Identify patient fluid status. 2.Fluid intake regulation according to status. 3. Monitor fluid status by observing daily weight, orthostatic blood pressure, skin turgor, and mucous membrane moistness and by meticulous intake and output comparisons. 4. Give learning teaching/ teaching guidelines to people being followed on an ambulatory basis concerning: (a) how to weigh themselves Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function Nursing Intervention
24. (b) how to interpret the relationship of daily weight loss or gain to their need for sodium and water. 5. Inform patient about circumstances that may cause excessive fluid loss and must be prevented and controlled.(for fluid volume deficit) 6. Offer suggestions about reducing thirst and moistening dry mucous membrane with lip balms, frequent oral hygiene, ice chips or spray bottles.(for excess fluid volume) Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function
25. 7. If intravenous fluid are used, carefully attend to them to ensure proper administration rates. 8. Reduce constriction of vessels. (for excess fluid volume)) 9. Restrict sodium intake as prescribed. (for excess fluid volume) 10. Â Instruct patient to avoid medications that may cause fluid retention. Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function
26. 7. If intravenous fluid are used, carefully attend to them to ensure proper administration rates. 8. Reduce constriction of vessels. (for excess fluid volume)) 9. Restrict sodium intake as prescribed. (for excess fluid volume) 10. Â Instruct patient to avoid medications that may cause fluid retention. 1. Administer diuretics as prescribed.(for excess fluid volume) Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function Medical Mgt.
27. 1. Take measures to relieve nausea and vomiting, stomatitis, and other gastrointestinal manifestations. 2.Diet counseling. 3. Inform patient how to translate the dietary regimen into a palatable, understandable food program. 4. Promote exercise. 5. Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Nursing Care Alteration in Nutrition: Less than Body Requirements due to Impaired Renal Function Nursing Intervention
28. 6. For hospitalized patients, encourage family to bring food from home as appropriate. Patients with specific ethnic, religious preferences, or restrictions may not be able to eat hospital foods. 7. Discourage beverages that are caffeinated or carbonated. 1. Discuss possible need for enteral or parenteral nutritional support with patient, family, and caregiver as appropriate. Enteral tube feedings are preferred for patients with a functioning GI tract. Nursing Care Alteration in Nutrition: Less than Body Requirements due to Impaired Renal Function Medical Mgt.
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31. Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the "graft") takes over the functions of nonworking kidneys. Kidney Transplant
