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Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
Acute renal failure
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Acute renal failure

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  • 1. MEDICAL-SURGICALPractice Teaching1Topic – Acute Renal FailurePresented By –Mr. Simon RajuBSc 2nd` year
  • 2. IntroductionARF is a syndrome of varyingcausation that results in a suddendecline in renal function.Associated with : Increase in BUN & creatinine Oliguria (less than 500ml urine /24h) Hyperkalemia Sodium retention
  • 3. Anatomy & Physiology
  • 4. Pathophysiology & Etiology1. Pre renal cause - result fromhypovolemia, shock,hemorrhage,burns,impairedcardiac outut,diuretic therapy.2. Post renal cause – arise fromobstruction or disruption to urine flowanywhere along urinary tract.3. Intra renal cause – results from injury torenal tissue & associated with intrarenal ishemia , toxins , immunologicprocesses ,systemic and vasculardisorders
  • 5. Contd….
  • 6. Contd…
  • 7. Clinical Course Onset - lasts from hours to days Oliguric phase – anuric phase ( urineless than 400 to 500ml/24h)a)Accompanied in rise in serumconcn.which are excreted by kidneysb) There can be decrease in renalfunction with increase in N2 retentioneven when the pt.is excreting morethan 2 to 3 L of urine daily – callednon oliguric or high output renalfailure.
  • 8. Contd… Diuretic phase – begins when the 24hrurine vol.exceeds 500ml and whenBUN & serum creatinine levels stoprising. Recovery phase -a) Several months to 1 yrb) Probably some scar tissue remains
  • 9. Clinical Manifestations Pre renal – decreased tissue turgor ,dryness of mucous membrane , weightloss , hypotension , oliguria or anuria ,tachycardia Post renal – obstruction to urine flow,nephrolithiasis , obstructive symptoms ofBPH Intra renal – edema , presentationbased on cause Changes in urine vol. and serum conc. ofBUN , creatinine , potassium and soforth…
  • 10. Contd…. Objectivesymptoms◦ Oliguric phase – vomiting disorientation, edema, ^K+ decrease Na ^ BUN and creatinine Acidosis uremic breath CHF and pulmonaryedema hypertension causedbyhypovolemia, anorexia sudden drop in UOP convulsions, coma changes in bowels
  • 11. Diagnostic Evaluation1. Urinalysis – reveals proteinuria, hematuria2. Rising serum creatinine and BUNlevels; 41:13. Urine chemistry examinations4. Renal ultrasonography
  • 12. Contd… Diagnostic tests◦ H&P◦ BUN, creatinine, sodium, potassium.pH, Hgb◦ Urine studies◦ US of kidneys◦ KUB◦ Renal CT/MRI◦ Retrograde pyloegram
  • 13. Treatment Treat underlying cause Blood pressure Infections Stop inciting medications Nephrostomy tubes/ureteral stents ifobstruction Hydration Diuresis (Lasix) Dialysis Renal Transplant
  • 14. Acute Renal Failure Medical treatment◦ Fluid and dietary restrictions◦ Maintain E-lytes◦ May need dialysis to jump start renalfunction◦ May need to stimulate production of urinewith IV fluids, Dopamine, diuretics, etc.
  • 15. Contd… Medical treatment◦ Hemodialysis Subclavian approach Femoral approach◦ Peritoneal dialysis◦ Continous renal replacement therapy(CRRT) Can be done continuously Does not require dialysate
  • 16. Contd.. Spl. Attention to draining wounds, burns , Avoid infections Care while administering blood
  • 17. Complications1. Infection2. Arrhythmias3. Electrolyte abnormalities4. GI bleeding5. Multiple organ systems failure
  • 18. Nursing diagnosis Fluid volume excess r/t decreased glomerularfiltration rate & sodium retention Risk for infection r/t alterations in immunesystem & host system Altered nutrition: less than body requirementsr/t catabolic state ,anorexia ,malnutritionassociated with ARF Risk for injury r/t GI bleeding
  • 19. Acute Renal Failure Nursing interventions◦ MonitorI/O, including allbody fluids◦ Monitor lab results◦ Watch hyperkalemiasymptoms:malaise, anorexia, parenthesia, ormuscleweakness, ECGchanges◦ watch forhyperglycemia orhypoglycemia ifreceiving TPN orinsulin infusions◦ Maintain nutrition◦ Safety measures◦ Mouth care◦ Daily weights◦ Assess for signs of heartfailure◦ Skin integrity problems
  • 20. Nursing management Stay focused on the primarydisorder, and monitor all complications. Assist in emergency treatment of fluidand electrolyte imbalances. Assess progress and response totreatment; provide physical andemotional support. Keep family informed about conditionand provide support.
  • 21. Nursing Management Monitoring Fluid and Electrolyte levels Reducing Metabolic Rate promoting pulmonary Function Avoiding Infection Providing Skin Care Providing Support During Dialysis
  • 22. Summary & Conclusion
  • 23. Thank you

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