MEDICAL-SURGICALPractice Teaching1Topic – Acute Renal FailurePresented By –Mr. Simon RajuBSc 2nd` year
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
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
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.
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
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…
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
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.
Contd… Medical treatment◦ Hemodialysis Subclavian approach Femoral approach◦ Peritoneal dialysis◦ Continous renal replacement therapy(CRRT) Can be done continuously Does not require dialysate
Contd.. Spl. Attention to draining wounds, burns , Avoid infections Care while administering blood
Complications1. Infection2. Arrhythmias3. Electrolyte abnormalities4. GI bleeding5. Multiple organ systems failure
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
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.
Nursing Management Monitoring Fluid and Electrolyte levels Reducing Metabolic Rate promoting pulmonary Function Avoiding Infection Providing Skin Care Providing Support During Dialysis