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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