6/9/2013 6NURSING CARE• Monitor fluid and electrolyte balance.• Monitor alteration in fluid volume.• Promote optimal nutritional status• Prevent complications from impaired mobility• Prevent fever and infection• Support client/S.O. & reduce/relieve anxiety
6/9/2013 7Diagnostics• a. Increased BUN and serum creatinine level.• b. Decreased urinary creatinine clearance.• c. Elevated blood sugar and triglycerides.• d. Increased scrum potassium.• e. Anemia (decreased hemoglobin andhematocrit).
6/9/2013 8Acute renal failure -PATHOPHYSIOLOGYPrerenal CAUSE:• Factors interfering with perfusion andresulting in diminished blood flow andglomerular filtrate, ischemia, and oliguria;include CHF, cardiogenic shock, acutevasoconstriction, hemorrhage, burns,septicemia, hypotension, anaphylaxis
6/9/2013 17Accumulationof soluteSystemic HormonalChanges in bloodInc. excretion ofSolute per nephronGlomerulosclerosisExtrarenal organDamage; uremicSyndrome;toxicEffects on renal cellsTubular cell damage& interstitial fibrosisTubularhyperthrophyHigh intraglomerularPressure and inc. filtrationof macromoleculesGlomerular hypertrophyand inc. SNGFRLoss of NeprhonsMaintenance of internalEnvironment up to limitsof Nephron adaptationAnd hyperthrophyPathophysiology of CRF
6/9/2013 18Chronic Renal FailurePredisposing factors:–DM= worldwide leading cause–Recurrent infections–Exacerbations of nephritis–urinary tract obstruction–hypertension
6/9/2013 19• It occurs in stages, is irreversible, and resultsin uremia or end-stage renal disease CRFaffects all of the major body systems andrequires dialysis or kidney transplant tomaintain life
6/9/2013 20• The result is azotemia to UREMIA• The nephrons left intact are subjected to anincreased work load, resulting in hypertrophyand inability to concentrate urine.
6/9/2013 21Chronic Renal Failure• CRF is a progressive, irreversible reduction inrenal function such that the kidneys are nolonger able to maintain the bodyenvironment.• Gradual, Progressive irreversible destructionof the kidneys causing severe renaldysfunction.• The GFR gradually decreases as the nephronsare destroyed.