NURSING MANAGEMENT

1. RENAL FAILURE
Durga keshi
PBBSc 2nd year

2. OBJECTIVES
● GENERAL OBJECTIVES
AT THE END OF THE CLASS STUDENT
WILL UNDERSTAND ABOUT THE
DISEASE CONDITION RENAL FAILURE
AND TO PROVIDE CARE BY USING
NURSING PROCESS APPLICATION

3. SPECIFIC OBJECTIVES
At the end student will be able to
● Review the anatomy and physiology of renal
● Define the renal failure
● Outline the incidence and prevalence of renal
failure
● List down the etiology and categories of acute
renal failure

4. ● Enumerate the pathophysiology of acute renal
failure
● List down the phases of acute renal failure
● Describe the sign and symptoms of acute
renal failure
● List down the various diagnostic measure for
acute renal failure
● Describe the management of acute renal
failure

5. ● List down the complications of acute renal
failure
● Discuss the prevention of acute renal failure
● Write a nursing care plan by using nursing
process

6. ANATOMY AND PHYSIOLOGY

7. INCIDENCE AND PREVALENCE
Incidence of acute kidney injury is 31.2% for
Southeast Asia
Aged affected
Infant,toddler, children, teenager,young
adults are rare
Adults and seniors are common

8. DEFINITION
Renal failure is failure of kidney to maintain
internal homeostasis. Renal failure is
situation in which the kidney fail to
function adequately and lead to
accumulation of waste products in the
blood

9. Renal failure can be acute or chronic
Acute renal failure is sudden decline in renal
function usually marked by decrease GFR ,
increase concentration of BUN and
creatinine,the urine put is less than 400ml/day
● Chronic renal failure occurs gradually over
time

10. CAUSES

11. RISK FACTORS
● Hospitalization for serious condition
● Advanced age
● Peripheral artery disease
● Diabetes
● High blood pressure, heart failure
● Diarrhea
● Liver and kidney disease

12. PHASES
Initiation: begins with the initial insult and ends
when oliguria develops
Oliguria: increase in serum concentration of
substance usually excreted by kidney. Urine
out put<30ml/hrs

13. Diuresis: gradually increased in GFR
>400ml/hrs. It may last for 5-25days, monitor
for dehydration
Recovery:signals the improvement of renal
function and may take 3-12months. Lab
values returns to normal level.

14. CLINICAL MANIFESTATION
Nausea, vomiting
Oliguria,dark colored
urine,foamy or bubbly
urine
Dehydration
Azotemia
Edema and fluid
retention
Hypertension
Flankpain, shortness
of breath
● Metabolic acidosis

15. General Malaise, fatigue
Fluid and electrolyte imbalance
Breath may have odor of urine
Headache, drowsiness, confusion, seizure,coma

16. DIAGNOSTIC MEASURE
● History collection
● Physical examination
● Renal function test (BUN, creatinine)
● Computed tomography
● MRI,USG, renal scan
● Renal biopsy
● Urine analysis

17. MANAGEMENT
1. Fluid and dietary restriction
2. Maintain electrolyte
3. Antibiotics
4. Loop diuretics
5. Treat dehydration
6. Dialysis
7. Renal transplantation
8. Dietary management
9. Cardiovascular support
10.Post renal: obstruction remove
11. Continue renal replacement therapy

18. COMPLICATIONS
● Pulmonary edema
● Pericarditis
● Metabolic acidosis
● Uremic enchephlopathy
● Hyperkalemia
● Cardiac arrhythmia

19. PREVENTION

20. PREVENTION
● Continue monitoring
● Monitor urine and central
pressure hourly
● Pay attention to the
wounds,Burns and sepsis
● Prevent and treat
infection,shock
● Adequate hydration
● Take precautions for blood
transfusion
● Prevent and treat UTI
● Treat hypertension

21. HEALTH EDUCATION

22. NURSING PROCESS

23. 1: EXESS FLUID VOLUME R/T DECREASE
URINE OUT PUT, RETENTION OF
SODIUM AND WATER
MAINTENANCE OF IDEAL BODY
WEIGHT WITHOUT EXCESS FLUID
● ASSESS FLUID STATUS
● LIMIT FLUID INTAKE
● IDENTIFY POTENTIAL SOURCE OF FLUIDS EG: FOOD
MEDICATION ORAL OR IV
● EXPLAIN PATIENT AND FAMILY THE RATIONAL FOR FLUID
RESTRICTION
● ASSISTS PATIENT TO COPE WITH DISCOMFORT
● PROVIDE OR ENCOURAGE FREQUENT ORAL HYGIENE

24. IMBALANCE NUTRITION LESS THAN BODY
REQUIREMENT R/T ANOREXIA,NAUSEA,
VOMITING
MAINTENANCE OF ADEQUATE
NUTRITIONAL INTAKE
● ASSESS NUTRITIONAL INTAKE
● ASSESS THE FACTORS
● PROVIDE PATIENT FOOD PREFERENCE WITHIN DIETARY
RESTRICTION
● ENCOURAGE HIGH CALORIES,LOW PROTEIN,LOW SODIUM
AND LOW POTASSIUM
● EXPLAIN RATIONAL FOR DIETARY RESTRICTION

25. ACTIVITY INTOLERANCE R/T FATIGUE ,
RETENTION OF WASTE PRODUCTS AND
DIALYSIS PROCEDURE
PARTICIPATE IN THE ACTIVITY
WITHIN TOLERANCE
● ASSESS THE FACTORS CAUSING
ACTIVITY INTOLERANCE
● PROMOTE INDEPENDENT IN SELF
CARE ACTIVITY
● ENCOURAGE ALTERNATIVE ACTIVITY

26. RISK FOR COMPLICATIONS
HYPOTENSION, CRAMPS, HEADACHE,
CONVULSIONS, CARDIAC ARREST,
COMPLICATIONS ARE PREVENTED
● MONITOR SERUM POTASSIUM LEVEL
● MONITOR FOR MUSCLE WEAKNESS
● ECG CHANGES
● JUGULAR VEIN DISTENTION
● GCS
● ADMINISTER ANTIHYPERTENSIVE

27. DEFICIT KNOWLEDGE REGARDING
CONDITION AND TREATMENT
INCREASE KNOWLEDGE REGARDING
CONDITION AND TREATMENT
1. ASSESS UNDERSTANDING ABOUT
DISEASE AND TREATMENT
2. PROVIDE INFORMATION ON
FOLLOWING IN SIMPLE TERMS
PREVENTION OF INFECTION
DRUG:TIME ,DOSE, ACTION,SIDE

28. ANY QUESTIONS