This document provides information on acute and chronic renal failure, including causes, pathophysiology, assessment, diagnosis, complications, nursing diagnoses, and nursing care. Acute renal failure can be pre-renal, intra-renal, or post-renal and is caused by decreased blood flow or obstruction. Chronic renal failure is a progressive loss of kidney function over time due to various injuries and diseases. Common complications include fluid imbalance, electrolyte abnormalities, nutritional deficits, and increased risk of infection or cardiovascular issues. Nursing focuses on monitoring fluid status, diet, nutrition, and treating related symptoms and complications.

1. DURADERO DOLOR DURADERO DOLOR ACUTE RENAL FAILURE CHRONIC RENAL FAILURE RENAL TRANSPLANT ENDURING PAIN

3. Introduction of the Disease Acute renal failure (ARF) refers to the abrupt lost of kidney function. Over a period of hours to a few days, the GFR drops. This rapid breakdown occurs when high levels of uremic toxins accumulate in the blood due to inability of the kidney to excrete metabolic wastes thru the urine. Types: Oliguric ARF Non-Oliguric or Diuretic ARF

4. Intra Renal Failure ( damage or injury with both kidneys) Causes: vesicular disease: renal artery obstruction, glomerulonephritis and vasculitis, renal vein obstruction acute tubular necrosis: ischemia, toxins Post Renal Failure ( acute obstruction) Causes: bladder outlet obstruction due to an enlarge prostate gland or bladder stone neurogenic bladder tubule obstruction Pre Renal Failure ( inadequate blood circulation to the kidneys) Causes: Dehydration Heart failure Sepsis Severe blood loss Etiology

5. Pathophysiology

6. Assessment Post Renal Anuria Flank Pain Intra Renal Oliguria Edema Hypertension Muscle Trauma Pre Renal Vomiting Diarrhea Intestinal Obstruction Thirst Reduced JVP ↓ Skin Turgor Dry Muscle Membrane

7. Diagnostics Urinalysis Blood Chemistry Renal Ultrasonography

8. Nursing Diagnosis Ineffective Tissue Perfusion related to decreased Blood Flow Excess fluid volume related to inability of the kidneys to produce urine Deficient fluid volume related to fluid loss from a variety of causes

9. Ineffective Tissue Perfusion related to decreased Blood Flow Nursing Intervention: 1. Monitor and report signs of hypokalemia, hyponatremia, or acidosis during oliguric phase, and hypokalemia during diuretic phase. 2. Assess for and report signs of gastrointestinal bleeding 3. During oliguric phase, provide bedrest and assist with ADL. Nursing Care

10. Ineffective Tissue Perfusion related to decreased Blood Flow 4. During diuretic phase, encourage independence in ADL and early ambulation as tolerated. 5. Provide protein sparing diet Medical Management: Administer Cations exchange resins,Sorbitol Nursing Care

11. Deficient fluid volume related to fluid loss from a variety of causes Nursing Intervention: 1. Monitor weight, intake and output and vital signs 2. Assess neck veins,skin turgor and mucous membranes 3. Keep accurate fluid balance records Nursing Care

12. Deficient fluid volume related to fluid loss from a variety of causes Medical: 1. Administer cation exchange resins 2. Administer Sodium Bicarbonate or glucose and insulin Nursing Care

13. Excess fluid volume related to inability of the kidneys to produce urine Nursing Intervention: 1. Monitor weight, intake and output and vital signs 2. Assess neck veins,skin turgor and mucous membranes 3. Keep accurate fluid balance records Nursing Care

14. Excess fluid volume related to inability of the kidneys to produce urine Medical: 1. Administer cation exchange resins 2. Administer Sodium Bicarbonate or glucose and insulin Nursing Care

15. Chronic renal failure (CRF) is the progressive loss of kidney function. The kidneys attempt to compensate for renal damage by hyperfiltration (excessive straining of the blood) within the remaining functional nephrons (filtering units that consist of a glomerulus and corresponding tubule). Over time, hyperfiltration causes further loss of function. Introduction of Disease Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure.

16. The cause of chronic renal failure are numerous. There are various injuries and disease processes that may potentially end in renal failure. Chronic glomerulonephritis, acute renal failure, polycystic kidney disease, obstruction, repeated bouts of pyelonephritis, and nephrotoxins are examples. Systemic diseases such as diabetes mellitus, hypertension, lupus erythematosus, polyarteritis, sickle cell Etiology disease, and amyloid disease, may also produce renal failure. Lazarus reports the following distribution of causes of chronic renal failure among people presenting for dialysis: glomerulonephritis, 44%; diabetic nephropathy, 13%; nephrosclerosis and renal vascular disease, 12%; congenital or hereditary kidney disease, 10%; chronic pyelonephritis, 6%; and others, 15%.

17. Pathophysiology Dilute polyuria Legend: Disease Process: S/Sx : Deterioration & destruction of renal nephrons ↓ GFR ↑ BUN ↑ serum creatinine Hypertrophy of remaining nephrons Inability to concentrate urine Dehydration Further loss of nephron function Loss of Na in urine hyponatremia Loss of nonexcretory renal function Disturbance in reproduction ↓ Libido, Infertility Immune disturbances ↓ Wound Healing, Infection ↑ Production of Lipids Advanced atherosclerosis Impaired Insulin action Erratic blood glucose level (-) erythropoetin production (-) Inactive calcium concertion Anemia, Pallor ↓ Calcium Absorption

18. Pathophysiology Legend: Disease Process: S/Sx : Loss of excretpry renal function ↓ Hydrogen excretion ↓ Phosphate excretion ↓ Potassium excretion ↓ Na reabsorption in tubules ↓ Excretion of nitrogenous waste Metabolic acidosis Hyperphosphatemia ↓ Ca absorption Hyperkalemia H2O retention HPN, HF, edema Uremia ↑ Uric acid Peripheral nerve changes CNS changes ↑ Creatinine ↑ BUN (+) Bleeding Proteinuria Pericarditis Pruritus Altered taste

19. Assessment Systemic signs: Malaise, weakness, and fatigue are very common. Gastrointestinal signs: GI disturbances include anorexia, nausea, vomiting, and hiccups. Peptic ulcer disease and symptomatic diverticular disease are common in patients with CRF. Neurological signs: Peripheral neuropathy and restless legs syndrome, seizures may occur Hematologic signs: Anemia, abnormalities in white cell and platelet functions lead to increased susceptibility to infection and easy bruising. Dermatologic signs: Pruritus is a common dermatologic complication Cardiac signs: Volume overload may cause CHF and pulmonary edema. Hypertension contributes to cardiovascular disease. Dyslipidemia is a primary risk factor for cardiovascular disease and a common complication of ESRD. Uremia may also lead to pericardial effusion and, in rare cases, pericardial tamponade. Metabolic/endocrine signs: Volume overload occurs when salt and water intake exceeds losses and excretion. This causes congestive heart failure (CHF) and exacerbates hypertension. Hyperkalemia. Anion gap acidosis, Hypocalcemia, Hypermagnesemia also may occur.

20. Diagnostics Abdominal Ultrasound Blood Test Urinalysis Biopsy Electrocardiography

21. Complications High Blood Pressure Congestive Heart Failure End Stage Kidney Disease Anemia Bleeding Seizures Fractures Infertility Liver Failure Erectile Dysfunction Peripheral Neuropathy Encephalopathy Pericarditis Miscarriage Cardiac Tamponade Nerve damage Gastrointestinal Bleeding Immune Disorders Dry Skin High Potassium Joint Disorders Skin Infections Decreased Libido Brittle bones Platelet Disorder Water-Electrolyte Imbalance White blood cell abnormality

22. Nursing Diagnosis Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function Alteration in Nutrition: Less than Body Requirements due to Impaired Renal Function Risk for Decreased Cardiac Output related to Alterations in Rate, Rhythm, Cardiac Conduction (Electrolyte Imbalances, Hypoxia)

23. 1. Identify patient fluid status. 2.Fluid intake regulation according to status. 3. Monitor fluid status by observing daily weight, orthostatic blood pressure, skin turgor, and mucous membrane moistness and by meticulous intake and output comparisons. 4. Give learning teaching/ teaching guidelines to people being followed on an ambulatory basis concerning: (a) how to weigh themselves Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function Nursing Intervention

24. (b) how to interpret the relationship of daily weight loss or gain to their need for sodium and water. 5. Inform patient about circumstances that may cause excessive fluid loss and must be prevented and controlled.(for fluid volume deficit) 6. Offer suggestions about reducing thirst and moistening dry mucous membrane with lip balms, frequent oral hygiene, ice chips or spray bottles.(for excess fluid volume) Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function

25. 7. If intravenous fluid are used, carefully attend to them to ensure proper administration rates. 8. Reduce constriction of vessels. (for excess fluid volume)) 9. Restrict sodium intake as prescribed. (for excess fluid volume) 10. Instruct patient to avoid medications that may cause fluid retention. Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function

26. 7. If intravenous fluid are used, carefully attend to them to ensure proper administration rates. 8. Reduce constriction of vessels. (for excess fluid volume)) 9. Restrict sodium intake as prescribed. (for excess fluid volume) 10. Instruct patient to avoid medications that may cause fluid retention. 1. Administer diuretics as prescribed.(for excess fluid volume) Nursing Care Alteration in Fluid Volume: Excess or Deficit due to Impaired Renal Function Medical Mgt.

27. 1. Take measures to relieve nausea and vomiting, stomatitis, and other gastrointestinal manifestations. 2.Diet counseling. 3. Inform patient how to translate the dietary regimen into a palatable, understandable food program. 4. Promote exercise. 5. Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Nursing Care Alteration in Nutrition: Less than Body Requirements due to Impaired Renal Function Nursing Intervention

28. 6. For hospitalized patients, encourage family to bring food from home as appropriate. Patients with specific ethnic, religious preferences, or restrictions may not be able to eat hospital foods. 7. Discourage beverages that are caffeinated or carbonated. 1. Discuss possible need for enteral or parenteral nutritional support with patient, family, and caregiver as appropriate. Enteral tube feedings are preferred for patients with a functioning GI tract. Nursing Care Alteration in Nutrition: Less than Body Requirements due to Impaired Renal Function Medical Mgt.

29. 1. Auscultate heart and lung sounds. Evaluate presence of peripheral edema or vascular congestion and reports of dyspnea. 2. Assess presence or degree of hypertension: monitor BP. 3. Investigate reports of chest pain, noting location, radiation, severity (0-10 scale), and whether or not it is intensified by deep inspiration and supine position. 4. Evaluate heart sounds (note friction rub), BP, peripheral pulses, capillary refill, vascular congestion, temperature, and sensorium or mentation. Nursing Care Risk for Decreased Cardiac Output related to Alterations in Rate, Rhythm, Cardiac Conduction (Electrolyte Imbalances, Hypoxia) Nursing Intervention

30. 5. Assess activity level, response to activity. 6. Monitor laboratory diagnostics studies: electrolytes, BUN/Cr, Chest X-rays. 1. Administer hypertensive drugs. 2. Prepare for dialysis. 3. Assist for pericardiocentesis as indicated. Nursing Care Risk for Decreased Cardiac Output related to Alterations in Rate, Rhythm, Cardiac Conduction (Electrolyte Imbalances, Hypoxia) Medical Mgt.

31. Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the "graft") takes over the functions of nonworking kidneys. Kidney Transplant

32. Living related donor Living unrelated donor Decreased donor Sources of Kidney

33. Indications End Stage Renal Disease Malignant Hypertension Infections Diabetes Mellitus Glomerulonephritis Polycystic Kidney Disease

34. Test done before the procedure include: Tissue and blood typing Blood test or skin test Cardiac examination Informed consent NPO 6-8 hours before surgery Patient teaching Remove jewelries, pins, make-up & nail polish Monitor test and lab results Preoperative Nursing Care

35. Postoperative Nursing Care Monitor vital signs Monitor urine output Inspect incision site for bleeding and signs of infection Monitor for signs of kidney rejection Wound care Administer pain medications as ordered Administer anti-rejection drugs as ordered

36. Nursing Diagnosis Risk for infection related to transplant surgery Risk for Infection related to immunosuppressive therapy Anxiety related to threat of possible graft rejection

37. Nursing Diagnosis Risk for infection related to transplant surgery Risk for Infection related to immunosuppressive therapy Anxiety related to threat of possible graft rejection

38. Nursing Care Risk for infection related to immunosuppressive therapy Assess patients level of pain before and after surgery Provide relaxation techniques Provide calm and peaceful environment Assist patient to a position of comfort Administer analgesics, NSAIDS as ordered Medical Mgt. Nursing Intervention

39. Risk for Infection related to immunosuppressive therapy Monitor vital signs. Assess for fever and chills Wound care Provide oral hygiene Provide good nutrition Administer prophylactic antibiotics ordered Nursing Care Medical Mgt. Nursing Intervention

40. Anxiety related to threat of graft rejection Assess patients level of anxiety. Provide opportunity for expression of patient’s feelings. Provide patient teaching. Assist in developing anxiety-reducing skills such as deep breathing relaxation, music therapy. Nursing Care Nursing Intervention