Renal failure

3,478 views

Published on

11

Published in: Health & Medicine
0 Comments
10 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
3,478
On SlideShare
0
From Embeds
0
Number of Embeds
14
Actions
Shares
0
Downloads
130
Comments
0
Likes
10
Embeds 0
No embeds

No notes for slide
  • Not parallel
  • S&P
  • S&P
  • S&P
  • S&P
  • S&P
  • S&P
  • S&P
  • Renal failure

    1. 1. Renal Failure Acute and Chronic
    2. 2. Acute Renal Failure <ul><li>Pathophysiology </li></ul><ul><li>Types of acute renal failure include: </li></ul><ul><ul><li>Prerenal </li></ul></ul><ul><ul><li>Intrarenal </li></ul></ul><ul><ul><li>Postrenal </li></ul></ul>
    3. 3. Phases of Acute Renal Failure <ul><li>Phases of rapid decrease in renal function lead to the collection of metabolic wastes in the body. </li></ul><ul><li>Phases include: </li></ul><ul><ul><li>Onset </li></ul></ul><ul><ul><li>Diuretic </li></ul></ul><ul><ul><li>Oliguric </li></ul></ul><ul><ul><li>Recovery </li></ul></ul><ul><li>Acute syndrome may be reversible with prompt intervention. </li></ul>
    4. 4. Assessment <ul><li>History </li></ul><ul><li>Clinical manifestations </li></ul><ul><li>Laboratory assessment </li></ul><ul><li>Radiographic assessment </li></ul><ul><li>Other diagnostic assessments such as renal biopsy </li></ul>
    5. 5. Drug Therapy <ul><li>Cardioglycides </li></ul><ul><li>Vitamins and minerals </li></ul><ul><li>Biologic response modifiers </li></ul><ul><li>Phosphate binders </li></ul><ul><li>Stool softeners and laxatives </li></ul><ul><li>Monitor fluids </li></ul><ul><li>Diuretics </li></ul><ul><li>Calcium channel blockers </li></ul>
    6. 6. Treatment <ul><li>Diet therapy </li></ul><ul><li>Dialysis therapies </li></ul><ul><ul><li>Hemodialysis </li></ul></ul><ul><ul><li>Peritoneal dialysis </li></ul></ul>
    7. 7. Continuous Renal Replacement Therapy <ul><li>Standard treatment </li></ul><ul><li>Dialysate solution </li></ul><ul><li>Vascular access </li></ul><ul><li>Continuous arteriovenous hemofiltration </li></ul><ul><li>Continuous venovenous hemofiltration </li></ul>
    8. 8. Posthospital Care <ul><li>If renal failure is resolving, follow-up care may be required. </li></ul><ul><li>There may be permanent renal damage and the need for chronic dialysis or even transplantation. </li></ul><ul><li>Temporary dialysis is appropriate for some clients. </li></ul>
    9. 9. Chronic Renal Failure <ul><li>Progressive, irreversible kidney injury; kidney function does not recover </li></ul><ul><li>Azotemia </li></ul><ul><li>Uremia </li></ul><ul><li>Uremic syndrome </li></ul>
    10. 10. Stages of Chronic Renal Failure <ul><li>Diminished renal reserve </li></ul><ul><li>Renal insufficiency </li></ul><ul><li>End-stage renal disease </li></ul>
    11. 13. Changes R/T CRF <ul><ul><li>Kidney </li></ul></ul><ul><ul><li>Metabolic </li></ul></ul><ul><ul><ul><li>Urea and creatinine </li></ul></ul></ul><ul><ul><li>Electrolytes </li></ul></ul><ul><ul><ul><li>Sodium </li></ul></ul></ul><ul><ul><ul><li>Potassium </li></ul></ul></ul><ul><ul><li>Acid-base balance </li></ul></ul><ul><ul><li>Calcium and phosphorus </li></ul></ul><ul><ul><li>(Continued) </li></ul></ul>
    12. 14. Changes R/T CRF (Continued) <ul><ul><li>Cardiac </li></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Hyperlipidemia </li></ul></ul></ul><ul><ul><ul><li>Congestive heart failure </li></ul></ul></ul><ul><ul><ul><li>Uremic pericarditis </li></ul></ul></ul><ul><ul><li>Hematologic </li></ul></ul><ul><ul><li>Gastrointestinal </li></ul></ul>
    13. 15. Clinical Manifestations <ul><li>Neurologic </li></ul><ul><li>Cardiovascular </li></ul><ul><li>Respiratory </li></ul><ul><li>Hematologic </li></ul><ul><li>Gastrointestinal </li></ul><ul><li>Urinary </li></ul><ul><li>Skin </li></ul>
    14. 16. Imbalanced Nutrition: Less Than Body Requirements <ul><li>Interventions include: </li></ul><ul><ul><li>Dietary evaluation for: </li></ul></ul><ul><ul><ul><li>Protein </li></ul></ul></ul><ul><ul><ul><li>Fluid </li></ul></ul></ul><ul><ul><ul><li>Potassium </li></ul></ul></ul><ul><ul><ul><li>Sodium </li></ul></ul></ul><ul><ul><ul><li>Phosphorus </li></ul></ul></ul><ul><ul><li>Vitamin supplementation </li></ul></ul>
    15. 17. Excess Fluid Volume <ul><li>Interventions: </li></ul><ul><ul><li>Monitor client’s intake and output. </li></ul></ul><ul><ul><li>Promote fluid balance. </li></ul></ul><ul><ul><li>Assess for manifestations of volume excess: </li></ul></ul><ul><ul><ul><li>Crackles in the bases of the lungs </li></ul></ul></ul><ul><ul><ul><li>Edema </li></ul></ul></ul><ul><ul><ul><li>Distended neck veins </li></ul></ul></ul><ul><ul><li>Drug therapy includes diuretics. </li></ul></ul>
    16. 18. Decreased Cardiac Output <ul><li>Interventions: </li></ul><ul><ul><li>Control hypertension with calcium channel blockers, ACE inhibitors, alpha- and beta-adrenergic blockers, and vasodilators. </li></ul></ul><ul><ul><li>Instruct client and family to monitor blood pressure, client’s weight, diet, and drug therapy. </li></ul></ul>
    17. 19. Risk for Infection <ul><li>Interventions include: </li></ul><ul><ul><li>Meticulous skin care </li></ul></ul><ul><ul><li>Preventive skin care </li></ul></ul><ul><ul><li>Inspection of vascular access site for dialysis </li></ul></ul><ul><ul><li>Monitoring of vital signs for manifestations of infection </li></ul></ul>
    18. 20. Risk for Injury <ul><li>Interventions include: </li></ul><ul><ul><li>Drug therapy </li></ul></ul><ul><ul><li>Education to prevent fall or injury, pathologic fractures, bleeding, and toxic effects of prescribed drugs </li></ul></ul>
    19. 21. Fatigue <ul><li>Interventions: </li></ul><ul><ul><li>Assess for vitamin deficiency, anemia, and buildup of urea. </li></ul></ul><ul><ul><li>Administer vitamin and mineral supplements. </li></ul></ul><ul><ul><li>Administer erythropoietin therapy for bone marrow production. </li></ul></ul><ul><ul><li>Give iron supplements as needed. </li></ul></ul>
    20. 22. Anxiety <ul><li>Interventions include: </li></ul><ul><ul><li>Health care team involvement </li></ul></ul><ul><ul><li>Client and family education </li></ul></ul><ul><ul><li>Continuity of care </li></ul></ul><ul><ul><li>Encouragement of client to ask questions and discuss fears about the diagnosis of renal failure </li></ul></ul>
    21. 23. Potential for Pulmonary Edema <ul><li>Interventions: </li></ul><ul><ul><li>Assess the client for early signs of pulmonary edema. </li></ul></ul><ul><ul><li>Monitor serum electrolyte levels, vital signs, oxygen saturation levels, hypertension. </li></ul></ul>
    22. 24. Hemodialysis <ul><li>Client selection </li></ul><ul><li>Dialysis settings </li></ul><ul><li>Works using passive transfer of toxins by diffusion </li></ul><ul><li>Anticoagulation needed, usually heparin treatment </li></ul>
    23. 25. Vascular Access <ul><li>Arteriovenous fistula, or arteriovenous graft for long-term permanent access </li></ul><ul><li>Hemodialysis catheter, dual or triple lumen, or arteriovenous shunt for temporary access </li></ul><ul><li>Precautions </li></ul><ul><li>Complications </li></ul>
    24. 26. Hemodialysis Nursing Care <ul><li>Postdialysis care: </li></ul><ul><ul><li>Monitor for complications such as hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps. </li></ul></ul><ul><ul><li>Monitor vital signs and weight. </li></ul></ul><ul><ul><li>Avoid invasive procedures 4 to 6 hours after dialysis. </li></ul></ul><ul><ul><li>Continually monitor for hemorrhage. </li></ul></ul>
    25. 27. Complications of Hemodialysis <ul><li>Dialysis disequilibrium syndrome </li></ul><ul><li>Infectious diseases </li></ul><ul><li>Hepatitis B and C infections </li></ul><ul><li>HIV exposure—poses some risk for clients undergoing dialysis </li></ul>
    26. 28. Peritoneal Dialysis <ul><li>Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate. </li></ul><ul><li>Types of peritoneal dialysis: </li></ul><ul><ul><li>Continuous ambulatory peritoneal </li></ul></ul><ul><ul><li>Automated peritoneal </li></ul></ul><ul><ul><li>Intermittent peritoneal </li></ul></ul><ul><ul><li>Continuous-cycle peritoneal </li></ul></ul>
    27. 29. Complications <ul><li>Peritonitis </li></ul><ul><li>Pain </li></ul><ul><li>Exit site and tunnel infections </li></ul><ul><li>Poor dialysate flow </li></ul><ul><li>Dialysate leakage </li></ul><ul><li>Other complications </li></ul>
    28. 30. Nursing Care During Peritoneal Dialysis <ul><li>Before treating, evaluate baseline vital signs, weight, and laboratory tests. </li></ul><ul><li>Continually monitor the client for respiratory distress, pain, and discomfort. </li></ul><ul><li>Monitor prescribed dwell time and initiate outflow. </li></ul><ul><li>Observe the outflow amount and pattern of fluid. </li></ul>
    29. 31. Renal Transplantation <ul><li>Candidate selection criteria </li></ul><ul><li>Donors </li></ul><ul><li>Preoperative care </li></ul><ul><li>Immunologic studies </li></ul><ul><li>Surgical team </li></ul><ul><li>Operative procedure </li></ul>
    30. 32. Postoperative Care <ul><li>Urologic management </li></ul><ul><li>Assessment of urine output hourly for 48 hours. </li></ul><ul><li>Complications include: </li></ul><ul><ul><li>Rejection </li></ul></ul><ul><ul><li>Acute tubular necrosis </li></ul></ul><ul><ul><li>(Continued) </li></ul></ul>
    31. 33. Postoperative Care (Continued) <ul><ul><li>Thrombosis </li></ul></ul><ul><ul><li>Renal artery stenosis </li></ul></ul><ul><ul><li>Other complications </li></ul></ul><ul><ul><li>Immunosuppressive drug therapy </li></ul></ul><ul><ul><li>Psychosocial preparation </li></ul></ul>

    ×