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Acute Renal Failure

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tin cabral

on 6 March 2011

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Transcript of Acute Renal Failure

ACUTE RENAL FAILURE sudden decline in renal function Increased concentrations of blood urea nitrogen Oliguria (<500 mL of urine in 24 hours) hyperkalemia and sodium retention prerenal - hypovolemia, shock, hemorrhage, burns, impaired cardiac output, diuretic therapy, aortic stenosis, hypotension, renal artery disesase intrarenal - ischemia, toxins, immunologic processes, systemic and vascular disorders, diabetic nephropathy Postrenal - crystal formation or renal stone formation, urethral kinks Pathophysiology Classification of ARD Onset phase - precipitating event to the onset of oliguria or anuria Oliguria - Anuria phase: during which output is <400 ml/day. longer duration can lead to poor prognosis.
the phase where toxins are accumulated
metabolic acidosis occurs from accumulation of acid end-products Early diuretic phase : form the time daily output is greater than 400 ml/day to the time that BUN values stops rising. Late diuretic or recovery phase:
extends from the first day BUN falls to the day it stabilizes or is in the normal range Convalescent phase: BUN is stable to the day urine volume is normal and patient returns to normal activity. Signs and Symptoms
weight gain and peripheral edema may be the only findings symptoms of uremia may myoclonic jerks, seizures, confusion, and coma; asterixis and hyperreflexia may be present on examination. Chest pain (typically worse with inspiration or when recumbent), a pericardial friction rub, and findings of pericardial tamponade dyspnea and crackles on auscultation. Pre renal – decreased tissue turgor, dryness of mucous membranes, weight loss, flat neck veins, hypotension, tachycardia Post renal- difficulty in voiding, changes in urine flow
--- nausea, vomiting, diarrhea, lethargy
Intrarenal – edema, fever, skin rash critically ill and lethargic With persistent nausea, vomiting, and diarrhea Skin and mucous membranes are dry Diagnostic Exams Blood Urea Nitrogen Creatinine Electrolyte leves in the blood Complete Blood Count Urinalysis Hematuria & low specific gravity, urinary casts 7 - 18 mg/dL Creatinine0.6 - 1.2 mg/dL Hyperkalemia dysrhythmias and cardiac arrest Metabolic acidosis Serum Phosphate concntrations; serum calcium levels (low) anemia Hematuria aminoglycosides, gentamicin, tobramycin, colistimethate, polymyxin B, amphotericin B, vancomycin, amikacin, cyclosporine proteinuria casts renal ultrasonography Medical Interventions surgical relief of obstruction Fluid restriction - For those types of kidney failure in which excess fluid is not appropriately eliminated by the kidneys correction and control of biochemical imbalances maintenance of adequate nutrition low protein, amino acids, vitamis If the patient's kidneys do not respond to treatment, and adequate kidney function does not return, they will need to undergo dialysis. Dialysis is done by accessing the blood vessels through the skin (hemodialysis) or by accessing the abdominal cavity through the lining that encases the abdominal organs (peritoneal dialysis). Arterial Blood Gass Complications: avoidance of substances that are toxic to the kidneys, called nephrotoxins. These include NSAIDs such as ibuprofen, iodinated contrasts such as those used for CT scans, and others. insertion of a urinary catheter should low blood pressure prove a persistent problem in the fluid-replete patient, inotropes such as norepinephrine and dobutamine may be given to improve cardiac output and hence renal perfusion. nephrostomy renal replacement therapy hemodialysis,
peritoneal dialysis,
hemofiltration and
renal transplantation. Monitor 24-hour urine volume to follow clinical course of the disease.
Monitor laboratory results
Weigh the patient to provide an index of fluid balance.
Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions.
Adjust fluid intake to avoid volume overload and dehydration.
Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment available in case of cardiac arrest.
Watch for urinary tract infection, and remove bladder catheter as soon as possible.
Employ intensive pulmonary hygiene because incidence of pulmonary edema and infection is high.
Provide meticulous wound care.

Nursing management Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.
Institute seizure precautions.
Encourage and assist the patient to turn and move because drowsiness and lethargy may reduce activity.
Explain that the patient may experience residual defects in kidney function for a long time after acute illness.
Encourage the patient to report routine urinalysis and follow-up examinations.
Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.

Metabolic acidosis, hyperkalemia, and pulmonary edema
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