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Acute & Chronic Renal Failure

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Kindra Celani

on 29 September 2015

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Transcript of Acute & Chronic Renal Failure

Acute & Chronic Renal Failure
Pain relief measures and analgesic medications
Promote airway clearance and effective breathing pattern by appropriate pain relief, deep breathing coughing exercises, and incentive spirometry and positioning
Monitor UO and maintain potency of urinary drainage systems
Use strict asepsis with catheter and appropriate technique in providing all care
Monitor for signs and symptoms of bleeding
Encourage leg exercises, early ambulation, and monitor for signs of DVT

Renal Transplantation

Preoperative considerations
Perioperative concerns
Postoperative management
Potential hemorrhage and shock
Potential abdominal distention and paralytic ileus
Potential infection
Potential thromboembolism

Kidney Surgery
Peritoneal Dialysis
Hemodialysis System
Assess nutritional status; weight changes and lab data
Assess patient nutritional patterns and history; note food preferences
Provide food preferences within restrictions
Encourage high-quality nutritional foods while maintaining nutritional restrictions
Assess and modify intake related to factors that contribute to altered nutritional intake, eg, stomatitis or anorexia
Adjust medication times related to meals
Imbalanced Nutrition
Assess for signs and symptoms of fluid volume excess, and keep accurate I&O and daily weights
Limit fluid to prescribe amounts
Identify sources of fluid
Explain to patient and family the rationale for the restriction
Assist patient to cope with the fluid restriction
Provide or encourage frequent oral hygiene

Excess Fluid Volume
Goals may include maintaining of IBW without excess fluid
maintenance of adequate nutritional intake
increased knowledge
participation of activity within tolerance improved self-esteem
absence of complications.

Nursing Process: The Care of the Patient with Renal Failure—Planning
Fluid status
Nutritional status
Patient knowledge
Activity tolerance
Potential complications
Nursing Process: The Care of the Patient with Renal Failure—Assessment
Results when the kidneys cannot remove wastes or perform regulatory functions
A systemic disorder that results from many different causes
Acute renal failure is a reversible syndrome that results in decreased GFR and oliguria
Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia
Renal Failure
Sequence of Events in Nephrotic Syndrome
Causes include repeated episodes of acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage.
Symptoms vary; may be asymptomatic for years, as glomerular damage increases, before signs and symptoms develop of renal insufficiency/failure.
Abnormal laboratory tests include urine with fixed specific gravity, casts, and proteinuria; and electrolyte imbalances and hypoalbuminemia.
Medical management is determined by symptoms.
Chronic Glomerulonephritis
An inflammation of the small blood vessels of the kidneys (glomerular capillaries)
Infection- strep throat
Autoimmune disease (lupus, RA)
Glomerular Diseases
Chronic Acute Renal Failure
Diabetes mellitus
Chronic glomerulonephritis,
Pyelonephritis or other infections
Obstruction of urinary tract
Hereditary lesions
Vascular disorders
Medications or toxic agents
Causes of Chronic Renal Failure
Instruct both patient and family
Drainage system care
Strategies to prevent complications
Signs and symptoms
Follow-up care
Fluid intake
Health promotion and health screening

Patient Teaching

Assessment: include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system
Diagnoses: ineffective airway clearance, ineffective breathing pattern, acute pain, fear and anxiety, impaired urinary elimination, and risk for fluid imbalance
Complications: bleeding , pneumonia, infection, and DVT

Postoperative Nursing Management

Patient Positioning and Incisional Approaches

Monitor all medications and medication dosages carefully. Avoid medications containing potassium and magnesium.
Address pain and discomfort.
Stringent infection control measures.
Dietary considerations: sodium, potassium, protein, and fluid; address individual nutritional needs.
Skin care: pruritis is a common problem; keep skin clean and well moisturized, and trim nails and avoid scratching.
CAPD catheter care.

Nursing Management of the Hospitalized Patient on Dialysis (2 of 2)

Protection of vascular access; assess site for patency and signs of potential infection, and do not use for blood pressure or blood draws.
Monitor fluid balance indicators and monitor IV therapy carefully; accurate I&O, IV administration pump.
Assess for signs and symptoms of uremia and electrolyte imbalance; regularly check lab data.
Monitor cardiac and respiratory status carefully.
Hypertension: monitor blood pressure, antihypertensive agents must be held on dialysis days to avoid hypotension.

Nursing Management of the Hospitalized Patient on Dialysis (1 of 2)
Peritoneal Dialysis
Internal Arteriovenous Fistula and Graft
Hemodialysis Catheter
Assess patient and family responses to illness and treatment
Assess relationships and coping patterns
Encourage open discussion about changes and concerns
Explore alternate ways of sexual expression
Discuss role of giving and receiving love, warmth, and affection

Risk for Situational Low Self Esteem
Pericardial effusion
Pericardial tamponade
Bone disease and metastatic calcifications
Collaborative Problems/Potential Complications
Excess fluid volume
Imbalanced nutrition
Deficient knowledge
Risk for situational low self-esteem
Nursing Process: The Care of the Patient with Renal Failure—Diagnoses
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins
Results in hypoalbuminemia and edema
Causes include chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythmatosus, multiple myeloma, and renal vein thrombosis.
Medical management includes drug and dietary therapy
Nephrotic Syndrome
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Teaching self-care
Nursing Management Chronic Glomerulonephritis
Postinfectious glomerulonephritis,
Hematuria, edema, azotemia, proteinuria, and hypertension
May be mild, or may progress to acute renal failure
Medical management: supportive care, dietary modifications, antibiotics, corticosteroids, and/or immunosuppressants.
Nephrotic Syndrome
Reduced cardiac output and heart failure
Obstruction of the kidney or lower urinary tract
Obstruction of renal arteries or veins
Causes of Acute Renal Failure
Acute Renal Failure
Chronic Renal Failure
Glomerular Disease
Nephrotic Syndrome
Renal Disorders
Renal Review
Severe blood loss Hypovolemia
Hypotension (MAP <65) low blood pressure
Severe infection (sepsis)
Medicines that interfere with the blood supply to the kidneys.
Severe dehydration caused by excessive fluid loss.
Severe burns.
Pancreatitis and liver diseases, such as cirrhosis, that create fluid shifts in the abdomen.

Intrarenal/Intrinsic Renal
Decreased blood flow within the kidney
Nephrotoxic Medications
Kidney stones
Enlarged prostate
Cancer (Prostate,Cervix,Colon)
Blood clots in ureters/urethra
Bladder that does not empty properly (Stroke, MS, SCI, Parkinsons)
What is the best measure of fluid loss or gain in an acutely ill patient?
The most accurate indicator of fluid loss or gain in an acutely ill patient is weight.

An accurate daily weight must be obtained and recorded.

A 1 kg weight gain is equal to 1000 mL of retained fluid.
Lab Values
Creatinine, CC
Specific Gravity
Serum Electrolytes
Total Protein
Diagnose this patient...
45 yo woman with right flank pain
WBC = 15.2
Hgb = 9.8
Hct = 38.9
Plts = 155
Neut % = 92
Na = 122
K = 7.4
CO2/Bicarb = 11
Glucose = 929
Mag = 1.8
Creat = 6.9
Phos = 5.3
Color = Yellow
Clarity = Cloudy
Sp Grav = 1.015
Protein = Pos.
Glucose = >1000
Ketones = Large
Blood = Pos.
Nitrate = Pos.
LET = Pos.
RBC's = 1
WBC's = 88

Culture: +
gram neg. rods
Functions of the Kidney
Urinary System
Acid Base Balance
Blood Pressure Regulation (maintaining Na & H2O balance)
Blood filter- remove waste
Hormone Production- Calcitriol, Erythropoietin, Renin
Reabsorption of water, glucose, amino acids
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