MEDICAL-SURGICAL

Practice Teaching1

Topic – Acute Renal Failure

Presented By –

Mr. Simon Raju

BSc 2nd` year

Introduction

ARF is a syndrome of varying causation that results in a sudden decline in renal function.

Associated with :

Increase in BUN & creatinine

Oliguria (less than 500ml urine /24h)

Hyperkalemia

Sodium retention

Anatomy & Physiology

Pathophysiology & Etiology

1. Pre renal cause - result from hypovolemia, shock,hemorrhage,burns,impairedcardiac outut,diuretic therapy.

2. Post renal cause – arise from obstruction or disruption to urine flow anywhere along urinary tract.

3. Intra renal cause – results from injury to renal tissue & associated with intra renal ishemia , toxins , immunologic processes ,systemic and vascular disorders

Contd….

Contd…

Clinical Course

Onset - lasts from hours to days

Oliguric phase – anuric phase ( urine less than 400 to 500ml/24h)

a)Accompanied in rise in serum concn.which are excreted by kidneys

b) There can be decrease in renal function with increase in N2 retention even when the pt.is excreting more than 2 to 3 L of urine daily – called non oliguric or high output renal failure.

Contd…

Diuretic phase – begins when the 24hr

urine vol.exceeds 500ml and when

BUN & serum creatinine levels stop

rising.

Recovery phase -

a) Several months to 1 yr

b) Probably some scar tissue remains

Clinical Manifestations

Pre renal – decreased tissue turgor , dryness of mucous membrane , weight loss , hypotension , oliguria or anuria , tachycardia

Post renal – obstruction to urine flow, nephrolithiasis , obstructive symptoms of BPH

Intra renal – edema , presentation based on cause

Changes in urine vol. and serum conc. of BUN , creatinine , potassium and so forth…

Contd….

Objective symptoms

◦ Oliguric phase – vomiting

disorientation,

edema,

^K+

decrease Na

^ BUN and creatinine

Acidosis

uremic breath

CHF and pulmonary

edema

hypertension caused

by

hypovolemia, anorexia

sudden drop in UOP

convulsions, coma

changes in bowels

Diagnostic Evaluation

1. Urinalysis – reveals proteinuria

, hematuria

2. Rising serum creatinine and BUN

levels; 41:1

3. Urine chemistry examinations

4. Renal ultrasonography

Contd…

Diagnostic tests

◦ H&P

◦ BUN, creatinine, sodium, potassium.

pH, Hgb

◦ Urine studies

◦ US of kidneys

◦ KUB

◦ Renal CT/MRI

◦ Retrograde pyloegram

Treatment

Treat underlying cause

Blood pressure

Infections

Stop inciting medications

Nephrostomy tubes/ureteral stents if obstruction

Hydration

Diuresis (Lasix)

Dialysis

Renal Transplant

Acute Renal Failure

Medical treatment

◦ Fluid and dietary restrictions

◦ Maintain E-lytes

◦ May need dialysis to jump start renal

function

◦ May need to stimulate production of urine

with IV fluids, Dopamine, diuretics, etc.

Contd…

Medical treatment

◦ Hemodialysis

Subclavian approach

Femoral approach ◦ Peritoneal dialysis

◦ Continous renal replacement therapy (CRRT)

Can be done continuously

Does not require dialysate

Contd..

Spl. Attention to draining wounds

, burns ,

Avoid infections

Care while administering blood

Complications

1. Infection

2. Arrhythmias

3. Electrolyte abnormalities

4. GI bleeding

5. Multiple organ systems failure

Nursing diagnosis

Fluid volume excess r/t decreased glomerularfiltration rate & sodium retention

Risk for infection r/t alterations in immune system & host system

Altered nutrition: less than body requirements r/t catabolic state ,anorexia ,malnutrition associated with ARF

Risk for injury r/t GI bleeding

Acute Renal Failure

Nursing interventions

◦ Monitor I/O, including all body fluids

◦ Monitor lab results◦ Watch hyperkalemia

symptoms: malaise, anorexia, parenthesia, or muscle weakness, ECG changes

◦ watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions

◦ Maintain nutrition

◦ Safety measures

◦ Mouth care

◦ Daily weights

◦ Assess for signs of heart failure

◦ Skin integrity problems

Nursing management

Stay focused on the primary disorder, and monitor all complications.

Assist in emergency treatment of fluid and electrolyte imbalances.

Assess progress and response to treatment; provide physical and emotional support.

Keep family informed about condition and provide support.

Nursing Management

Monitoring Fluid and Electrolyte levels

Reducing Metabolic Rate

promoting pulmonary Function

Avoiding Infection

Providing Skin Care

Providing Support During Dialysis

Summary & Conclusion

Thank you