Acute renal failure.ppt

Acute renal failure.ppt

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  NCM 106: AcuteBiologic Crisis ACUTE RENAL FAILURE
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  Acute Renal Failure •It is a rapid loss of renal function due to the damage of the kidneys. • It is a syndrome of varying causation that results in sudden decline in renal function
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  Pathophysiology: Prerenal, Intrarenal, Postrenal causes ↓ Hypoperfusion of the kidneys ↓ Alteration in kidney function ↓ Decreased glomerular filtration rate ↓ Retention of fluids and urinary sediments ↓ Increase in serum concentration of renal substances ↓ Kidney damage
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  Categories: A. Prerenal Azotemia -It is the result of impaired blood flow that leads to hypoperfusion of the kidney and a decrease in the GFR. B. Intrarenal/ Intrinsic Renal failure - It is the result of actual parenchymal damage to the glomeruli or kidney tubules C. Post renal Azotemia - It occurs when urinary flow from both kidneys, or a single functioning kidney, is obstructed
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  Phases of AcuteRenal Failure I. Onset/Initiation - begins with the initial insult and ends when oliguria develops II. Oliguric-Anuric phase - accompanied by an increase in serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids and intracellular cations- potassium and magnesium). III. Diuretic Phase - Marked by a gradual increase in urine output. IV. Recovery phase - Improvement of renal function
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  Clinical Manifestations • Lethargy •Hypovolemia- causes prerenal disease a. Dehydration- dry skin and mucous membranes • Hypervolemia- result from intrinsic or post renal disease a. Hyperkalemia b. Arrythmias c. Rales • Azotemia a. Nausea and vomiting b. Body malaise c. Altered sensorium d. Pericardial effusion/ pericardial friction rub
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  Clinical Manifestations • CNS- a.Encephalopathic changes- asterixis and confusion a. Drowsiness b. Headache c. Muscle twitching d. Seizures • Non-specific diffuse abdominal pain and ileus • Platelet dysfunction- bleeding
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  Assessment and DiagnosticFindings • Urine assessment a. Scanty to normal volume b. Hematuria may be present c. Low specific gravity d. Unconcentrated urine e. Prerenal Azotemia- decreased sodium and normal urinary sediment and other cellular debris f. Intrarenal Azotemia- increased sodium with urinary casts • Renal UTZ/ CT or MRI • BUN • Serum Creatinine levels
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  • Electrolyte imbalances Hyperkalemia Increasephosphate levels Hypocalcemia • Metabolic acidosis • Anemia
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  Prevention: 1. Obtain acareful history to identify exposure to nephrotoxic agents or environmental toxins. 2. Patients should be monitored closely for changes in the renal function. 3. Provide adequate managements depending on its cause to prevent further occurrence of complications
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  Medical Management: Objectives oftreatment: 1. Restore normal chemical balance 2. Prevent complications until repair of renal tissue and restoration of renal function can occur. • 1. Eliminate underlying cause. • 2. Maintain fluid balance basing on patient’s daily body weight, serial measurements of CVP, serum and urine concentrations, fluid losses, BP and clinical status of the patient. a. Fluid replacement b. Assess for fluid excess
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  Medical Management: c. Administermedications that will initiate diuresis as ordered: • mannitol (Osmitrol) • furosemide (Lasix) • ethacrynic acid (Edecrin) d. IV fluids or transfusions of blood products e. Dialysis may be initiated to prevent complications  Hemodialysis  Peritoneal dialysis  Continuous Renal replacement Therapies (CRRTs)
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  Pharmacologic Therapy 1. ManageHyperkalemia promptly • Kayexalate- orally or retention enema • Sorbitol in combination with Kayexalate • IV dextrose 50%, insulin and calcium replacement • Albuterol sulfate (Ventolin HFA) by nebulizer 2. Treat severe acidosis and increase in phosphate levels • Sodium bicarbonate therapy • Phosphate-binding agents (Calcium or lanthanum carbonate)
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  Nutritional therapy 1. High-proteindiet 2. High-carbohydrate meal 3. Restrict foods and fluids that are high in potassium and phosphorus Nursing Management: 1. Monitoring Fluid and Electrolyte Imbalance - Monitor serum electrolyte levels and physical indicators of complications during all phases of the disorder. - Parenteral fluids, all oral intake and all medications are screened carefully to ensure that hidden sources of potassium are not inadvertently administered or consumed.
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  Nursing Management: 1. MonitoringFluid and Electrolyte Imbalance - Monitor patient’s cardiac function and musculoskeletal status to signs of hyperkalemia. - MIO and weigh daily accurately 2. Reducing Metabolic Rate - Bed rest to reduce exertion and metabolic rate during the most acute stage. - Prevent infection and fever. 3. Promoting Pulmonary Function - Assist patient to turn, cough and take deep breaths frequently to prevent atelectasis and respiratory tract infection.
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  Nursing Management: 4. PreventInfection - Asepsis should be thoroughly practiced with handling of invasive lines and catheters to minimize the risk of infection and increase in metabolism. 5. Providing Skin care - Meticulous skin care should be performed to prevent breakdown as a result of edema. - Bath the patient with cool water. - Frequently turn the patient and keep the skin clean and well-moisturized. 6. Providing Psychosocial Support - The patient and the family should be given assistance, thorough explanation and support during the lengthy treatment.
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  NCM 106: AcuteBiologic Crisis Lecture Series ACUTE RENAL FAILURE Cygnette S. Lumbo, RN,MN