acute renal failure voice over

Chapter 44 Management of Patients With Renal Disorders : 

Chapter 44 Management of Patients With Renal Disorders

Acute Renal Failure : 

Acute Renal Failure Pathophysiology- renal failure develops over days or weeks

Causes of Acute Renal Failure : 

Causes of Acute Renal Failure Hypovolemia Hypotension Reduced cardiac output and heart failure Obstruction of the kidney or lower urinary tract Obstruction of renal arteries or veins

Types of acute renal failure include: : 

Types of acute renal failure include: Prerenal- common with intravascular volume depletion: Fever, vomiting, and diarrhea, diuretics, dehydration can lead to decreased kidney perfusion. Intrarenal - tubular, glomerular, interstitial, and vascular injury. NSAIDS and contrast dye can tubular injury. Postrenal- obstruction of the outflow tracts of the kidneys. Causes include prostatic hypertrophy, catheters, tumors, strictures, and crystals.

Phases of Acute Renal Failure : 

Phases of Acute Renal Failure Phases of rapid decrease in renal function lead to the collection of metabolic wastes in the body. Phases include: Onset – UOP >400ml/day Oliguric – UOP<400ml/day last few day-2weeks Diuretic- urinary output increase Recovery – returning to baseline renal function may take weeks-months Acute syndrome may be reversible with prompt intervention.

Assessment : 

Assessment History Clinical manifestations Laboratory assessment- ↑ bun &creatitine, metabolic acidosis, hyponatremia, hyperkalemia, hypocalcemia, Radiographic assessment Other diagnostic assessments such as renal biopsy

Treatment : 

Treatment Diet therapy Dialysis therapies

Hemodialysis : 

Hemodialysis Client selection Dialysis settings Works using passive transfer of toxins by diffusion Anticoagulation needed, usually heparin treatment

Hemodialysis Catheter : 

Hemodialysis Catheter

Internal Arteriovenous Fistula and Graft : 

Internal Arteriovenous Fistula and Graft

Vascular Access : 

Vascular Access Arteriovenous fistula, or arteriovenous graft for long-term permanent access Hemodialysis catheter, dual or triple lumen, or arteriovenous shunt for temporary access Precautions Complications

Hemodialysis Nursing Care : 

Hemodialysis Nursing Care Postdialysis care: Monitor for complications such as hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps. Monitor vital signs and weight. Avoid invasive procedures 4 to 6 hours after dialysis. Continually monitor for hemorrhage.

Complications of Hemodialysis : 

Complications of Hemodialysis Dialysis disequilibrium syndrome- refers to acute symptoms developing during or immediately after hemodialysis. Early findings include headache, nausea, disorientation, restlessness, blurred vision. It is characterized by neurologic symptoms of varying severity that are thought to be due primarily to cerebral edema. Infectious diseases Hepatitis B and C infections HIV exposure—poses some risk for clients undergoing dialysis

Continuous Renal Replacement Therapy (CRRT) : 

Continuous Renal Replacement Therapy (CRRT) Patients requiring dialysis cannot tolerate a regular four-hour hemodialysis treatment usually due to hypotension Slow, continuous removal of toxins and fluids. By removing fluids continuously over a 24 hour period, CRRT mimics the actions of the kidneys Because there is no buildup of toxins and fluids, patients receiving CRRT can receive as much protein and fluid as Needed to achieve optimal nutrition. CRRT also allows the freedom to administer large-volume infusions whenever needed, because the therapy can be titrated to achieve specific hemodynamic goals

Complications of CRRT : 

Complications of CRRT Bleeding Infection Hypothermia Electrolyte Imbalances Acid Base Imbalances

Renal Transplantation : 

Renal Transplantation A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood. Candidate selection criteria Donors Preoperative care Immunologic studies Surgical team Operative procedure

Kidney Surgery : 

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

Renal Transplantation : 

Renal Transplantation

Postoperative Care/nursing care : 

Postoperative Care/nursing care Fluid and electrolyte imbalance-1st. priority Assessment of urine output hourly for 48 hours, a sudden decrease in UOP is cause for concern Kidney may not function immediately, so dialysis may be necessary for days to weeks Complications include: Rejection Acute tubular necrosis bleeding (Continued)

Postoperative Care (Continued) : 

Postoperative Care (Continued) Thrombosis Renal artery stenosis Other complications Immunosuppressive drug therapy Psychosocial preparation

Postoperative Nursing Management : 

Postoperative Nursing Management 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

Interventions : 

Interventions 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

Patient Teaching : 

Patient Teaching 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

Signs of rejection : 

Signs of rejection Increased creatinine and BUN Fever Weight Gain Decreased urine output Increased blood pressure Tenderness over transplanted kidney