...ACUTE RENAL FAILURE Overview Acute renal failure is the most common disease in the acute care setting. It is estimated that acute renal failure occurs in up to 25% of all patients admitted to the hospital with a critical illness (Broden, 2009). It is even noted that patients who are admitted to the intensive care unit with no prior renal insufficiencies seem to have worse outcomes than do patients who have preexisting acute renal failure (Broden, 2009). Acute renal failure is a rapid decrease in kidney function, leading to collection of metabolic waste in the body. The pathophysiology of acute renal failure is reduced blood flow to the kidneys, toxins, infections and obstruction (Broden, 2009). There are three types of acute renal failure. They are pre-renal azotemia. This is caused by poor blood flow to the kidneys. The most common causes of this are hypovolemic shock and heart failure. The second type is intra-renal acute renal failure. This is caused by infections, drugs, tumors, glomerulonephritis, and obstruction. The third type is post-renal azotemia. It is caused by an obstruction outside of the kidneys (Dirkes, 2011). Assessment Data Ongoing comprehensive assessments are critical for the acute renal failure patient. The nurse must be attentive to the signs and symptoms of renal disease as well as complications with other organs and systems. The primary effect of acute renal failure is a decrease in urinary output that leads to fluid retention and edema. Oliguria...
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...Abstract: Renal failure can take its toll on those affected patient and family. At the end of 2009, there were 572,569 U.S. resident under treat for End-stage Renal Disease (ESRD). Among the U.S resident with ESRD, there were 150.5 deaths per 1,000 patient totaling 88,620 deaths in all patients undergoing ESRD treatment. With so many experiencing the disease, understanding how it occurs and progresses might prove useful. Table of Contents Introduction…………………………………………..…………………………………..4 Mechanisms of Fluid Regulation………………………………………..7 Discussion……………………………………………………………………………….8 Etiology/Cause……………………………………….………….............8 Clinical Manifestations…………………………………………………11 Labs and Diagnostic Tests……………….……………………………..11 Treatment……………………………………………………………………………......13 Pharmacological…………………………………………………..……15 Nutritional………………………………………………..…………….15 Dialysis…………………………………………………………………16 Introduction The kidneys are bean shaped organs that are approximately 12cm long, 6cm wide and 2.5 cm thick. They are highly vascular, receiving 25% of cardiac output. The kidneys efficiently separate the excess of fluids, electrolytes, and metabolic by-products to produce urine. The kidneys’ location is described as retroperitoneal which means they are located outside and posterior to the abdominal cavity but lateral and anterior to the lumbar spine. Both kidneys are protected by the posterior rib cage; with the right kidney slightly lower then the left because of liver...
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...body. The intent of this paper is to inform the importance of taking medication to reduce the surplus of cystine into the body’s system. Recognizing signs and symptoms and properly diagnosing is a key factor in treating this disorder. Individuals with infantile cystinosis experience both tubular dysfunction (renal Fanconi syndrome) and glomeralular deterioration. The renal Fanconi Syndrome usually occurs within the first year of life. Glomeralular deterioration progresses throughout the first decade of life, resulting in end-stage renal failure unless patients are treated with cysteamine (The importance of early diagnosis of nephropathic cystinosis to limit tissue and organ damage by treating it with specific medication, and if left untreated patient can develop renal failure by the age of 10. The prevalence of the infantile form of cystinosis transpires in 1 in 100,000 – 200,000 live births and in the North American population there is a carrier frequency of 1 in every 200. Europeans from the United Kingdom, France, and Germany have a higher prevalence of infantile cystinosis. Cystinosis is prone to but not limited to European descendants with blue eyes, fair skinned and pale blond hair (Rahkeja, Wooten &et al, 2005). Without treatment, infantile cystinosis can lead to advancement of renal failure that requires dialysis or renal transplant by approximately 10 years of age. A kidney...
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...Renal Failure and Organ Transplant Andy Nguyen, Pradip Gautam The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of N4581 Critical Care Mrs. McClellan Clinical Instructor April 09, 2014 Introduction The purpose of this teaching project is to give our clinical group a good review over renal failure and organ transplantation. By the end of our presentation, students will be able to grasp the most important concept of renal failure and transplantations. We have gathered resources from our text books, lecture notes, trusted web pages, and YouTube videos for demonstration. Kidney Failure Overview Kidney failure is the partial or complete impairment of kidney function. It results in an inability to excrete metabolic waste products and water, as well as contributing to disturbances of all body systems. Kidney disease can be classified as acute or chronic. Acute renal failure (ARF) has a rapid onset. Chronic kidney disease usually develops slowly over months to years and renal replacement therapy (dialysis or transplantation) is needed for long-term survival (Lewis 1165). ARF is a clinical syndrome characterized by a rapid loss of renal function with progressive azotemia, such as BUN and increasing levels of serum creatinine. ARF is often associated with oliguria and usually develops over hours or days. It most commonly follow severe, prolonged hypotension, hypovolemia, or exposure to a nephrotoxic agent. Chronic...
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...HONOURS COURSE TITLE: RENAL NURSING CONTENTS NO | TITLE | PAGES | 1 | INTRODUCTION * URINARY SYSTEM * WHAT DO NORMAL KIDNEYS DO? | 3 | 2 | RENAL REPLACEMENT THERAPY * HEAMODIALYSIS * PERITONEAL DIALYSIS | 4 - 7 | 3 | RENAL TRANSPLANTATION * TRANSPLANT PROCEDURE * TISSUE TYPING * CONTRAINDICATION OF TRANSPLANTATION * TYPES OF TRANSPLANT * DONOR WORK UP * RECIPIENT WORK UP | 8 - 14 | 4 | PRE OPERATIVE MANAGEMENT | 14 - 15 | 5 | INTRA OPERATIVE MANAGEMENT | 16 | 6 | POST OPERATIVE MANAGEMENT | 16 - 17 | 7 | COMPLICATIONS OF KIDNEY TRANSPLANT | 17 - 18 | 8 | NURSING PROCESS | 18 - 21 | 9 | HEALTH EDUCATION FOR PATIENT | 22 | 10 | CONCLUSION | 23 | 11 | REFERENCES | 24 | INTRODUCTION URINARY SYSTEM The urinary system consists of the kidneys, ureters, urinary blabber and urethra. The kidneys produce the urine and account for the other functions attributed to the urinary system. The ureters convey the urine away from the kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to outside of the body. WHAT DO NORMAL KIDNEYS DO? * Remove extra water. * Remove waste products. * Balance chemicals in the body. * Help control blood pressure. * Help make red blood cell. * Help build strong bones. When the kidneys no longer able to perform normal functions and starts to deteriorate, renal failure will occur, this...
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...Associate Level Material Appendix D Read each scenario and write a 25- to 50-word answer for each question following the scenarios. Use at least one reference per scenario and format your sources consistent with APA guidelines. Scenario A Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Acute Kidney failure occurs when your kidneys suddenly become unable to filter waster products from your blood.(www.mayoclinic.org). Acute kidney failure fails into three categories such as prerenal, postrenal, and renal. Mrs. Jones suffers from Acute Renal Failure which means that the kidneys itself that prevent filtration of blood or production or urine. Kidneys is what filter the body's blood, it produces roughly about one milliliter of urine a minute and when the urine changes it is expected to shut down of the kidneys. Mrs. Jones body may have went into shock due to the surgery that she underwent, and an abnormal amount of urine is also known as oliguria. What other symptoms and signs might occur? The other symptoms that Mrs. Jones may suffer are breath odor, mood changes, decreased appetite, decreased sensation, fatigue, flank pain, tremor in the hands, high blood pressure, Nausea, nosebleeds, hiccups, seizures, shortness of breath...
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...included arthritis, hypertension, depression, and alcoholism. He had been taking an anti-inflammatory medication for arthritis and an antidepressant. Overnight, he became agitated and required increasing doses of a benzodiazepine, together with physical restraints for behavior control. The next morning, he was transferred to the ICU where he was evaluated for acute renal failure. The patient was rehydrated and his arthritis and antidepressant medication were withheld. Lab test results are listed below: Na+ | 139 mmol/L | K+ | 3.5 mmol/L | Cl- | 107 mmol/L | CO2 | 23 mmol/L | BUN | 16 mg/dL | Creatinine | 1.4 mg/dL | Discussion Questions: 1.) Is the patient still in acute renal failure? Explain your answer. * Yes, the patient is still in acute renal failure. Acute renal failure, also called acute kidney failure, is when the kidneys suddenly become unable to filter waste products from your blood. When the kidneys lose their filtering ability dangerous levels of wastes can accumulate and the body’s chemical makeup may get out of balance. * It is clear that he is still in acute renal failure because his BUN (blood urea nitrogen) and creatinine chemistry results were nearly four times...
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...nervous system activation Increase release of catecholamines Increase myocardial contractility and peripheral vasoconstriction s/sx: increased BP Neurohormonal response Decrease CO will be sensed by the kidneys Decrease CO will be sensed by posterior pituitary gland RAAS will be activated Increase release of ADH Increase aldosterone level Peripheral vacoconstriction Na and water retention s/sx: increased BP Nephrotoxicity /Nephropathy Increase water reabsorption by renal tubule Dilation and enlargement of heart chambers Stretching of muscle fibers of the heart Increase contraction (Frank-starling law) Increase O2 requirement to perform work Presence in the skin/skin changes Tissue Hypoperfusion s/sx: Weakness, fatigue, pallor. Pale nail beds and lips Increase cardiac workload, leading to overworked heart Heart failure Increased Fluid backup into the lungs Increased Pulmonary Pressure Impaired Gas exchange s/sx; dry Cough, Fatigue, Orthopnea, Irritability, Crackles Legend: pathophysiology signs/symptoms lab result diagnosis Kidney hypoperfusion Decrease glomerular filtration rate Decrease nephron function Heart failure Renal Failure...
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...Nursing 344 Week 1: Report Writing & GFHP Report Writing Pt records are sometimes called in evidence before a court of law in order to establish events that may have contributed to a pt’s death or injury. They may also be required as evidence for an inquiry or hearing by the NMB of NSW. ▪ Frequency of documentation relies on: - physical/ mental status of the pt. - the type of care provided (self care v. intensive care) - requirements of health care agency - any legal or other obligations that the health record must meet ▪ Content of documentation needs to be: - relevant - appropriate - accurate - requirements will vary according to pt acuity - content may be guided by framework (assessment, intervention, response) ▪ Documentation framework: - assessment: conclusions reached utilising subjective and objective data - intervention: reflects the action taken - response: reflects the pt’s response to the intervention ▪ Example of using framework to case: Mrs Pat Martin, a 28y/o lady has been admitted overnight via Casualty accompanied by husband. She is 16 wks pregnant and has been diagnosed with appendicitis by Dr Chan. At the moment she is only experiencing mild pain and has a low grade fever of 37.7. IMI Pethidine 50mgs was given at 2am, and may be repeated PRN. Shes been added to the theatre list at 9.30am. She remains NMB and has IV normal saline running over 10hrs. IV Keflin QID commenced, is next due 12md...
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...Excretory System 1) Respiration(CO2 2) Digestive System 3) Kidney 4) Skin(Sweat, Sebum Kidney • Elimination of waste product of body • Maintain body volume and composition of body fluids • Kidneys are paired situated in lumbosaccral region • Covered by peritoneal • Shape o Mostly it is bean shaped o Cattle it is lobulated o Horse it is heart shaped Urinary System • Kidneys • Ureters • Urinary Bladder • Urethra • Epithelial cells are transitional Muscle of bladder is known as Detruser Muscle Kidney contains 3 main parts • Cortex • Medulla o Outer medulla • Pelvis Types of Nephrons 1) Cortical a. Nephron in cortex but portion is also medullary is known as cortical. 2) Juxta Medullary Nephron has 2 parts 1) Bowmans Capsule 2) Tubular system # of Nephrons in each species |CATTLE |40 LACK | |PIG |12.5 LACK | |HUMAN |10 LACK | |DOG |4.15 LACK | |CAT |1.9 LACK | Note Diagram Tubular System 1) Renal Tubule 2) Loop of Henli a. Descending Lymph b. Thin segment of Ascending Lymph c. Thick segment of Ascending Lymph 3) Collecting Tubule form Collecting Duct 4) Capillary unit work around the structure is known as peritubular...
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...Scenario A Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output. 1. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Ms. Jones just had open-heart surgery and her kidneys did not have enough blood flowing to them (possibly because of low blood pressure during the surgery) and are struggling to work effectively now (The Mayo Clinic Staff, 2011). 2. What other symptoms and signs might occur? Confusion, Fluid retention, fatigue, drowsiness, and an ammonia smell to the breath are a few other signs and symptoms that may occur with acute renal failure although some signs may be confused with post-operative complaints (The Mayo Clinic Staff, 2011). 3. What is causing Ms. Jones’s kidney disease? Ms. Jones’s recent open-heart surgery is most likely the cause of her kidney disease. Low blood pressure during the operation caused her kidneys to stop working because of lack of blood to the organ to filter toxins from the body (Leurs, 1989). 4. What are possible treatment options, and what is the prognosis? A variety of medication can be used to treat kidney failure in this case, including temporary dialysis (The Mayo Clinic Staff, 2011). The prognosis for Ms. Jones is good she will most likely recover, and suffer no long term effects. Scenario B Chronic renal failure: Mr. Hodges...
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...excess fluid, minerals, and wastes. They also make hormones that keep the bones strong and the blood healthy. After removing the water and waste from the bloodstream, it excretes them through urine (McDonnell & Mallon, 2005). Various conditions can damage your kidneys, including both chronic kidney disease and other conditions that affect the kidneys. If kidney damage becomes too severe, your kidneys lose their ability to function normally. This is called kidney failure or end-stage renal failure. According to the National Kidney Foundation (2005), more than 378,000 Americans suffer from chronic kidney failure and need dialysis or kidney transplantation to stay alive. End-stage renal disease is the name for kidney failure so advanced that it cannot be reversed. Renal is another word for kidney. The “renal” name is appropriate due to the fact that the kidneys in end- stage renal disease functions so poorly that they can no longer keep you alive (McDonnell & Mallon, 2005). End-stage renal disease cannot be treated with conventional medical treatments such as drugs. In chronic kidney disease only two treatments allow you to continue living when your kidneys stop functioning: dialysis and kidney transplantation, but only one offers a longer chance of survival. Dialysis is the term for several different methods of artificially filtering the blood (McDonnell & Mallon, 2005). Dialysis is a procedure that replaces some of the kidney’s normal functions, but does not cure the...
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...implications in an effort to highlight the importance of early detection and prevention of kidney disease, with the best interest of the patient at heart Background Normal kidney anatomy http://doctorstock.photoshelter.com/image/I000096SqkYwaLhE The bean-shaped kidneys lie in retroperitoneal position in the superior lumbar region. Extending approximately from T12 to L3, the kidneys receive some form of protection from the lower part of the rib cage (E.N. Marieb, K Hoehn, 2010) The kidneys functions can be divided into two, non-excretory functions and excretory functions. Under excretory we have Glomerular filtration, Tubule reabsorption and Tubule secretion. Making up the non-excretory functions of the kidney are Renin-Angiotensin system, production and function of Erythropoietin and lastly activation and function of Vitamin D3 What is Chronic Kidney Disease? Is the drop in GFR to less than 60mL/min/1.73m2 over three consecutive months with or without kidney damage. Chronic Kidney disease can be classified...
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...difficult to get out of bed without assistance but for the most part, she can ambulate and walk around on her own once she is out of the bed with the assistance of a walker. Because of her obesity, Ms. C has several skin folds throughout her body, which make a great medium for fungal infections. The area underneath her skin folds is red and irritated. Ms. C has had oliguria for the past several days and is outputting very little to no urine. A foley catheter has been placed in order to remove any urinary retention. However, very minimal urine seems to be coming out of foley. The doctors have requested labs to be drawn on a regular basis to check her kidney function and to also monitor her electrolytes. Her admitting diagnosis is Acute Renal Failure. Past Medical History: o Essential Hypertension o Hyperlipidemia o Diabetes Mellitus Type 2 o Stage 3 Diabetic Chronic Kidney Disease o Severe Obesity Present Medical History: o Severe abdominal pain o Dehydration o Oliguria o Uncontrolled Diabetes o Chronic Kidney Disease o Hypertension o Obesity Active Orders: o Foley Catheter o Oxygen 2 L NC o Blood Sugar Monitoring AC and HS o Insulin Regular o Insulin NPH 10 units in AM o Insulin NPH 5 units before bed time o Flucanozole 100 mg IV o D5W 1000 mL with Sodium Bicarb 100 mEq IV solution running at 75 ml/hr o Albuterol 2.5 mg/0.5 mL Nebulizer 2.5 mg o Morphine Inj Syg 2mg PRN Q4H o Morphine Inj Syg 4 mg PRN Q4H o Lotrimin Cream o Ondansetron inj...
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...Congestive heart failure: a fluid overload condition associated with heart failure. -inadequate tissue perfusion. -result when the heart cannot generate a CO sufficient to meet the body's demands. -myocardial disease in which there is a problem with the contraction of the heart, systolic or filling. -LF. Sided HF: pulmonary congestion occurs when the LF ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic system. Pulmonary venous blood volume and pressure increases, forcing fluid from the pulmonary caps into the pulmonary tissues and alveoli, causing pulmonary interstitial edema and impaired gas exchange. Dyspnea, cough, crackles, low O2, extra heart sound S3, may need pillows (difficulties breathing while lying down). -RT. sided HF: congestion of the peripheral tissues and the viscera predominates. Right side cannot eject blood and cannot accommodate all the blood that normally returns to it. Edema of lower extremities, hepatomegaly (venous engorgement of the liver) ascites (gastro distress), anorexia, weakness. Th increased pressure interferes with the livers function, increased pressure in the portal veins-forcing fluid into the abdominal cavity. Hepatomegaly may also cause pressure on the diaphragm-resp distress. Medical Management -if possible, eliminate or reduce contributing factors. Reduce the workload of the heart - preload, after load. -prevent exacerbation of HF. -ACE inhibitors: promote diuresis by decreasing...
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