...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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...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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...1. What are possible factors predisposing Mr. K. G. for acute renal failure? Possible predisposing factors for Mr. K.G. include his past medical history of hypertension and diabetes mellitus type 2, which can cause renal ischemia and cell injury (Moore, 2013). His myocardial infarction two years ago is also a predisposing factor because it has reduced his cardiac output, which could result in hypoperfusion of the kidneys. Mr. K.G.’s age also puts him at risk since after age 40, “renal blood flow gradually diminishes at a rate of 10% per decade” (Sole et al., 2013, p. 434). Additionally, decreased renal mass, number of glomeruli, and peritubular density often occur with advanced age (Sole et al., 2013). Mr. K.G. takes an NSAID and an ACE inhibitor,...
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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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...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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...department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is non-responsive. She is admitted to the critical care unit to be closely monitored for the development of ventilatory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased at about 20 ml/hr. Her laboratory values are: * Serum K+ = 5.7 mEq/L * Arterial blood gases (ABGs) * pH = 7.13 * PaCO2 = 56 mm Hg * PaO2 = 89 mm Hg * HCO3– = 18 mEq/L. Questions 1. What is the relationship between acid-base balance and serum potassium level? 2. What is the reason for L.S.’s low urine output? How should her fluids be managed? 3. Categorize and explain the probable cause of L.S.’s acid-base disorder. 4. Can L.S. compensate for her acid-base disorder? Why or why not? 5. How should her acid-base imbalance be medically managed? 1. Acid-base balance can influence the serum K+ levels detected in the blood. When a patient experiences hypokalemia, K+ is excreted from the cells and H+ takes its place creating an alkalotic state; K+ is processed out of the body via the kidneys and polyuria can be a clinical symptom. In the case of hyperkalemia, K+ is not properly processed by the kidneys as a result of renal failure; decreased urine output is a clinical symptom. 2. The reason for the patient’s low urine output is due to her acute renal failure. Since the kidneys are in failure, they cannot properly process...
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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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...also has fatigued, his urine output has changed, loss his appetite and he is losing weight. These four symptoms are also signs of serious kidney problems. Acute kidney issues are most often diagnosed during a hospital stay for another cause. Acute renal failure happens quickly whereas chronic renal failure develops over time. 2. The normal RBC in men: 4.7 to 6.1 million cells per microliter (cells/mcL). George’s is 3.8 millions cells/mcL which is fairly low. His Hgb is 11.0. This is lower than the normal range of 12.4/14.9. These results from the blood test are symptoms of mild anemia. The low RBC and the low Hbg is usually caused by an abnormality or a disease. Cancer and aplastic anemia can cause the body to produce fewer red blood cells. 3. All of George’s urine test results were abnormal. When the kidneys are damaged, they fail to discharge excess creatinine and urea nitrogen, serum creatinine and blood urea nitrogen level increase. In patients with damaged Chronic Kidney Failure, their glomerular filtration membrane is damaged seriously and large amounts of protein leak into urine, causing proteinuria. For his age, his GFR is low. This shows moderate decrease in renal function. 4. By stage II, 78-80 percent nephron function is lost and replaced by scare tissue. During End Stage Renal Disease only 10% of nephrons remain functioning. At this stage the GFR is significantly diminished. For those that have GFR of 10, it means that they have less...
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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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...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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...An Overview of Renal Failure and Its Treatment Option Renal failure can affect any population in society with no discrimination to age or race. There are several different types of renal failure and a multitude of treatment options depending on the severity or complexity of the disease process. With a change in healthcare on the horizon an examination into the area and the current school of thought is a must. While renal failure is just one small area of the healthcare sector, it is rapidly growing and affecting more and more every day. According to the data from the CDC more than 4.4 million Americans are diagnosed with some form of kidney disease (CDC). Renal Failure is best defined when the kidneys no longer work properly. Now one might ask, what do the kidneys do? The kidney’s simply remove metabolic waste and water from the human body and maintain homeostasis. Without the kidneys functioning properly the body will no longer make urine and dangerous electrolyte abnormalities can occur. One must realize there are several categories of renal failure. The two main classifications are Acute and Chronic Renal Failure. Acute Renal Failure is best defined as rapid and new onset renal failure sometimes reversible when treated appropriately while Chronic Renal Failure long term and irreversible unless treated via transplant. Now that a basic foundation definition of Renal Failure has been established, one must gain knowledge of what causes Renal Failure. Now that there...
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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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...Pathophysiology: Neoplasia and Renal System School of Nursing 1. Cancer Staging Cancer staging describes the severity of a person’s cancer based on the person’s initial tumor, and whether or not the cancer has metastasized (American Cancer Society, 2012, www.cancer.org). Knowledge of the stage is very important in that is can be used to explain prognosis to the patient, and can be used by the doctor and the patient to plan treatment. Staging of cancer is based on knowledge of the way in which cancer progresses in the body. Malignant cells grow and reproduce without any control or order, and they do not die when they should. In most cases the cancer cells will form a mass called a tumor. As the tumor grows it can invade tissues and organs that are close to it. The malignant cells can also break away from the tumor and enter the bloodstream (Lemone, 2004, p. 284). There are five common elements considered in most staging systems: site of the primary tumor, tumor size and number, lymph node involvement, cell type, and the presence or absence of metastasis. A common staging system is called TNM, which stands for Tumor, lymph Nodes, and Metastasis. When staging a number is added to each letter to indicate the size of the primary tumor and the extent of the cancer spread. (Lemone, 2004, p. 284) Infection, immunity and inflammation in cancer patients are all interrelated. They form what could be...
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...Central University of Technology, Bloemfontein Early detection and prevention of Chronic Kidney Disease Contents page Definition of key terms used in the assignment Abbreviations used in the assignment Introduction Chronic Kidney Disease, a condition characterised by a gradual loss of kidney function. CKD is often misdiagnosed owing to the lack of knowledge about the disease. With early detection and prevention of the progression of the disease CKD patients can still enjoy life to the fullest while they manage their disease, however if the healthcare professionals fail to identify the disease on time the patient can suffer dire consequences. Besides the financial implications associated with the disease, there are the emotional implications together with physical and psychological. This assignment seeks to explore such 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...
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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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