...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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...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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...1.Describe process of referral and management of renal dialysis patients. Nephrology referral is especially indicated when there is a rapid decline in kidney function, and elevated albumin and creatinine in stage four of chronic kidney disease. Also, when the kidney function is severely reduced. 2. Discuss the nursing role in care and management of clients in renal dialysis center. The nursing role in nursing care and management of clients in renal dialysis center: assess vital signs including blood pressure, respirations, apical pulse, and lung sounds. Record weight before and after treatment, assess vascular access site for a palpable pulsation or vibration and an audible bruit. Also, alert all personal to avoid using the extremity with...
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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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...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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...ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching the end of their lives are choosing to discontinue receiving aggressive renal replacement therapy and what knowledge and skills would be required to facilitate a change in practice and help them towards a ‘peaceful death’. End Stage Renal Disease presents many challenges to the patient who experience and suffer from it and the health care professionals who care for them. Its chronicity and...
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...DRUG STUDY Prescribed and Recommended Dosage, Frequency, and route of Administration ; tab OD, oral Generic Name Brand Name Classifications Mechanism of Action Indication Contraindication Adverse Reaction Nursing Responsiblities Sodium Bicarbonate Arm & Hammer Baking Soda, Neut, Soda Mint Acidifiers and alkalinizing Restores buffering capacity of the body and utilizes excess acid. >cardiac arrest >metabolic acidosis >systemic or urinary alkalinization >antacid >Contraindicated to pts w/ metabolic or respiratory alkalosis & in those with hypocalcaemia in w/c alkalosis may produce tetany, hypertension, seizures or heart failure >Also contraindicated in pts losing chlorides bec. of vomiting or continuous GI suction & receiving diuretics that produce hypochloremic alkalosis CNS: tetany CV: edema GI: gastric distention, flatulence Metabolic: hypokalemia, hyponatremia >Monitor pt closely for toxicity and affectiveness >Avoid using NaHCO3 and enteric-coated drugs together. DRUG STUDY Prescribed and Recommended Dosage, Frequency, and route of Administration 100mg OD, oral Generic Name Brand Name Classifications Mechanism of Action Indication Contraindication Adverse Reaction Nursing Responsiblities Allopurinol Aloprim, ApoAllopurinol + Zyloprim Hyperuricemia and gout preparations Reduces uric acid production by inhibiting xanthine oxidase >Gout or hyperurocemia >Hyperuricemia caused by malignancies >To prevent acute...
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...Levels of Neutrophil Gelatinase- Associated Lipocalin for Early Kidney Disease. Student’s Name University Table of Contents 1.0 Introduction/Background of the Study………………………………………………...3 2.0 Problem………………………………………………………………………………..3 3.0 Significance to Nursing……………………………………………………………….4 4.0 Purpose………………………………………………………………………………..4 5.0 Objectives……………………………………………………………………………..4 6.0 Research Questions……………………………………………………………………4 7.0 Methods of Study……………………………………………………………………...4 8.0 Quantitative or Qualitative…………………………………………………………….5 9.0 Research Design……………………………………………………………………….5 10.0 Sample………………………………………………………………………………..5 11.0 Procedures/results of Study…………………………………………………………..5 12.0 Findings………………………………………………………………………………6 13.0 Implications for Nursing……………………………………………………………....6 14.0 Contribution of Findings to Nursing Knowledge…………………………………….6 15.0 Ethical Considerations………………………………………………………………..6 16.0 Study Approval…………………………………………………………………….....7 17.0 Patient Privacy Protection………………………………………………………….....7 18.0 Conclusion…………………………………………………………………………….7 References……………………………………………………………………………….…8 1. Background of the Study Neutrophil Gelatinase also known as Oncogene 24p3 is associated with Lipocalin, Coresh et. al(2007). NGAL is a protein that is in humans and is always associated with the genes of LCN2.Lipocalin abbreviated...
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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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...Medication Sheet Medication/Dose/RouteClassificationGeneric/Trade Name | Action | ContraindicationAdverse Effects | Nursing Considerations | Acetaminophen/500mg/ By MouthAntipyretic& Analgesic (nonopioid)Acetaminophen/TylenolCarvedilol/6.25mg/By MouthAlpha- and beta-adrenergic blocker & AntihypertensiveCarvedilol/CoregDocusate Sodium/100mg/By MouthLaxative stool softenersDocusate Sodium/ColaceFurosemide/40mg/By MouthLoop diureticsFurosemide/Lasix | Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial...
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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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...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...
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...own until 4-27-12 when her family found her lying on the floor in her home. Pts family brought her to live with them but pt continued to have episodes of falling and hitting her head. Pt was taken to the ER and given a Ct of the brain where all results turned up normal. After at least 5 more falls the pts family took her back to the hospital with complaints of chest pain and palpitations. Pt was more confused than usual & and was having increased difficulty in gait. Physician suspected pt to have some left-sided weakness greater than left-sided weakness and chest pain. A second CT of the brain turned up normal. VS stable, but pt remains confused, weak, & complains of some dizziness and palpitations. Physician referred pt for admission to nursing home with admitting chief complains: chest pain, palpitations and frequent falls. PRESENT ILLNESS HISTORY: Patient currently has a diagnosis of essential (primary) hypertension, chest pain, palpitations, chronic kidney disease, dementia w/o behavioral disturbances, hyperlipidemia, and anemia. *Give a brief definition/description of each diagnosis. Essential hypertension is another term for high blood pressure. It is a systolic reading that is above 140 or a diastolic reading that is above 90 continuously. 120/90 is a normal blood pressure reading. (Burton & Ludwig. 2015, Pg. 345) Hyperlipidemia is a condition where high levels of fat accumulate in the blood (Hopper & Williams. 2015, pg. 471). Coronary Artery Disease...
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...Kidney disease 1 Running Head: CHRONIC KIDNEY DISEASE Understanding Chronic Kidney Disease Kim Prior Rock Valley College Kidney disease 2 Understanding Chronic Kidney Disease Chronic kidney disease is a growing problem with increasing numbers of patients being diagnosed and those beginning dialysis or the transplant process. “Currently, 26 million Americans have CKD…and 111,000 patients were newly diagnosed with end-stage renal disease in 1 year” (Castner, 2010, p. 26). Chronic kidney disease develops over years and can be considered a silent disease because many patients with this disease are diagnosed while being tested for another condition. Signs and symptoms of the disease are dependent on the cause, stage, and other medical conditions the patient has that may complicate the kidney disease. The first step is to identify patients with increased risk factors and early signs and symptoms of kidney disease. Risk factors include a family history, diabetes, smoking, obesity, hypertension, exposure to harmful substances that may injure the kidneys, and cardiac conditions such as heart failure or acute myocardial infarction (Castner, 2010). Patients that have these risk factors should be evaluated frequently by their physician as well as educated about lifestyle changes to decrease their risk (weight loss, exercise, smoking cessation, blood sugar control, blood pressure monitoring, and a healthy diet. Early signs and symptoms include fatigue...
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