1 / 16

Adult Medical-Surgical Nursing

Adult Medical-Surgical Nursing. Renal Module: Acute Renal Failure. Acute Renal Failure: GFR. The glomerular filtration rate (GFR) indicates the efficiency of the kidney nephrons: In concentrating urine to excrete toxins from the body In maintaining water and electrolyte balance in the body

jarrod-eaton
Download Presentation

Adult Medical-Surgical Nursing

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adult Medical-Surgical Nursing Renal Module: Acute Renal Failure

  2. Acute Renal Failure: GFR • The glomerular filtration rate (GFR) indicates the efficiency of the kidney nephrons: • In concentrating urine to excrete toxins from the body • In maintaining water and electrolyte balance in the body • Average urine output is approximately 1500 ml/ 24 hours

  3. Acute Renal Failure: Classification • A sudden decrease in the glomerular filtration rate (occurring in hours to days) • Oliguria: < 400ml urine output in 24 hours • Anuria: < 50 ml in 24 hours • There may be normal volume but failure to concentrate urine therefore inability to rid the body of waste products • Urine output should be at least 30ml/ hour (400 ml/24 hours) in order to excrete metabolic waste

  4. Acute Renal Failure: Causes • Pre-renal (60% of cases) • Acute Tubular Necrosis (35-40%) • Post-renal (5%)

  5. Acute Renal Failure:Pre-renal Causes (Hypoperfusion) • Pre-renal: hypoperfusion of the kidneys. Impaired blood flow leads to ↓ GFR and urine output • Caused by: • Hypovolaemia (haemorrhage, burns, diarrhoea and vomiting) • Impaired cardiac function • Vasodilation (anaphylactic or septic shock)

  6. Acute Renal Failure: Acute Tubular Necrosis • Direct trauma or toxicity to kidney tissue (nephrons: glomeruli, tubules) from: • Burns } myoglobin from muscle • Crush injuries • ABO incompatibility (agglutination RBCs) • Drugs: including nephrotoxic chemotherapy • Severe infections/ auto-immune reactions: pyelonephritis/ glomerulonephritis

  7. Acute Renal Failure: Post-renal Causes • Obstruction to urine flow in the renal tract leads to back-pressure, progressing to hydronephrosis and ↓ GFR. Caused by: • Tumours • Strictures • Calculi (stones) • Clots • Prostatic hyperplasia

  8. Acute Renal Failure:Four Clinical Phases • Initiation phase: from time of insult to oliguria (hours to days) • Oliguric period: Period of most clinical manifestations and abnormal kidney function tests (KFT) (10-20 days but may be months) • Diuresis: ↑ urine output but urine may be mostly water. Risk of dehydration. Symptoms/ KFT begin to improve (2-3 weeks) • Recovery: Symptoms/ KFT improved (3-12 months)

  9. Acute Renal Failure: Outcome • Recovery is possible but may not be complete: GFR 1-3% below normal • 50% of patients do not recover: acute renal failure may result in death or chronic renal failure

  10. Acute Renal Failure: Effects Failure of kidney function causes: Reduced urine volume, fluid retention, circulatory overload, ↑ BP Reduced urine concentration and excretion of toxic waste products of metabolism, most significantly: Raised blood urea/ creatinine Raised potassium: dysrhythmias Acidic substances: metabolic acidosis

  11. Acute Renal Failure: Clinical Manifestations • Reduced urine output • Weight gain and oedema; hypertension • Lethargy, drowsiness, sleep disturbance, convulsions, coma • Nausea, vomiting, cramps, diarrhoea • Hiccoughs, muscle twitching, restlessness • Cardiac dysrhythmias • Hyperventilation (acidosis) • Dry skin/ mucous membranes, fetor on breath

  12. Acute Renal Failure: Diagnosis • History and clinical picture • Oliguria • Altered KFT: • Raised blood urea, creatinine, potassium, uric acid, phosphates • Low serum calcium • Changes in urine specific gravity • ↑ urine sodium, cellular debris, RBC, WBC, casts • Metabolic acidosis (basal deficit; bicarb ↓)

  13. Acute Renal Failure:Clinical Management • Treat the cause • Support the patient (ICU) until recovery by: • Dialysis (usually via temporary central line) • Ventilation if necessary • Strict fluid intake restriction • Foley catheter • Diuretics to stimulate kidney function • Monitor for dysrhythmias and overload • Medications

  14. Acute Renal Failure:Nursing Considerations • Care in ICU; on ventilator if necessary • Continuous ECG monitoring • Monitor BP, JVP, oedema (overload) • Strict monitoring of intake/ output • Care of Foley catheter; hourly output (report <30ml) • Monitor progress through general condition, urine output, lab tests • Support relatives

  15. Acute Renal Failure: Medications • Diuretics: stimulate renal function • Insulin and Dextrose } ↓ high blood • Kayexalate potassium level • Calcium Gluconate • Sodium Bicarbonate: correct acidity • Aluminium hydroxide } correct • Calcium carbonate phosphate/ calcium levels

  16. Acute Renal Failure: Follow-up • Diet: Fluid restriction • Increased CHO (protein-sparing) • Reduced protein initially • Reduced potassium-containing foods • Reduced medication doses as toxic • Monitor progress: urine output, weight, BP, KFT • Monitor for anaemia: erythropoietin ↓

More Related