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Notes on Acute Renal Failure - Nursing |, Study notes of Nursing

Material Type: Notes; Class: Nursing; Subject: Nursing; University: Morehead State University; Term: Forever 1989;

Typology: Study notes

Pre 2010

Uploaded on 12/09/2009

germywade82
germywade82 🇺🇸

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Acute Renal Failure
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Acute Renal Failure

Acute vs. Chronic

  • (^) ARF
  • (^) Onset
    • (^) sudden
  • (^) Nephron involvement
    • (^) 50%
  • (^) Duration
    • (^) less than 3 months
  • (^) Prognosis
    • (^) Good
      • (^) CRF
      • (^) Onset
        • (^) Gradual (months-years)
      • (^) Nephron involvement
        • (^) 90%-95%
      • (^) Duration
        • (^) Permanent
      • (^) Prognosis
        • (^) Fatal without renal replacement therapy

Renal Insufficiency

  • (^) enough function to survive but with significant

loss of function

  • (^) 25% of normal function
    • (^) GFR of 25-30 ml/min
  • (^) any additional stressor can lead to failure

ARF

  • (^) Causes (Iggy p 1730,Table 75-2)
    • (^) Prerenal: perfusion
    • (^) intrarenal (intrinsic): damage to kidney (toxins/infection)
    • (^) post renal: obstruction

OLIGURIC

  • (^) Potassium Imbalance
    • (^) hyperkalemia with oliguric phase
    • (^) arrhythmias, death, paresthesias, paralysis
  • (^) Sodium Imbalance
    • (^) hyponatremia with fluid overload
      • (^) warm moist flushed skin, muscle weakness, muscle twitching, mental status changes, seizure
    • (^) hypernatremia
      • (^) with too much sodium intake

OLIGURIC

  • (^) Metabolic Acidosis
    • (^) H+ secretion & HCO3 production decrease in tubules
    • (^) Kussmauls respirations
      • (^) respiratory system compensates

CLINICAL MANIFESTATIONS

  • (^) CHART
  • (^) Laboratory Profile
    • (^) Chart
  • (^) Radiographic
    • (^) X-ray of abdomen-size of kidney
    • (^) Renal ultrasound: renal calculi
    • (^) CT: obstruction/tumors
    • (^) Aortorneal angiography: renal blood flow

Medication Therapy

  • (^) determine cause - treat underlying factors
  • (^) Prerenal azotemia
  • (^) hypovolemia
    • (^) hypotonic solutions (.45% NS) or NS
    • (^) Diuretics
  • (^) blood loss - transfuse/NS
  • (^) hyperkalemia
    • (^) dialysis, Kaexylate, loop diuretics
  • (^) inflammation: glucocorticoids

Dialysis

  • (^) Blood is filtered through a semi permeable

membrane

  • (^) helps correct
    • (^) fluid overload
    • (^) azotemia
    • (^) hyperkalemia
    • (^) metabolic acidosis
    • (^) remove certain toxins

Continuous Renal Replacement Therapy

  • (^) continuous UF of ECF

and clearance of toxins

  • (^) done in ICU
  • (^) CVVHD

Activity

  • (^) severe activity intolerance
    • (^) anemia
    • (^) acidosis
  • (^) plenty of rest

Referrals

  • (^) Dietician
  • (^) National Kidney Foundation

Renal Disorders

Nephrosclerosis

  • (^) damage to renal arteries, arterioles, glomeruli
  • (^) caused by HTN, atherosclerosis, DM
  • (^) Benign
    • renal arteries - lumen - thick/narrow
    • (^) glomeruli capillaries - sclerosed/collapse
    • atrophy of renal tubules
    • (^) symptoms: mild, proteinuria, casts, renal insufficiency, increased risk for ARF