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Acute vs Chronic Renal Failure.

Acute vs Chronic Renal Failure.

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Published by Stephanie Hurewitz
A short essay about acute vs. chronic renal failure for nursing school (LPN)
A short essay about acute vs. chronic renal failure for nursing school (LPN)

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Published by: Stephanie Hurewitz on Jan 13, 2013
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Acute vs. Chronic Renal Failure
 Renal failure is caused by conditions that diminish blood flow to the kidneys resulting in damageleaving the kidneys unable to function. Metabolic waste products ultimately build up in the body causingfluid, electrolyte and acid-base imbalances. Renal failure is classified as either acute or chronic based ononset and reversibility. Acute renal failure occurs within one to seven days and may be reversible.Chronic renal failure can take months to years to occur and is not reversible. The causative factors of 
acute and chronic renal failure are different as well. Acute renal failure’s causative factors are divided
into 3 categories prerenal, intrarenal, and postrenal. The glomeruli need a systolic blood pressure of greater than 70 mmHg for adequate function. If SBP drops to less than 70 mmHg, prerenal damage canoccur. Nephrotoxic agents, kidney infections, blockage of arteries inside the kidneys, hypertension,diabetes mellitus, or direct trauma to the kidney can cause intrarenal damage. Postrenal damage occurswhen urine backs up due to obstruction past the kidneys caused by benign prostatic hypertrophy, andureteral calculi.Acute renal failure can affect nearly every body system causing symptoms such as lethargy,nausea, vomiting, diarrhea, dehydration, drowsiness, headaches, muscle twitching and seizures. Theprogression of the condition follows four stages; onset, oliguric, diuresis, and recovery. The onset stagetypically lasts 1-3 days and is when symptoms first occur. The oliguric stage lasts up to 14 days duringwhich urine output is less than 400mL per day. During the diuretic stage urine output increases to over400mL per day and may increase to around 4L per day. Despite excreting such large volumes of fluid,waste products are excreted causing additional electrolyte imbalances. The final stage is the recoverystage which can last up to 12 months. If during the recovery stage enough healing does not occur toresume normal function, chronic renal failure may develop.When assessing a patient in acute renal failure the most important aspect is monitoring fluid,electrolyte, and acid-base balances. During renal failure BUN and serum creatinine rise dramatically andare monitored frequently to assess kidney function and progression of the disease. Due to decreasedkidney function potassium is not excreted causing hyperkalemia which can lead to cardiac dysrhythmias.Metabolic acidosis frequently occurs due to the inability of the kidneys to function as a buffering systemand an increase in acidic components in the blood. In addition to fluids and electrolyte imbalances,erythropoietin production is reduced causing decreased red blood cell production which causes anemia. Inorder to measure fluid levels strict I&Os should be obtained however a more accurate method of 
 
monitoring fluids is by taking the patient’s weight daily.
When weighing the patient, make sure thatvariables such as amount of clothing, time, and specific scale used are kept the same to ensure accuracy.
If a patient’s weight changes by one pound that is equivalent to 500mL of fluid.
Treatment for acute renal failure is aimed at preventing further damage to the kidneys, resolvingany causative factors, and to allow healing to take place. Supportive measures help to control symptomsand prevent additional complications. Supportive measures include fluid and diet adjustments,supplementation to restore electrolyte balance, and dialysis if needed. Conditions that warranthemodialysis include hyperkalemia, severe metabolic acidosis, pulmonary embolism, and rising BUN.The initial cause of the kidney damage is determined and treated. Various medications are used to treatindividual symptoms or complications. Some examples of this are diuretic agents are used to treatoliguria and IV hypertonic glucose and insulin, sodium bicarbonate, and calcium gluconate to treathyperkalemia. Determination of chan
ges to the patient’s diet is
 
made based on the individual patient’s
needs. Carbohydrate intake is usually increased to prevent the breakdown of fat and protein.The nurse caring for a patient with acute renal failure must monitor fluid balance, givemedications as ordered, monitor for adverse effects, and monitor cardiac and respiratory function. Fearand anxiety may occur so it is important to provide honest answers to any questions the patient mighthave. Any specific questions about their prognosis should be referred to the physician. Due to electrolyteimbalances and reduced mobility, complications may arise in other body systems. It is important that thenurse be aware of these potential complications and performs the appropriate interventions to preventthem. It is important that the patient understand the reason for the interventions to increase complianceand improve self-care when discharged. Patient teaching is aimed at providing basic information aboutthe disease and any diagnostic tests, procedures, or treatments. Provide patient teaching about diet,management of fluids, drug therapy, activity, and signs and symptoms that should be reported to thephysician such as dyspnea, edema, or fever.Chronic renal failure is a progressive, irreversible decline in renal function in which the kidneyscannot maintain fluid and electrolyte balance. The most common causes of chronic renal failure arediabetes mellitus, hypertension, and vascular disorders. Chronic kidney infections, obstruction of urine,polycystic kidney disease, and nephrotoxic agents can lead to chronic renal failure as well. Chronic renalfailure is divided into three stages; stage 1 also called reduced renal reserve, stage 2 or renal insufficiency,and stage 3 or end-stage renal disease. During the reduced renal reserve stage, nephron function loss isabout 40%-70%. Typically the patient does not present with symptoms because the remaining nephronsare able to compensate for the decline in function. During the renal insufficiency stage, only 10%-25% of nephrons are functioning. Serum creatinine and BUN are elevated, urine output is significantly increased

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