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Test 4 Outline[1]

Test 4 Outline[1]

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Published by mara5140
Nursing
Acute Renal Failure stuff
Nursing
Acute Renal Failure stuff

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Published by: mara5140 on Oct 22, 2008
Copyright:Attribution Non-commercial

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05/09/2014

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Test 4 Outline
Kidney(Endocrine)Secreted hormone From cells EffectRenin(Primarily)
Calcitriol(1,25-dihydroxyvitamin D
3
)
Active form of vitaminD3 Increase absorption of calciumand phosphate  fromgastrointestinaltractand kidneysinhibit release of PTH
stimulatesmegakaryocytesto produce  platelets
Acute Renal Failure (ARF)-rapid loss of renal fxn due todamage to kidneys resulting in retention of nitrogenous waste(urea and Creatinine) and non-nitrogenous waste products thatare norm excreted to the kidneys
Incidence and Mortality
Prevention
Precipitating factors
o
Prerenal(causes in the blood supply):
Hypovolemia (decreased blood volume),usually fromshock or dehydration and fluid loss or excessivediureticsuse.
hepatorenal syndrome in which renal perfusionis compromised inliver failure
vascular problems, such asatheroembolic disease andrenal vein thrombosis(which can occur as acomplication of thenephrotic syndrome)
infectionusuallysepsis, systemic inflammation due to infection
o
Intrarenal(damage to the kidney itself):
 
rhabdomyolysis(breakdown of muscletissue) - the resultant release of myoglobinin the blood affects thekidney; it can be caused byinjury (especially crush injury and extensive blunt trauma),statins,stimulantsand some other drugs
hemolysis(breakdown of red bloodcells) - thehemoglobindamages the tubules; it may be caused by variousconditions such assickle-cell disease,and lupus erythematosus 
multiple myeloma, either due tohypercalcemiaor "cast nephropathy"(multiple myeloma can also causechronic renal failure  by a differentmechanism)
acuteglomerulonephritiswhich may bedue to a variety of causes, such as antiglomerular basement membranedisease/Goodpasture's syndrome,Wegener's granulomatosisor acute lupusnephritis with systemic lupuserythematosus
o
Post renal(obstructive causes in the urinarytract) due to:
Medicationinterfering with normal bladder emptying.
Due to abdominal malignancy (e.g.ovarian cancer , colorectal cancer ).
.
Pathophysiology
o
Prerenal conditions
o
Intrarenal conditions
o
Post renal conditions
Clinical manifestations- Metabolic Acidosis andHyperkalemia most serious biochemical manifestations
DX:
o
BUN, Creatinine
o
UA
o
CBC
Medical Mgmt
o
Diuretics
o
Correct electrolyte imbalances
 
o
Dialysis
o
Fluid restriction
o
diet
 Nsg Dx:
o
Tissue perfusion
o
Alteration in elimination
 Nsg Interventions:
o
Pt assessment
o
VS
o
UOP
o
Labs
o
QD weights
o
 Nutrition
o
Prevent systemic infection
o
Prevent comps of immobility
o
Skin and mucous membrane care
o
Assess for GI bleed
o
Assist with hemodialysis
o
Assure pt safety
o
Provide psychosocial support
o
Pt. teachingChronic Renal Failure
Incidence and Mortality
Prevention
Precipitating factors
o
Tubulointerstitial disease
o
Glomerulonephropathies
o
 Nephritic syndrome
o
Renal vascular disorders
o
Renal CA
Pathophysiology
o
Diminished renal reserve
o
Renal insufficiency
o
End stage renal disease
o
Uremic syndrome
Manifestations
DX
Med/Surg mgmt
o
Diet
o
Fluid restriction
o
Pharmacology
o
Blood product transfusion
o
Dialysis
o
 Nephrostomy tubes/ nephrectomy
o
Renal transplantation
 Nsg Dx:
o
Excess fluid vol
o
Alteration in nutrition
 Nsg. Interventions
o
Pt assessment
o
VS
o
LAB
o
I/O
o
QD weight
o
Cardio pulmonary assessment
o
Adequate nutrition

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