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INTRODUCTION
WHAT IS ACUTE RENAL FAILURE?
the sudden loss of our kidneys' ability to perform their main function of eliminating excess fluid and salts (electrolytes) as well as waste material from our blood. develops rapidly over a few hours or a few days.
urine volume less than 400 ml per 24 hours. increased in serum creatinine, urea, uric acid, organic acids, potassium, and magnesium lasts 3 to 5 days in infants and children 10 to 14 days in adolescents and adults.
CAUSES OF ARF
3 categories: 1. PRERENAL - A sudden, serious drop in blood flow to the kidneys. 2. INTRARENAL - Direct damage t the kidneys by inflammation, toxins, drugs, infection or reduced blood supply. 3. POSTRENAL - A sudden blockage that stops urine from flowing out of the kidneys.
COMPLICATIONS
1.Permanent kidney damage 2.DEATH
TERMS
HYPOTHESIS
INFERENCE
Blood urea nitrogen (BUN) measures the amount of urea nitrogen, a waste product of protein metabolism, in the blood. Urea is formed by the liver and carried by the blood to the kidneys for excretion. Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass).
Reference: http://en.wikipedia.org/wiki/Creatini ne http://www.rnceus.com/renal/renalb un.html
CONCLUSION
Partially accepted.
Nitrogen
Waste products excreted by the kidneys.
HYPOTHESIS
INFERENCE
CONCLUSION
Accepted
the urine .
Measureme nt of amount of sodium
excreted in
the urine.
TERMS
HYPOTHESIS
INFERENCE
CONCLUSION
Urine specific Accepted gravity is a laboratory test that measures the concentration of all chemical particles in the urine.
Reference: http://www.nlm.nih.gov/medli neplus/ency/article/003587.ht m
LEARNING ISSUE 1. What is the relationshi p of (+) history of heart trouble in the renal alteration of the client?
HYPOTHESIS
When the patient
INFERENCE
CONCLUSION
Renal vasoconstriction, has renal failure, which is the narrowing of the blood vessels there is water resulting from retention in the contraction of the body that results muscular wall, is an early symptom of to fluid overload. congestive heart This results to an failure. Progressively, severe hypertension increase in the can do incredible workload of the damage to the kidneys
REJECTED
LEARNING ISSUE
2. Why does the patient experience dizziness when getting up from lying position?
HYPOTHESIS
Maybe this is due to orthostatic hypotension. The patient maybe suddenly gets up from a lying position that causes sudden decrease in his blood pressure and also because of his age.
INFERENCE
Orthostatic hypotension also called postural hypotension is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint. Orthostatic hypotension can happen to anyone but is more common in older adults.
Reference: http://www.mayoclinic.com/health/ort hostatic-hypotension/DS00997
CONCLUSION
ACCEPTED
LEARNING ISSUE
3. What is the
possible diagnosis for the patients case?
HYPOTHESIS
Based on the patients case, it can be urinary retention or acute renal failure.
INFERENCE
CONCLUSION
LEARNING ISSUE
4. Why does the
patient experience swelling / edema of the feet?
HYPOTHESIS
Because there is fluid overload and urinary retention.
INFERENCE
Swollen foot indicates heart failure, kidney failure. In these conditions, there is too much fluid in the body. Reference: http://www.nlm.nih.gov/ medlineplus/ency/article /003104.htm
CONCLUSION
ACCEPTED
LEARNING ISSUE
5. What are the
risk factors contributing to the possible diagnosis (acute renal failure)?
HYPOTHESIS
Age, history of heart trouble, lifestyle and genetics.
INFERENCE
Being hospitalized, especially for a serious condition that requires intensive care, Advanced age, Blockages in the blood vessels in your arms or legs (peripheral artery disease),Diabetes, High blood pressure, Heart failure, Kidney diseases, Liver disease. Reference: http://www.mayoclinic.co m/health/kidneyfailure/DS00280/DSECT ION=risk-factors
CONCLUSION
ACCEPTED
LEARNING ISSUE
6. What are the
signs and symptoms of the possible diagnosis (acute renal failure)?
HYPOTHESIS
Urinary retention, edema, dry skin, hypertension, dizziness.
INFERENCE
Decreased urine output, although occasionally urine output remains normal Fluid retention, causing swelling in your legs, ankles or feet Drowsiness Shortness of breath Fatigue Confusion Nausea Seizures or coma in severe case Chest pain or pressure Reference: http://www.mayoclinic.co m/health/kidneyfailure/DS00280/DSECT ION=symptoms
CONCLUSION
ACCEPTED
LEARNING ISSUE
7. What are the
normal values of BUN, creatinine, urine sodium, and specific gravity of the urine?
HYPOTHESIS
BUN = 60-80mg/dL CREATININE= 0.1 1.0 mg/dlL URINE SPECIFIC GRAVITY = 0.001 0.010 URINE SODIUM = 8 10 mEq/L
INFERENCE
BUN = 8.00 23.00 CREATININE = 0.51 0.95 URINE SPECIFIC GRAVITY = 1.002 1.030 URINE SODIUM = 15 250 mEq/L REFERENCE: (PPDs Nursing Drug Guide 2nd edition) Medical Surgical Nursing by J.B. Lippincott Company
CONCLUSION
REJECTED
LEARNING ISSUE
8. What are the
purpose or indications of BUN, creatinine, urine sodium and specific gravity in the possible diagnosis (acute renal failure)?
HYPOTHESIS
To asses if the result are within the normal and can be useful in diagnosing the patients condition.
INFERENCE
Kidney function tests are common lab tests used to evaluate how well the kidneys are working. These include: BUN, creatinine blood, creatinine clearance, creatinine urine. Reference: http://www.nlm.nih.gov/ medlineplus/ency/article /003435.htm
CONCLUSION
ACCEPTED
The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines.
Every day, a persons kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.
The kidneys remove wastes and water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters. Wastes in the blood come from the normal breakdown of active tissues, such as muscles, and from food. The body uses food for energy and self-repairs. After the body has taken what it needs from food, wastes are sent to the blood. If the kidneys did not remove them, these wastes would build up in the blood and damage the body.
The actual removal of wastes occurs in tiny units inside the kidneys called nephrons. Each kidney has about a million nephrons. In the nephron, a glomeruluswhich is a tiny blood vessel, or capillaryintertwines with a tiny urine-collecting tube called a tubule.
The glomerulus acts as a filtering unit, or sieve, and keeps normal proteins and cells in the bloodstream, allowing extra fluid and wastes to pass through. A complicated chemical exchange takes place, as waste materials and water leave the blood and enter the urinary system.
PATHOPHYSIOLOGY
Prolonged HPN
Increase Viscosity of blood
glumerulosclerosis
No release of renin
Increase BUN,Crea
Decrease GFR
Na,H2o,Urea retention
HPN
Postural hypotension
LABORATORY RESULTS
ANALYTE
RESULT
NORMAL RANGE
Nursing Consideration
1. Assess for urine ferrous, odor of breath, stomatitis and gastro
mg/dL 25 mg/dl
intestinal bleeding.
2. Provide oral
pruritus.
ANALYTE
RESULT
NORMAL RANGE
Creati 4 nine
0.4
stomatitis and
gastro intestinal bleeding. 2. Provide oral
skin care to
prevent uremic frost and pruritus.
ANALYTE
RESULT
NORMAL RANGE
SIGNIFICANCE
Nursing Consideration
1. Accurate measurement and recording of intake and output.
Sodium 15
15
mEq/L 250
mEq/L
2. Monitor for
weight gain and edema. 3. Encourage patient to remain within prescribed fluid restriction. 4. Provide hard candy and chewing
ANALYTE
RESULT
NORMAL RANGE
SIGNIFICANCE
Nursing Consideration
1.002
1.030
http://pathcuriel.
swmed.edu/path
demo/nrrt.htm#ur
ine
Assessment
Diagnosis
Planning
Intervention
Rationale
Expected Outcome