NURSING CARE OF PATIENT WITH ACUTE RENAL FAILURE

PRESENTED BY H. RUFUS RAJ .MSN Lecturer, Al-Shifa college of nursing

What is Renal failure ?
Renal failure is the partial or complete impairment of kidney function resulting in an inability to excrete metabolic waste products & water, as well as causing functional disturbances of all body systems.

What is Acute renal failure?
Acute renal failure is a clinical syndrome characterised by rapid loss of renal function with progressive azotemia

ARF is often associated with oliguria which is a decrease in urinary outputto 400 ml/day

ARF usually develops over hours or days with progressive elevations of BUN, creatinine, & potassiun with or without oliguria

ETIOLOG Y

Contd…

PROGRESSIVE EVENTS IN ARF

CLNICAL COURSE OF ARF
INITIATING PHASE

OLIGURIC PHASE

DIURETIC PHASE

RECOVERY PHASE

CLINICAL MANIFESTATIONS
URINARY
Ø

Decreased urinary output Proteinuria Decreased specific gravity Decreased osmolality Increased urinary sodium

Ø

Ø

Ø

RESPIRATORY ØPulmonary edema ØPlural effusions

Ø

CARDIOVASCULAR ØVolume overload ØHeart failure ØHypotension Hypertension ØPericarditis ØPericardial effussion ØDysrhythmias

GASTROINTESTINAL ØNausea & vomiting ØAnorexia ØStomatitis ØBleeding ØDiarrhea ØConstipation
Contd…..

Contd….

HEMATOLOGIC

METABOLIC ØIncreased BUN ØIncreased creatinine ØDecreased sodium ØIncreased potassium ØDecreased pH ØDecreased bicarbonate ØDecreased calcium ØIncreased phosphate

Ø

Anemia Increased suspectibility to infection Defect in platelet functioning

Ø

Ø

NEUROLOGIC ØLethargy ØSeizures ØAsterixis ØMemory impairment

DIAGNOSTIC STUDIES
HISTORY & PHYSICAL EXAMINATION IDENTIFICATION OF THE PRECIPITATING CAUSE

LABORATORY STUDIES Serum creatinine & BUN Serum electrolytes Urinalysis

MANAGEMENT
Treatment of the precipitating cause Fluid restriction (600ml plus previous 24 hrs fluid loss) Nutritional therapy Measures to lower potassium Calcium supplements or phosphate binding agents Parentral nutrition Enteral nutrition Dialysis

Nutritional therapy
Adequate protein intake (0.6-2 g/kg/day) Potassium restriction Phospahate restriction Sodium restriction Daily calorie requirement – 30-35 kcal/day Sodium restricted to

DIALYSIS
INDICATIONS Volume overload resultinf g in compromised cardiac or pulmonary status Elevated potassium level with ECG changes Metabolic acidosis BUN level (>120 mg/dl) Significant change in mental status Pericarditis, pericardial effusion, cardiac tamponade

Peritoneal dialysis
v

Peritoneal dialysis uses the lining of the abdominal cavity as a filter to clean blood and remove excess fluid. A catheter is implanted into the abdomen by a minor surgical procedure and a fluid (dialysate solution) is infused through this. The dialysate solution, left for a few hours, capture and eliminate the waste products from your blood. The most common form of peritoneal dialysis called continuous ambulatory peritoneal dialysis (CAPD) changes dialysate four times a day.

v

v

v

Hemodialysis
Ø

Hemodialysis uses a mechanical membrane (dialyzer) with a special filter that removes waste and excess water from the blood.

Ø

The patient is connected to the machine by a tube running from a conduit created surgically between a large artery and vein.

Ø

The blood is circulated through the artificial kidney, which removes toxins and wastes. The blood is then returned to your body.

NURSING PROCESS

LIST OF NURSING DIAGNOSES
1. 2.

Excess fluid volume related to renal failure & fluid retention. Risk for infection related t invasive lines , uremic toxins, & altered immune responses secondary to kidney failure. Imbalanced nutrition: less than body requirement related to altered metabolic sate & dietary restrictions. Disturbed thought processes related to effects of uremic toxins on CNS. Fatigue related to anemia. Metabolic acidosis, & uremic toxins. Anxiety related to disease process, therapeutic interventions & uncertainty of progress.

3.

4.

5.

6.

THANK YOU
Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level

Sign up to vote on this title
UsefulNot useful