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Acutetubularnecrosis
Acutetubularnecrosis
• Joyce, age 45, was admitted to the emergency room following a major
automobile accident in which her husband was killed. She had massive
abdominal injuries and a fractured femur. She was taken immediately to
surgery for repair of a lacerated liver and perforated ileum. She had two units
of blood during surgery and two units while she was in the recovery room.
The fifth unit of blood was discontinued in surgical intensive care because
she developed a transfusion reaction.
• On the day after surgery, her urine output declined to 10-20 ml/hr.
Increasing her fluid intake with plasma expanders and blood did not increase
her urine output. Lab results indicated an elevated urinary sodium, BUN 70
mg/dl, and serum creatinine 4 mg/dl.
• Her urine output stabilized at 20-25 ml/hr on the third day after surgery.
She was diagnosed as having acute tubular necrosis.
• Because of a persistently elevated serum potassium and severe
hypertension (BP 190/120), she was started on hemodialysis using an
external cannula. She resented all the “plumbing” in her body and expressed
a desire to die.
QUESTIONS FOR DISCUSSION
1. What are the possible causes of acute tubular necrosis that Joyce developed?
2. What clinical indicators that Joyce is in the oliguric phase of acute renal failure?
3. What are the critical nursing assessments indicated when caring for Joyce?
6. What are the usual indications for using hemodialysis in the management of acute renal
failure?
7. Joyce wants to know if she is going to be on hemodialysis for the rest of her life. How
would you answer this question?
8. What is the nursing care of the external cannula when not in use?
2. What clinical indicators that Joyce has in the oliguric phase of acure renal failure?
Decrease urine output <30 cc/hr
3. What are the critical nursing assessments indicated when caring for Joyce?
Replace fluid by: 10 = 240 cc/24 hrs. 20 = 480 cc/24 hrs.
3. T.C. ‘s serum creatinine climbs to 5.4mg/dl and his BUN to 101mg/dl. He is becoming
more irritable and lethargic. The family (wife, 5 children and spouses, numerous
grandchildren) maintain a vigil at the bedside.
5. Laboratory values indicate that dialysis is necessary, but prior to the initial surgery. T.C.
indicated that he wanted no heroic measures taken if the surgery did not go well. He
refuses dialysis and the family supports his decision. What can the nurse do to
comfort both the patient and his family?
3. T.C.’s serum creatinine climbs to 5.4 mg/dl and his BUN to 101
mg/dl. He is becoming irritable and lethargic. The family (wife, 5
children and spouses, numerous grandchildren) maintain a vigil at
the bedside. What can you do to help the family?
Answers #2
4. Give emotional support. Explain that patient undergone massive loss of
blood and this contribute to poor functioning.” Hopefully, he’ll come out
of it, and we’re doing everything we can.”
5. Lab. Values indicate that dialysis is necessary, but prior to the initial
surgery T.C. indicated that he wanted no heroic measures taken if the
surgery did not go well. He refuses dialysis. What can the nurse do to
comfort both the patient and his family?
6. Explain kidney failure and dialysis is indicated to help get rid of toxic
substances in the system to prevent patient from dying.