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Types - Renal Failure | 12th Nursing : Chapter 2 : Medical Surgical and Applied Nursing Management Psychology of Human Diseases

Chapter: 12th Nursing : Chapter 2 : Medical Surgical and Applied Nursing Management Psychology of Human Diseases

Renal Failure

Kidneys are two bean-shaped organs located in lower back.

Renal Failure

Kidneys are two bean-shaped organs located in lower back. It excretes wastes and extra fluids from the body and producing and balancing chemicals that are necessary for body to function

Types

Acute real failure(ARF)

               Sudden onset

               Rapid reduction in urine output-usually irreversible

Chronic renal failure(CRF)

               Progressive

               Not reversible

 

1. Acute Renal Failure

Definition

Acute Renal Failure –is a sudden and almost complete loss of kidney function caused by failure of the renal circulation or by glomerular or tubular dysfunction

Causes of ARF

               Pre-renal (60-70 % )

               Volume Depletion

               Hemorrhage

               Renal losses

               Sepsis

               Cardiac failure

               Anaphylaxis

Intra renal (5-10%)

               Pigment Nephropathy

               Myoglobinuria

               Hemoglobinuria

               Nephrotoxic agents

Post-renal (20-40% cases)

               Urinary tract obstruction

               Calculi

               Tumors in lower urinary tract

People in risk

               Being hospitalized especially for a serious condition that requires intensive care

               Advanced age

Post-renal (20-40% cases)

               Urinary tract obstruction

               Calculi

               Tumors in lower urinary tract

People in risk

               Being hospitalized especially for a serious condition that requires intensive care

               Advanced age

               Blockages in the blood vessels in arms or legs

               Diabetes

               High blood pressure

               Heart failure

               Kidney diseases

               Liver disease

 

Signs and Symptoms of ARF

               Oliguria - Urine output less than 400ml/ day

               Anuria - Urine output less than 100ml/day

               Increased BUN creatinine

               Hyper Kalemia

               Metabolic acidosis

               Edema

               Mental changes

               Heart failure

               Nausea, vomiting

               Pruritus

 

Diagnosis

               History of underlying cause

               Blood- Increased potassium, BUN, Creatinine

               Urine: decreased volume and specific gravity is fixed or increased

               Renal ultrasound, renal scan, renal biopsy, CT scan or MRI, KUB X-ray, Retrograde pyelogram.

 

Management

               Removal of the underlying cause

               Diuretics

               Fluid restriction (600 ml plus previous day output) Calcium supplements or phosphate binding agents

               Nutritional therapy

               -Protein intake 0.6/kg/day

               -Potassium restriction

               -sodium restriction

               -Calorie intake 30 to 35 kcal/day/kg body weight

               -Dialysis

 

2. Chronic Renal Failure (ESRD-End stage Renal Disease)

Definition

Chronic or irreversible renal failure is a progressive reduction of functioning renal tissue or loss of renal function in which the body’s ability to maintain metabolic and fluid electrolyte balance fails, resulting in uremia or azotemia over a period of months or years.

Causes

               Diabetic Nephropathy

               Hypertension

               Glomerulonephritis

               Pyelonephritis.

               HIV nephropathy

               Reflux nephropathy in children

               Polycystic kidney disease

               Kidney infections and obstructions

               Chronic pyelonephritis

               Head, Cadmium, mercury and chromium

Clinical manifestation

               Amenorrhea

               Testicular atrophy

               Malaise and Fatigue

               Pitting edema

               Periorbital edema

               Engorged neck veins

               CHF

               Anorexia

               Nausea

               Vomiting

               Seizure

               Constipation

               Peptic ulceration

               Diverticulosis

               Anemia

               Pruritus

               Jaundice

               Hypertension

               Pericarditis

               Peripheral neuropathy, dialysis dementia

Diagnosis

               History collection

               Physical examination

               Identification of reversible renal disease

               Renal ultrasound

               CT scan / Doppler

               Renal biopsy

               Blood-BUN, creatinine, electrolytes, Hb level

               Urine analysis

               Renal biopsy

Management

Medical

               Calcium and phosphorous binders and phosphate binders

               Anti hypertensive drugs-to control BP

               Hypoglycemic agents-to reduce and maintain blood sugar level

               Fluid restriction-600 ml plus previous day output)

               Diuretics-to increase the output

               Erythropoien-to maintain RBC count

               Dialysis

               Peritoneal

               Hemodialysis

Diet

               Low protein - 0.8 gm protein/kg/day with normal carbohydrate

               Low potassium (avoid bananas, dry fruits, fruit juices), low phosphorus (soak vegetables 24 hr prior to cooking).

               Fluid allowances per day is 500 ml to 600 ml plus previous day urine output

Surgical management

               Renal transplantation

Nursing management

               Assessing fluid status and ideentifying potential source of imbalance

               Implementing a dietery program to ensure proper nutrional intake

               Promoting positive feelings by encouraging increased self-care and greater independence

               Provide explanations and information to the patient and family concerning ESRD, treatment options and potential complications.

               Provide emotional support to the patient and family

               Health education on diet and fluids.

Complications

               Hyperkalemia

               Pericarditis

               Pericardial effusion

               Pericardial tamponade

               Hypertention

               Anaemia

               Increased incidence of fracture

 

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12th Nursing : Chapter 2 : Medical Surgical and Applied Nursing Management Psychology of Human Diseases : Renal Failure | Types

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12th Nursing : Chapter 2 : Medical Surgical and Applied Nursing Management Psychology of Human Diseases


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