7/27/2019 Acute / Chronic Renal Failure

1/4

Aileen Anne G. De Ocampo

BSN IV-1 Group 1

Acute renal failure

Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove

toxic products from the body

PATHOPHYSIOLOGY

1. Pre-renal failure

Factors interfering with perfusion and resulting in diminished blood flow and glomerular filtrate,

ischemia, and oliguria; include CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, burns,

septicemia, hypotension, anaphylaxis

2. Intra-renal failure

Conditions that cause damage to the nephrons; include acute tubular necrosis (ATN),

endocarditis, diabetes mellitus, malignant hypertension, acute glomerulonephritis, tumors, blood

transfusion reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes, pesticides,

anesthetics)

3. Post-renal failure

Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors,

strictures, blood clots, trauma, and anatomic malformation

Three phases of acute renal failure

1. Oliguric phase

Urine output less than 400 cc/24 hours

duration 12 weeks

Manifested by dilutional hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia,

hypermagnesemia, and metabolic acidosis Diagnostic tests: BUN and creatinine elevated

2. Diuretic phase

Diuresis may occur (output 35 liters/day) due to partially regenerated tubules inability to

concentrate urine

Duration: 23 weeks; manifested by hyponatremia, hypokalemia, and hypovolemia

Diagnostic tests: BUN and creatinine slightly elevated

3. Convalescence or recovery phase

Renal function stabilizes with gradual improvement over next 312 months

Laboratory findings:

Urinalysis: Urine osmo and sodium

BUN and creatinine levels increased

Hyperkalemia

Anemia

ABG: metabolic acidosis

7/27/2019 Acute / Chronic Renal Failure

2/4

Nursing interventions

1. Monitor and maintain fluid and electrolyte balance.

Measure l & O every hour. note excessive losses in diuretic phase

Administer IV fluids and electrolyte supplements as ordered.

Weigh daily and report gains.

Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed

2. Monitor alteration in fluid volume.

Monitor vital signs, PAP, PCWP, CVP as needed.

Weigh client daily.

Maintain strict I & O records.

3. Assess every hour for hypervolemia

Maintain adequate ventilation.

Restrict FLUID intake

Administer diuretics and antihypertensives

4. Promote optimal nutritional status.

Administer TPN as ordered.

With enteral feedings, check for residual and notify physician if residual volume increases.

Restrict protein intake to 1 g/kg/day

Restrict POTASSIUM intake

HIGH CARBOHYDRATE DIET, calcium supplements

5. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, and

atelectasis)

6. Prevent fever/infection.

Assess for signs of infection.

Use strict aseptic technique for wound and catheter care.

7. Support client/significant others and reduce/ relieve anxiety.

Explain pathophysiology and relationship to symptoms.

Explain all procedures and answer all questions in easy-to-understand terms

Refer to counseling services as needed

8. Provide care for the client receiving dialysis

Chronic Renal Failure (END-STAGE RENAL DISEASE)

Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction.

The result is azotemia to UREMIA

Predisposing factors:

DM= worldwide leading cause

Recurrent infections

Exacerbations of nephritis

urinary tract obstruction

7/27/2019 Acute / Chronic Renal Failure

3/4

hypertension

PATHOPHYSIOLOGY

STAGE 1= reduced renal reserve, 40-75% loss of nephron function

STAGE 2= renal insufficiency, 75-90% loss of nephron function

STAGE 3= end-stage renal disease, more than 90% loss. DIALYSIS IS THE TREATMENT!

Assessment findings

1. Nausea, vomiting; diarrhea or constipation; decreased urinary output

2. Dyspnea

3. Stomatitis

4. Hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub

Diagnostic tests:

a. 24 hour creatinine clearance urinalysis

b. Protein, sodium, BUN, Crea and WBC elevated

c. Specific gravity, platelets, and calcium decreased

d. CBC= anemia

Medical management

Diet restrictions

Multivitamins

Hematinics and erythropoietin

Aluminum hydroxide gels

Anti-hypertensive

Anti-seizures

DIALYSIS

Nursing interventions1. Prevent neurological complications.

Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy,

confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).

2. Promote optimal GI function.

Assess/provide care for stomatitis

Monitor nausea, vomiting, anorexia

Administer antiemetics as ordered.

Assess for signs of Gl bleeding

3. Monitor/prevent alteration in fluid and electrolyte balance

4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and

administer aluminum hydroxide gels (Amphojel) as ordered

5. Promote maintenance of skin integrity.

Assess/provide care for pruritus.

Assess for uremic frost (urea crystallization on the skin) and bathe in plain water

7/27/2019 Acute / Chronic Renal Failure

4/4

6. Monitor for bleeding complications, prevent injury to client.

Monitor Hgb, hct, platelets, RBC.

Hematest all secretions.

Administer hematinics as ordered.

Avoid lM injections

7. Promote/maintain maximal cardiovascular function.

Monitor blood pressure and report significant changes.

Auscultate for pericardial friction rub.

Perform circulation checks routinely.

8. Provide care for client receiving dialysis.

Important Drugs

Aluminum hydroxide

(Amphogel)

Binds with PHOSPHATE to decrease

phosphorus

Kayexalate Binds with POTASSIUM to manage

hyperkalemia

Diuretics To decrease edema

Erythropoietin (Epogen) To increase RBC

Anti-Hypertensives To manage Hypertension