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Critical Care Nursing A Holistic Approach Part 6

Critical Care Nursing A Holistic Approach Part 6. Anatomy and Physiology of the Renal System. Chapter 28. Hormones. Antidiuretic Renin hormone Aldosterone Calcitriol Erythropoietin. Functions of the Renal System. Renal clearance Regulation Electrolyte concentration.

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Critical Care Nursing A Holistic Approach Part 6

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  1. Critical Care Nursing A Holistic ApproachPart 6

  2. Anatomy and Physiology of the Renal System Chapter 28

  3. Hormones • Antidiuretic • Renin hormone • Aldosterone • Calcitriol • Erythropoietin

  4. Functions of the Renal System • Renal clearance • Regulation • Electrolyte concentration

  5. Patient Assessment: Renal System Chapter 29

  6. History • Other diseases that contribute to renal failure • Diabetes mellitus • Systemic lupus erythematosus • Hypertension • Sickle-cell anemia • Other causes of renal injury • Recent illness including surgery or infection • Exposure to nephrotoxic agents

  7. Assessment of Costovertebral Angles

  8. Site of Renal Bruits

  9. Diagnostic Tests • Urinalysis • Creatinine and creatinine clearance • Blood urea nitrogen (BUN) • Osmolality • Radiological studies • Renal biopsy • Renal angiogram

  10. Assessment of Fluid Balance • Daily weight • Intake and output • Lab studies • Hemodynamic monitoring

  11. Patient Management:Renal System Chapter 30

  12. Patient Access • Vascular catheter • A-V fistula • Synthetic vascular graft

  13. Hemodialysis • Removes urea, creatinine, and uric acid • Removes excess water • Restores the body buffer system • Maintains appropriate levels of electrolytes

  14. Complications of Dialysis • Dysequilibrium – Removal of uric acid too quickly • Hypovolemia • Hypotension/Hypertension • Muscle cramps – Removal of fluid too quickly • Dysrhythmias • Angina

  15. Continuous Renal Replacement Therapies (CRRT) • Similar to hemodialysis • Removes waste product slowly • Requires more time • Used when uric acid needs to be aggressively managed

  16. Peritoneal Dialysis • The peritoneum is used as the semipermeable membrane • Osmosis is used to remove fluid • Peritoneal catheter is placed in surgery • Used for patients who do not live close to a dialysis center

  17. Advantages Less complicated equipment and supplies Less adverse effects because fluid and electrolyte change is slower Disadvantages Requires more time Peritonitis Peritoneal Dialysis

  18. Renal Failure Chapter 31

  19. Causes of Acute Renal Failure • Prerenal • Physiological event causing hypoperfusion • Intrarenal • Acute damage to renal parenchyma • Postrenal • Obstruction to flow of urine out of the kidney

  20. Chronic Renal Failure • Slow, progressive, irreversible • Progressive destruction of nephrons • Diabetes mellitus and hypertension are the most common causes • More common in African Americans, Hispanics, and Native Americans

  21. Chronic Renal Failure • Slow the rate of nephron damage • Avoid nephrotoxins • Aminoglycosides • IV contrast agents • Strict blood glucose control • Reduction in hyperlipidemia • Control of hypertension • Use of ACE inhibitors

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