Download
slide1 n.
Skip this Video
Loading SlideShow in 5 Seconds..
RENAL FAILURE 2008 PowerPoint Presentation
Download Presentation
RENAL FAILURE 2008

RENAL FAILURE 2008

281 Views Download Presentation
Download Presentation

RENAL FAILURE 2008

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. RENAL FAILURE 2008 ACUTE RENAL FAILURE CHRONIC RENAL FAILURE

  2. OBJECTIVES • Identify normal functioning of the kidney and laboratory tests that assess kidney function • Define renal failure • Discuss the causes of acute renal failure and compare those with chronic renal failure • Compare prerenal, intrarenal and postrenal conditions • Identify the alterations seen in patients, explaining why they exist • Identify nursing measures appropriate to the alterations

  3. NORMAL KIDNEY FUNCTION What does the kidney do in terms of? • wastes and water balance? • Acid base balance? • Controlling BP? • Controlling anemia?

  4. RENAL FAILURE DEFINED • Kidneys no longer function properly • Kidneys unable to excrete waste • kidneys cannot concentrate urine • Kidneys cannot conserve electrolytes

  5. HORMONES WHICH INFLUENCE THE KIDNEY • ALDOSTERONE • Produced: • Action: • RENIN/ANGIOTENSIN • Produced: • Action:

  6. HORMONES WHICH INFLUENCE THE KIDNEY • ANTIDIURETIC HORMONE • Produced: • Action: • ERYTHROPOIETIN (EPO) • Produced: • Action:

  7. IDENTIFYING THE THREE PRIMARY RENAL FUNCTIONS • GLOMERULAR FILTRATION:glucose, amino acids, creatinine, urea, phosphates, uric acid • GLOMERULAR REABSORPTION:bicarbonate, phosphates, sulfates, 65% of Na and water, glucose, K, amino acids, H ions, urea • GLORMERULAR SECRETION: hydrogen and potassium, remove acids (hydrogen) to maintain appropriate acid base balance, potassium, urea

  8. ASSESSMENTS OF RENAL FUNCTION • u/a: negative for glucose, protein, blood, leukocytes, nitrites, ketones • Specific gravity: measures concentration of the urine; normal values: 1.010-1.025 • Urine osmolality: normal 300-900 mOsm/ kg/24 • Serum creatinine: 0.6-1.2mg/dl • BUN: 7-18mg/dl • BUN to creatinine ratio: about 10:1

  9. DIAGNOSTIC ASSESSMENTS CONTINUED • STANDARD FOR RENAL FUNCTION: assess glomerular filtration rate (GFR) • Norm for this assessment is the creatinine clearance test done over 24 hours: normal rate is 80-125ml/min

  10. DEFINITIONS • OLIGURIA: urine output is less than 30 ml/hr • ANURIA: no urinary output • NORMAL URINARY OUTPUT: 1500-1800ml/day

  11. CAUSES OF ACUTE RENAL FAILURE • PRERENAL or factors external to the kidney which interferes with renal perfusion (55% cases of ARF) • INTRARENAL: conditions that cause direct damage to renal tissue (35-40% cases of ARF) • POSTRENAL: mechanical obstruction in the urinary tract (5% cases of ARF)

  12. CAUSES OF RENAL FAILURE CONTINUED • Multiple problems may exist at same time • AGING

  13. RENAL FAILURE DEFINED • To define renal failure ask yourself: How is the kidney functioning with regard to? • Excreting nitrogenous wastes • Concentrating urine • Conserving electrolytes

  14. PROBLEMS FOR PATIENT • Retention of metabolic wastes • Imbalance of fluid and electrolytes • Alterations of sensorium

  15. 3 phases of acute renal failure • Oliguria • Diuresis • Recovery

  16. OLIGURIC PHASE (lasts 10-14 days) • Urinary changes • Fluid volume excess • Metabolic acidosis • Sodium balance • Potassium excretion

  17. OLIGURIC PHASE (lasts 10-14 days)continued • Hematologic disorders • Calcium deficit and phosphate excess • Waste product accumulation • Neurologic disorders

  18. DIURETIC PHASE (lasts 1-3 wks) Gradual increase of urine output as a result of osmotic diuresis • Why does this happen? • What is the state of nephron? • Can the kidney excrete wastes? • Can the kidney concentrate urine? • What would we see in the patient during this stage?

  19. RECOVERY PHASE • When does this begin? • Do all patients recover?

  20. GOALS OF TREATMENT • Restore renal function • Identify cause • Eliminate cause

  21. MAINTAINING FLUID AND ELECTROLYTE BALANCE • How do we assess fluid excess? • How can we control fluid intake? • What physical assessments would be done? • What would you expect to see? • What laboratory tests would be used to assess client status?

  22. NURSING CARE FOR: • Elevated serum phosphate: • Hypocalcemia: • Hypermagnesemia: • Hypovolemia: • Fluid retention: diuretics: • Hypertension: • Metabolic acidosis:

  23. TREATING HYPERKALEMIA • Regular insulin IV • Sodium bicarbonate • Calcium gluconate IV • Dialysis • Kayexalate • Dietary restriction

  24. DIET FOR ACUTE RENAL FAILURE • dietary protein • calories • K and phosphorus • Na • Fe

  25. CHRONIC RENAL FAILURE DEFINED • Progressive deterioration in renal function resulting in fatal uremia (excess of urea and other nitrogenous wastes in the blood) • Irreversible destruction of nephrons • Called ESRD (end stage renal disease) • Dialysis or transplant

  26. TERMS ASSOCIATED WITH CHRONIC RENAL FAILURE • Azotemia: collection of nitrogenous wastes in blood • Uremia: azotemia • Uremic syndrome: systemic clinical and laboratory manifestations of ESRD

  27. Alterations: Chronic Renal Failure • Metabolic Disturbances: • elevated BUN, • creatinine, • hyponatremia, • hyperkalemia, • metabolic acidosis, • hypocalcemia, • hyperphosphatemia • Reproductive Disturbances: • For woman: menstrual irregularities, amenorrhea, infertility, decreased libido • For men: impotence, reduced sperm motility • Integumentary Disturbances: pruritus,dry,hair brittle, nails thin, UREMIC FROST: white/yellow crystals of urate on skin

  28. ALTERATIONS OF CHRONIC RENAL FAILURE CONTINUED • Gastrointestinal Disturbances: Anorexia, N&V, metallic taste in mouth, breath smells like ammonia, stomatitis, ulcers/GI bleeding, constipation • Neurological Distrubances: uremic encephalopathy progresses to seizures & coma • CHF: from increased workload on heart from anemia, hypertension and fluid overload • Uremic pericarditis: pericardium becomes inflammed from toxins

  29. ALTERATIONS OF CHRONIC RENAL FAILURE CONTINUED • Respiratory: • breath smells like urine: uremic fetor or uremic halitosis • Metabolic acidosis: see tachypnea (increased rate) and hyperpnea (increased depth) indicates worsening metabolic acidosis • See Kussmaul respirations extreme hyperventilation

  30. NURSING CARE FOR PT WITH CHRONIC RENAL FAILURE FOR ANEMIA: FOR HYPOCALCEMIA FOR FLUID RETENTION AND HYPERTENSION FOR SKIN ITCHING

  31. DIETARY RESTRICTIONS FORCHRONIC RENAL FAILURE • calorie • protein • Na • K • calcium • Phosphorus • Magnesium

  32. DIALYSIS: peritoneal and hemodialysis

  33. PERITONEAL DIALYSIS • Diffusion of solute molecules through a semi-permeable membrane passing from the side of higher concentration to that of lower concentration • Fluids passing through the semi-permeable membrane via osmosis • Renal Failure pt has dialysis to remove waste products and to maintain life until kidney function can be restored • Dialysis indicated for high levels of K and fluid overload

  34. PERITONEAL DIALYSIS • Sterile dialyzing fluid is introduced into the peritoneal cavity • Peritoneum is an inert semipermeable membrane • The dialyzing solution promotes osmosis leading to diuresis • Urea and creatinine are removed

  35. NURSING CARE OF PT ON PERITONEAL DIALYSIS • Baseline VS and wgt • Assess for fluid overload • Maintain highly accurate inflow and outflow records • When PD starts the outflow may be bloody or blood tinged • This clears within a week/two • Effluent should be clear and light yellow

  36. Nursing care during PD • Drainage bag is lower than the client’s abdomen to enhance gravity drainage • Avoid kinking or twisting, ensure clamps are open • Reposition client to stimulate inflow or outflow • Sitting/standing/coughing: increases intraabdominal pressure

  37. COMPLICATIONS OF PERITONEAL DIALYSIS • Respiratory difficulties • Hypotension • Infection: • peritonitis: see cloudy or opaque dialysate outflow (effluent), fever, abdominal tenderness, pain, malaise, N&V • Hypo-albuminemia • Bowel perforation: • Bladder perforation: • Catheter may get clogged

  38. COMPLICATION OF PD: Fibrin Clot formation • Fibrin Clot formation • Milking the tubing • Xray

  39. COMPLICATION OF PD: LEAKAGE • Dialysate leakage • See with obese, diabetic, older clients, those on long term steroids

  40. HEMODIALYSIS • Process by which the uremic toxins and accumulated waste products are removed from the blood

  41. HEMODIALYSIS CONTINUED • A synthetic semi-permeable membrane replaces the renal glomeruli and tubules and acts as a filter for the impaired kidneys • Must have 3 times/week for 4 hours per treatment for rest of life

  42. Access to pt’s circulation via: • AV shunt (less common): external silastic tubing placed in an adjacent artery and vein • AV Fistula: internal access using pts own vessels (artery and vein) • AV Graft: internal access using a foreign material

  43. COMPLICATIONS Hemodialysis vascular access • BLEEDING • INFECTION • CLOTTING

  44. Assessment during Hemodialysis • Assess for disequilibrium reaction • CAUSE: • due to rapid decrease in fluid volume and BUN levels • Change in urea levels can cause cerebral edema and increased intracranial pressure • Neurologic complications: HA, N&V, restlessness, decreased LOC, seizures, coma, death • PREVENTION: starting HD for short periods with low blood flows

  45. Nursing care pre dialysis • Vasoactive drugs which cause hypotension are held until after treatment • CHECK WITH MD ABOUT WHICH DRUGS TO BE HELD • Know pt’s BP predialysis

  46. Post dialysis nursing care • BP and wgt • Hypotension • Temperature may also be elevated: • If client has a fever • Bleeding risk:

  47. KIDNEY TRANSPLANT • Involves transplanting a kidney from a living donor or human cadaver to a recipient who has end-stage renal disease and requires dialysis to live