Pathophysiology. Acute renal failure occurs when a person experiences sudden and a near complete loss of kidney function, which occur over a period of hours to days. It’s most commonly seen, but not limited to hospitalized patients. It manifests with oliguria, anuria, or normal urine.
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Pathophysiology • Acute renal failure occurs when a person experiences sudden and a near complete loss of kidney function, which occur over a period of hours to days. It’s most commonly seen, but not limited to hospitalized patients. • It manifests with oliguria, anuria, or normal urine. • The major categories of acute renal failure include: • Prerenal (hypoperfusion of the kidney) • Intrarenal (actual damage to kidney tissue) • Postrenal (obstruction of urine flow) Acute Renal Failure
Assessment • Evaluate for changes in urine • Ultrasound of the kidneys
Nursing Management • Monitoring Fluid and Electrolyte Balance • Reducing Metabolic Rate • Promote Pulmonary Function • Preventing Infection • Providing Skin Care • Providing Support
Pathophysiology Chronic Renal Failure Is the progressive, irreversible deterioration in renal function, where the body’s ability to maintain metabolic, fluid and electrolyte balance fails. This results in uremia and azotemia (retention of urea, and other nitrogen waste). As renal function declines, the end products of protein metabolism accumulate in the blood. This causes a build up of waste which has systemic affects on the body
Stages of Chronic Kidney Disease: • GFR greater or equal to 90mL/min/1.73 m2 • GFR equal to 60-89 mL/min/1.73 m2 • GFR equal to 30-59 mL/min/1.73 m2 • GFR equal to 15-29 mL/min/1.73 m2 • GFR less than 15 mL/min/1.73 m2 (kidney failure)
Assessment • Sodium and water retention • Assess urine characteristics
Nursing Management • Education • Fluid status • Potential sources of electrolyte imbalance • Proper nutritional uptake • Increased self care and independence • Emotional support
Treatment • ARF: the goal of treatment is to restore normal chemical balance, and prevent complications. Any possible cause of AFR is identified, treated and eliminated. • CRF: the goal of treatment is to prevent complications of disease. It is complicated and individualized.
Case Study • Mrs. H. is a 67 year old female who yesterday required coronary bipass surgery to relieve her coronary artery disease. During the post op period, it was discovered that Mrs. H. was hemorrhaging. She was returned to surgery and required 4 units of blood. • Today Mr. H. urine output is less 10mL/hr, she is appears lethargic and dehydrated and has complaints of a headache.