Transcript CARE OF PATIENT WITH ACUTE RENAL FAILURE

Care Of Patient With Renal Failure
1
2
3
Objectives






4
Define acute & chronic renal failures.
Identify causes of ARF & CRF.
List the signs and symptoms.
Describe the management & care.
List the complications.
Discuss relevant patient / family
education.
Acute & Chronic
 Alternative
names
 Renal failure acute; Kidney
failure; Kidney
failure - acute;
Renal failure; Arf
5
 Alternative names
 Kidney failure -
chronic; Renal failure
- chronic; Chronic
renal insufficiency;
CRF; Chronic kidney
failure
Definition
Definition
 Definition .
Acute renal failure is
 Chronic renal failure is
sudden loss of the
ability of the kidneys to
excrete wastes,
concentrate urine, and
conserve electrolytes.
("Acute" means sudden,
"renal" refers to the
kidneys.)
6
a gradual and
progressive loss of
the ability of the
kidneys to excrete
wastes, concentrate
urine, and conserve
electrolytes.
White Nail Syndrome (CRF)
7
Causes ( ARF )
 Decreased blood flow
 Severe acute nephritic syndrome
 Acute tubular necrosis (ATN)
 Direct injury to the kidney
 Myoglobinuria (myoglobin in the
urine)
8
Causes ( ARF )
 Urinary tract obstruction
 Infections such as acute
pyelonephritis or septicemia
 Disorders of the blood
 Autoimmune disorders
9
Causes (ARF)
 Over-exposure to metals, solvents,
radiographic contrast materials,
certain antibiotics, and other
medications or substances
 In young children, hemolytic uremic
syndrome
10
Causes (CRF)
 Decreased blood flow is one cause
of kidney damage
 Acute tubular necrosis
 Direct injury to the kidney
 Disorders of the blood
11
Causes (CRF)
 Infections
 Urinary tract obstruction
 Tumors
 Kidney stones
12
Symptoms (ARF)
 Decreased urine output
 Decreased urine volume (oliguria)
 No urine output (anuria)
 Urination, excessive at night (can occur
in some types of renal failure)
13
Symptoms (ARF)
 Generalized swelling, fluid retention
 Decrease in sensation, especially
the hands or feet
 Slow, sluggish, movements
 Ankle, feet, and leg swelling
14
Symptoms (ARF)
 Seizures
 Hand tremor
 Nausea, vomiting
 May persist for days
 Morning sickness
 Vomiting blood
15
Symptoms (ARF)
 Prolonged bleeding, bruising easily
 Stools, bloody
 Nosebleed
 Growth, slow (child 0-5 years)
16
Symptoms (ARF)
 Changes in mental status or mood
 Agitation
 Drowsiness, lethargy
 Delirium or confusion
 Coma
 Fluctuating mood
 Difficulty paying attention (attention deficit)
 Hallucinations
17
Symptoms (ARF)
 Flank pain
 Fatigue
 Ear noise/buzzing
 Breath odor
 Breast development in males
 Blood pressure, high
18
Symptoms (CRF)
Initial symptoms may include the
following:
 Unintentional weight loss
 Nausea, vomiting
 General ill feeling
 Fatigue
 Headache
19
Symptoms (CRF)
 Frequent hiccups
 Generalized itching (pruritus)
Later symptoms may include the
following:
 Increased or decreased urine
output
20
Symptoms (CRF)
 Need to urinate at night
 Easy bruising or bleeding;
 May have blood in the vomit or in stools
 Decreased alertness
 Drowsiness, somnolence, lethargy
 Confusion, delirium
 Coma
21
Symptoms (CRF)
 Muscle twitching or cramps
 Seizures
 Uremic frost -- deposits of white
crystals in and on the skin
 Decreased sensation in the hands,
feet, or other areas
22
Symptoms (CRF)
Additional symptoms that may be
associated with this disease:
 Excessive nighttime urination
 Excessive thirst
23
Symptoms (CRF)
 Abnormally dark or light skin
 Paleness
 Nail abnormalities
 Breath odor
 High blood pressure
 Loss of appetite
 Agitation
24
Signs (ARF)
Lab values may change suddenly (within
a few days to 2 weeks):
 Urinalysis may be abnormal.
 Serum creatinine may increase by 2
mg/dl or more over a 2-week period.
 Creatinine clearance may be decreased.
25
Signs (ARF)
 BUN may increase suddenly.
 Serum potassium levels may be
increased.
 Arterial blood gas and blood
chemistries may show metabolic
acidosis.
26
Signs (ARF)
 Kidney or abdominal ultrasound is
usually the best test, but abdominal xray, abdominal CT scan or abdominal
MRI may also reveal the cause of acute
renal failure. Kidney size is usually
normal or slightly large.
27
Signs (ARF)
 Chemical tests of blood and urine
may also help to distinguish the
causes. A clean catch urine
specimen will indicate if the cause
is infection within the urinary tract.
28
Signs (ARF)
 Renal angiography (renal
arteriography) may be used to
diagnose causes within the blood
vessels of the kidney.
29
Signs (CRF)
 Blood pressure may be high, with
mild to severe hypertension. A
neurologic examination may show
polyneuropathy. Abnormal heart or
lung sounds may be heard with a
stethoscope.
30
Signs (CRF)
 A urinalysis may show protein or
other abnormalities. An abnormal
urinalysis may occur 6 months to 10
or more years before symptoms
appear.
 Creatinine levels progressively
increase.
31
Signs (CRF)
 BUN is progressively increased.
 Creatinine clearance progressively
decreases.
 Potassium test may show elevated
levels.
 Arterial blood gas and blood chemistry
analysis may show metabolic acidosis.
32
Signs (CRF)
 Changes that indicate chronic renal
failure, including both kidneys being
smaller than normal, may be seen on:
 Renal or abdominal x-ray.
 Abdominal CT scan.
 Abdominal MRI.
 Abdominal ultrasound.
33
Signs (CRF)
 This disease may also alter the results
of the following tests:
 Urinary casts
 Renal scan
 Pth
 Serum magnesium - test
 Erythropoietin
34
Care & Management (ARF)
The goal of treatment is to identify
and treat any reversible causes of
the kidney failure (e.G., Use of
kidney-toxic medications,
obstructive uropathy, volume
depletion).
35
Care & Management (ARF)
 Treatment also focuses on
preventing excess accumulation of
fluids and wastes, while allowing
the kidneys to heal and gradually
resume their normal function.
Hospitalization is required for
treatment and monitoring.
36
Care & Management (ARF)
Your fluid intake may be severely
restricted to an amount equal to the
volume of urine you produce. You may
be given specific dietary modifications to
reduce build-up of toxins normally
handled by the kidneys, including a diet
plan high in carbohydrates and low in
protein, salt, and potassium.
37
Care & Management (ARF)
Antibiotics may be used to treat or
prevent infection. Diuretics may be
used to remove fluid from the
kidney.
38
Care & Management (ARF)
 A major priority in treatment is to control
dangerous hyperkalemia (increased blood
potassium levels). A variety of different
medications may be used, including IV
(intravenous) calcium, glucose/insulin, and oral or
rectal administration of potassium exchange resin
(kayexalate).
39
Care & Management (ARF)
 Dialysis may be used to remove excess
waste and fluids. This often makes the
person feel better and may make the
kidney failure easier to control. Dialysis
may not be necessary for all people, but
is frequently lifesaving, particularly if
serum potassium is dangerously high.
40
Care & Management (ARF)
 Common symptoms that require the use
of dialysis include decreased mental
status, pericarditis, increased potassium
levels, total lack of urine production, fluid
overload, and uncontrolled accumulation
of nitrogen waste products (serum
creatinine > 10 mg/dl and BUN > 120
mg/dl).
41
Care & Management (CRF)
 Treatment focuses on controlling
the symptoms, minimizing
complications, and slowing the
progression of the disease.
42
Care & Management (CRF)
 Associated diseases that cause or result
from chronic renal failure must be
controlled. Hypertension, congestive
heart failure, urinary tract infections,
kidney stones, obstructions of the
urinary tract, glomerulonephritis, and
other disorders should be treated as
appropriate.
43
Care & Management (CRF)
 Blood transfusions or medications such as iron
and erythropoietin supplements may be needed
to control anemia.
Fluid intake may be restricted, often to an amount
equal to the volume of urine produced.
Dialysis or kidney transplant may be required
eventually.
44
Care & Management (CRF)
 Dietary protein restriction may slow
the build-up of wastes in the
bloodstream and control associated
symptoms such as nausea and
vomiting. Salt, potassium,
phosphorus, and other electrolytes
may be restricted.
45
Complications (ARF)
increased risk of infections
 gastrointestinal loss of blood
 chronic renal failure
 End-stage renal disease
 Damage to the heart or nervous system
 Hypertension

46
Complications (CRF)
 End-stage renal disease
 Pericarditis
 Cardiac tamponade
 Congestive heart failure
47
Complications (CRF)
 Hypertension
 Platelet dysfunction
 Decreased immune response
48
Complications (CRF)
 Loss of blood from the gastrointestinal tract
 Ulcers
 Hemorrhage
 Anemia
 Hepatitis B, hepatitis C, liver failure
 Decreased functioning of white blood cells
49
Complications (CRF)
 Increased incidence of infection
 Peripheral neuropathy
 Seizures
 Encephalopathy, nerve damage,
dementia
 Weakening of the bones
 Fractures
50
Complications (CRF)
 Joint disorders
 Changes in glucose metabolism
 Electrolyte abnormalities including hyperkalemia
 Decreased libido, impotence
 Miscarriage, menstrual irregularities, infertility
 Skin dryness, itching/scratching with resultant
skin infection
51
Patient / Family Education
 Call your health care provider if decreased urine
output or other symptoms indicate the possibility
of acute renal failure.
 Call your health care provider if nausea or
vomiting persists for more than 2 weeks.
 Call your health care provider if decreased urine
output or other symptoms of chronic renal failure
occur.
52
.
Any Question ?
53