Acute Renal Failure
Content:
1.
Definition.
2.
Causes.
3.
Clinical features.
4.
Investigation.
5.
Nursing diagnosis.
6.
Nursing intervention.
7.
Management.
8.
Complication.
Definition of Acute Renal Failure:
Acute renal
failure refers to a sudden and usually reversible loss of renal function. Which
develops over a period of days or weeks. An increase in plasma creatinine count
to greater than 200 mol/L is often used as a biochemical definition.
Causes of Acute Renal Failure:
A. Pre-renal causes:
1. Reduction of circulatory blood volume (hypovolemia)
· Hemorrhage
· Severe burns
· Crush injuries
· Severe vomiting
· Severe diarrhoea
2. Reduction in cardiac output e.g. heart failure
3.
Reduction of
glomerular filtration rate (GFR)
· Hypocalcaemia
· Hepatorenal syndrome
B. Renal causes:
1.
Glomerulonephritis
2.
Pyelonephritis
3.
Acute tubular necrosis
4.
Acute interstitial
nephritis
5.
Intravascular
coagulation
C. Post-renal causes:
1. Urinary tract obstruction:
· Prostatic enlargement
· Urethral stricture
· Surgical accident.
2.
Bladder rupture or
trauma.
Clinical features of Acute Renal Failure:
1.
Little or no urine.
2.
Swelling, especially
in legs and feet.
3.
Not feeling like
eating.
4.
Nausea and vomiting.
5.
Feeling confused,
anxious and restless or sleepy.
6.
Pain in the back just
below the rib cage.
7.
Drowsiness, apathy-muscle
twitching.
8.
Anaemia, pulmonary
edema, oliguria.
9.
Shallow respiration.
10.
Loss skin elasticity.
Investigation of Acute Renal Failure:
1.
Culture of mid-stream
urine.
2.
Microscopic
examination or cystometry of urine for white &red cells.
3.
Plasma urea, serum
creatinine, serum electrolytes.
4.
Full blood count –TC, DC,
Hb%, ESR.
5.
USG of kidney.
6.
Blood culture.
7.
urinalysis
Nursing diagnosis of Acute Renal Failure:
1.
Excess fluid volume.
2.
Imbalanced nutrition;
less than body requirement.
3.
Risk for infection
related to compromised immune response.
4.
Risk for injury
related to decreased level of consciousness.
5.
Fatigue related to
uremia, anaemia.
6.
Acute pain related to
sodium depletion (reduction),uremia, muscle cramping.
7.
Ineffective coping
related to situational crisis.
8.
Situational low
self-esteem.
9.
Deficit knowledge etc.
Nursing intervention of Acute Renal Failure:
1.
Maintaining fluid and
electrolyte balance.
2.
Facilitating
nutrition.
3.
Preventing infection
and injury.
4.
Promoting comfort test
and sleep.
5.
Facilitating coping
with changes in life style and feeling regarding self.
6.
Patient and family
education including :
7.
Relationships between
symptoms and causes.
8.
Relationships among
diet, fluid restriction medication and blood chemistry values.
9.
Preventive health care
measures: oral hygiene, prevention of infection etc.
10.
Dietary regimen
including fluid excess – accurate measurement of intake / output etc.
11.
Medications.
12.
Measures to control
pruritus.
13.
Planning for follow
–up care.
Management of Acute Renal Failure:
1.
Correct hypovolaemia
and optimize systemic haemodynamic status with inotropic drugs if necessary.
2.
Administer glucose and
insulin to correct hyperkalaemia if K+ >6.5 mmol/L.
3.
Consider administering
sodium bicarbonate (100 mmol) to correct acidosis if pH < 7.0 (>100
mmol/L).
4.
Discontinue
potentially nephrotoxic drugs and reduce doses of therapeutic drugs according
to level of renal function.
5.
Match fluid intake to
urine output plus an additional 500 mL to cover insensible losses once patient
is euvolaemic.
6.
Measure body weight on
regular basis as a guide to fluid requirements.
7.
Ensure adequate
nutritional support.
8.
Administer proton pump
antagonists to reduce the risk of upper gastrointestinal bleeding.
9.
Screen for inter-current
infections and treat promptly if present
Complication of Acute Renal Failure:
1.
Oedema.
2.
Electrolytes imbalance.
3.
Acid base imbalance.
4.
Infection.
5.
Cardiac disorder.
6.
Hypertension.
7.
Bleeding
manifestations.
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