Acute renal failure powerpoint presentation

1. 1
ACUTE RENAL FAILURE
 A reversible condition characterized
by a sudden reduction or cessation of
renal function  azotemia

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Phases of ARF
1. Onset
 Initial phase of insult or injury
2. Oliguric Phase
 Oliguria (less than 400 cc/24hr)
 For older (600-700 cc/24 hours)
 Lasts 8-14 days

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3. Diuretic Phase
 Lasts 10 days
 Diuresis of 3-5 L / day
 BUN and Creatinine elevated
 Dangers: FVD, hyponatremia,
hypotension, shock
4. Recovery Phase
 Avoid nephrotoxic drugs
 Lasts from 6 to 12 months

4. 4
CHRONIC RENAL FAILURE
 Is an irreversible condition of
progressive damage to the
nephrons and glomeruli 
azotemia

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Etiology (ARF & CRF)
PRERENAL
INTRARENAL
POST RENAL

6. 6
Stages, Pathophysiology and
Manifestations
Classification of Manifestations:
1. Excretory
2. Endocrine

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First stage (Diminished Renal
reserve)
 Renal function is reduced
 No metabolic wastes accumulate.
 The healthier kidney compensates
for the diseased one.

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Second stage (Renal Insufficiency)
 Metabolic wastes accumulate
 Decreasing GFR
 Classified as mild, moderate, or
severe (25% or above)
 Azotemia starts to develop

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Final stage (End-stage Renal failure)
 Excessive amounts of metabolic
wastes
 Kidneys are unable to maintain
homeostasis-a life-threatening
condition.

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Nursing
Interventions

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Maintain Fluids and Electrolytes
Balance
Monitor fluid and electrolyte
balance
 Assess I and O every 8 hours
 Weigh patient everyday
 Assess presence and extent of
edema
 Auscultate breath sounds
 Monitor cardiac rhythm and BP
every 8 hours

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Encourage patient to remain
within prescribed fluid
restrictions.
Administer phosphate – binding
agents with meals as prescribed
(Amphogel/ AL – OH)
Encourage a diet high CHO and
within the prescribed sodium,
potassium, Phosphorus &
protein limits.

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Prevent infection and injury
 Promote meticulous skin care.
 Encourage activity but avoid fatigue.
 Protect person from exposure to
infectious agents.
 Maintain good medical / surgical
asepsis
 Avoid aspirin products.
 Encourage use of soft-bristled
toothbrush

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Promote comfort
 To relieve pruritus:
 Bathe with warm water and distilled vinegar
Medicate, as ordered
 Antipruritics
 Emollient baths
 keep skin moist
 control environmental temperature
 Maintain mucosal integrity
 damp cloth to keep lips moist
 good oral hygiene.
 Encourage rest for fatigue; however,
encourage self – care as tolerated

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Assist with coping in life-style and
self-concept
 Promote hope
 Provide opportunity for patient to
express feelings about self.
 Identify available community
resources.

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Medical Management

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Hemodialysis
 Alternates to the excretory but not
on the endocrine function of the
kidneys
 Practice ARM PRECAUTION
 Assess for patency: auscultate for
bruit, palpate for thrill

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 Vascular access:
Arteriovenous fistula
• Advantages:
• Longevity
• No danger of
dislodgement
• Disadvantages:
• Requires 4-6 weeks to
mature

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External arteriovenous shunt.
1. Advantages:
• Used immediately
• Use is relatively simple
2. Disadvantages:
• Clotting
• Infection
• Dislodgement with
hemorrhage
• Limited longevity
Emergency equipment: Tourniquet

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Nursing Interventions in
Hemodialysis:
Facilitating fluid and electrolyte
balance.
 Preventing hypovolemia and shock.
 Administer blood transfusion as ordered
 Omit dose of hypertensive drug

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 Preventing disequilibrium phenomenon.
 Initial hemodialysis be done for 30 mins.
only
 If ongoing, stop or slow down infusion

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 Prevent blood loss
 Promote comfort
 Provide hygienic measures
 Maintain activity and nutrition
 Facilitate learning

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PERITONEAL DIALYSIS
Advantages:
 Steady state of blood chemistries.
 Patient:
 can dialyze alone (no machinery)
 can readily be taught the process.
 has few dietary restrictions (because
of loss of CHON in daily dialysate)
 has much more control over daily life.
 can dialyze even if hemodynamically
unstable

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Care During Peritoneal Dialysis
 Regulate fluid volume and drainage
 Promote comfort
 Prevent complications
 Monitor urine / blood glucose levels