Acute Renal Failure MSN Bsc Nursing 2nd semester.pdf

Bsc nursing

1. [ MEf>ICAL. SVl.6ICAL. IJVl.'SIIJ6 -I]
U#AL ,:"AtL.~
Urinary system
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ACUTE RENAL FAILURE
/. lnfroducfion:-
•Acufe kidne!J failure occurs when !four kidne!Js sudden/!}
become unable f o fi/f er wasf e producfs from !lour blood.
•When !1our kidne!1s lose f heir filf ering abilif!j,
and dangerous increases level wasf e producfs in blood

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l2. Definifion:-
• Acufe Renal Failure if is a reversible loss of kidne!J
f uncfion associafed wifh an increase in BUN and
creafinine level

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3. Causes:-
• re-ena • nfra-enal • os -ena
( Cause is before fJ,e kidne!JJ (Cause is inside fJ,e kidne!J) (Cause is affer fJ,e kidne!J)
Hearf failure, burn efc. Acufe fubular necrosis, Bladder sfone, urefer sfone efc.
:J'ornerulonephrifis
ef c

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3. Causes:-
/. Pre-renal Causes:- lnferrupfion of blood flow fo fhe kidne!Js from
severe irjur!J or illness. ( 60-70% all cases)
E9-Hearf failure, Deh!Jdrafion,Shock, Burn efc.
2. Infra-renal Causes:-Direcf damage fo fhe kidne!Js b!J inflammafion,
foxins, drugs, infection. (25-40% cases)
E9-Glomerulonephrifis, Tubular necrosis efc.
3. Posf-rena/ Causes:- There is a obsfrucfion in fhe passage of urine
flow due fo kidne!J sfone, bladder. (5-/0% cases)
Eg-Bladder sfone, urefer sfone, efc.
PRE-RENAL
Impaired perfusion:
•
Cardiac failure
• Sepsis
•
Blood loss
• Dehydration
• Vascular occlusion
RENAL
GlomerulonephrltJs
Small-vessel
vasculitis
Acute tubular necrosis
• Dru
gs
•To,cins
• Prolon
ged hypotension
lntEll'StitiaJ nephritis
• Drugs
•Toxins
• Inflam
matory disease
• Infection
I POST-RENAL
Urinary calculi
Retroperitoneal fibrosis
Benign prostatic
enlargement
Prostate cancer
Cervical
cancer
Urethral stricture/valves
Meatal stenosis/phimosis

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4. Phase:-
/. /nifiafion phase:-Be9ins when fhe kidne!j is irjured and decrease urine oufpuf. lasfs
from hours f o da!js.
2.
O/i9uria phase:- Urine oufpuf less fhan 400 ml/ da!j Si9ns of excess fluid volume
such as h!jperf ension, edema, h!jpervolemia, increase in BUN and creafinine level.
3. Diuresis phase:- Urine oufpuf slow/!} rises Gradual decline in BUN level and creafinine
level.
H!jponafremia and h!jpovolemia can Occur.
4. Recover!j__ e_hase:- lme_rovemenf in CFR

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5. P afhoe_l'l!J_Siolog_!f-
Due fo anu Causes
tfi J
"
Decrease CFR (C/omerular Fi/frafion Rafe)
Increase work load of remaining nephron
Nephrons damage
Loss of renal f uncfion
Increase BUN, uric acid in blood
Acufe Renal failure

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6.C/inical Manifesfafions=-
• Decreased urine oufpuf, • Shorfness of breafh
af f hou:3h occasiona/1!1 urine • F afi:3ue
oufpuf remains normal • Confusion
•
Fluid refenfion, causin:3 • Nausea
swel/in:3 in !}our le:3s, ankles • Weakness
or f
eef • Che sf pain or pressure
• H!jperfension • /rre:3ular hearfbeaf
~
C
loss of
appetite
,hortne .. :J
breath
Irregular
heartbeat
~, chest pain or
~f J l pressure
decreased urine
output e,
- edema

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7. Oia:J_nosfic Evaluafion:-
• Blood fesf-Azof emia (increase in urea and n level in blood)
Increase Serum creafinine
• Urine fesf-check Amounf of urine in 24 hour
Heamfuria (
blood in urine), Profeinuria
Decrease amounf
of sodium in urine ef c.
• R enaf Uf frasono5raph!j-assess fhe size, locafion, and shape of fhe
kidne!:1s and ref af ed sf rucfures
serum creatlne /
other blood tests
urine volume
ultrasound,
CT scan or MRI

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• Elecfrocardio!ram-Peaked T waves, widened QR and
P waves is disappearing
• Kidne!j Biops!j-Removing of a small sample of kidne!j
f issue for laboraf or!j f esf ing.
Biopsy
n
eedle
Cross section
showing
biopsy needle entering kidney

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Managemenf
P'1armacoloqical
manaqemenf
Fluid & Elecf ro/ijf e
R
ep.lacemenf
N ufrifional
Manaqemenf

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/. Pharmacolo3ical fherap!J-
• Oiurefics fherapf-Increase urine e-:J,, furosemide and mannifol
• Anfi-h!Jperfensive
:_ Decreases blood pressure and freaf H!Jperfension.
E3-Capfopril Propranolol efc.
2.
Fluid and Elecfro~fe replacemenf should be 3iven.
3. Nufrifional fherap!J-Hi3h calorie and low profein, sodium dief.

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4. Dia/ijsis-
• Dial!Jsis is fhe arfificia/ process of remove fluid and wasf e producf from bod!J·
•
T!Jpes-Hemodia/!Jsis and Perifoneal Dia/!Jsis .
Haemodlalysls
Diily-lnllow
,..... .... -""°'
,/·
Peritoneal dlalysls
Dlalysate bag
Dlalysate bag
Twist -clamp

Catheter
Drainage bag

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