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1. 1 Critical Care Nursing Mr.Goran Ab. Osman 2022

2. 2 Introduction Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients. These specialists generally take care of critically ill patients who require mechanical ventilation by way of endotracheal intubation and vasoactive intravenous medications. Critical Care Nurses are also known as ICU nurses. They treat patients who are chronically ill or at risk for deadly illnesses. ICU nurse apply their specialized knowledge base to care for and maintain the life support of critically ill patients who are often on the verge of death.

3. 3 Introduction ….. Continue On a day-to-day basis a critical care nurse will commonly, "perform assessments of critical conditions, give intensive therapy and intervention, advocate for their patients, and operate/maintain life support systems which include mechanical ventilation via endotracheal, tracheal, or naso- tracheal intubation, and titration of continuous vasoactive intravenous medications in order to maintain a " mean arterial pressure that ensures adequate organ and tissue perfusion.

4. 4 Critical Care Nursing Critical Care Nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems Is term used to describe as care for patients who are extremely ill and whose clinical condition is unstable.

5. 5 Critical care unit Critical care unit: is a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for dependent patients with a life threatening problem.

6. 6

7. 7 Aim of the Critical Care 1. Promote optimal delivery of safe and quality to the critically ill patients and their families 2. Care for the critically ill patients with a holistic approach, biological, psychological, cultural and spiritual dimension. 3. Use appropriate and up – to –date knowledge, caring attitude prevention, early detection and treatment. 4. Provide palliative care to the critically ill patients in situations.

8. 8 • A Critical Care Nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care • Critical care nursing : defined as is that specialty within nursing that deals specifically with human responses to life-threatening problems.

9. 9 Critical Care Unit is a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for patients with a life- threatening problem that is potentially reversible

10. 10 Characteristic of Critical care nurse to be consider in recruiting critical care nurses have: • Technical qualification • Educational background • Clinical experience • Have knowledge

11. 11 What are the condition considered as critical? Any person with life threatening condition. • Sever shock • Heart block • Acute renal failure • Poly trauma ( multiple organ failure ) • Sever burn • Any critical Abnormalities

12. 12 • Critical Care Environment: Intensive care units cater to patients with life- threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medications in order to ensure normal bodily functions. They are staffed by highly trained physicians and nurses who specialize in caring for critically ill patients.

13. 13 Types of critical care 1.Respiratory Care Unit (RCU) 2.Coronary care unit ( CCU) 3.Emergency Unit 4. Burn Unit 5. Renal Dialysis Unit 6.Intensive Care Unit(ICU) • New natal intensive care unit ( NICU). • Pediatric intensive care unit ( PICU). • Psychiatric intensive care unit ( PICU). • Cardiac surgery intensive care unit ( CSICU)

14. 14 Examples for equipment in critical care unit

15. 15 Roles and Responsibilities of Critical Care Nurse • Assessing a patient’s condition and planning and implementing patient care plans. Assessment of Critically Ill patients is • Treating wounds and providing advanced life support • Assisting physicians in performing procedures • Able to attach equipment on patients as ordered and interprets the data, graphs on monitors etc. • Maintain infection control principles. • Keep update with advance information

16. 16 • Observing and recording patient vital signs • Ensuring that ventilators, monitors and other types of medical equipment function properly • Administering intravenous fluids and medications • Collaborating with fellow members of the critical care team • Responding to life-saving situations, using nursing standards and protocols for treatment

17. 17 • Acting as patient advocate • Documents appropriately • Ensures patient safety • Follows the policies and procedures of the unit and the institution • Promotes quality assurance in nursing • Providing education and support to patient families

18. 18 Principles of critical nursing care • Priorities of patients. • Early detection and promote action. • Collaborative practice. • Communication : interpersonal, intradepartmental • Crisis intervention and stress reduction. • Critical thinking .

19. 19 General criteria for ICU admission 1- unstable airway 2- unstable blood pressure 3- unstable mental status 4- life-threatening cardiac arrhythmias 5- respiratory failure 6- severe metabolic derangements 7- the need for frequent (more than every 2 hours) measurement of vital signs.

20. 20 Protocol for managing emergency in ICU • Quick review of patient identity, history, physical exam. • Be with the patient ask for help. • Place the patient with the suitable position. • Attach the cardiac monitor. • Maintain ABCDE. • Introduce IV & CV line.

21. 21 Protocol for managing emergency in ICU • Administered medication as needed • Carry on investigation ABG, ECG, Urea, Creatnine, Blood sugar, cardiac enzymes. • Maintain fluid balance • Record right things in right time

22. 22 Critical Care Team • Staff nurses • Physicians • Patients • Families • Paramedical Staff

23. 23 Organization/ Design of ICU

24. 24 Thanks for your Attention

25. 25 Nursing Care for Patient with Respiratory Failure Respiration Respiration - a life process common to both plants & animals. is an exchange of Oxygen and Carbon dioxide between the atmosphere and the blood and the body’s cells.

26. 26 BREATHING lungs Diaphragm Br ath1ng in l -:- Trachea Lungs Diaphragm · Br ea thin , g out t Inspiration Exhalation

27. 27 Human Respiratory System pulmonary venule pulmonary arteriole

28. 28 low er lobe alveoli

29. 29 Respiratory failure • Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. • It is a sudden and life-threatening deterioration in pulmonary gas exchange, resulting in carbon dioxide retention and inadequate oxygenation.

30. 30 • Respiratory failure is a clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which PaO2 is lower than 60 mmHg and/or PaCO2 higher than 50 mmHg . • Respiratory Failure Not a disease but a condition Not a disease but a condition Result of one or more diseases involving the lungs or other body systems Result of one or more diseases involving the lungs or other body systems

31. 31 Clinical indicators of acute respiratory failure include: 1. Partial pressure of arterial oxygen (Pao ) below 60 2 mm Hg, or arterial oxygen saturation as measured by pulse oximetry (Spo ) below 91% on room air 2 2. Paco above 50 mm Hg and pH below 7.35 2

32. 32 Types of Respiratory Failure According of abnormal gas exchange 1- Hypoxemic (Group Ⅰ ) respiratory failure A PaO2 of less than 60 mm Hg with a normal or low PaCO2. Cause of: Vascular disease, Chest Wall. Chronic bronchitis and emphysema • Pneumonia • Pulmonary edema • Asthma • 2- Hypercapnic (Group Ⅱ ) respiratory failure A PaO2 low 60 mm Hg and PaCO2 of more than 50 mm Hg. Cause of : Airway obstruction, Neuromuscular disease. COPD • Asthma • Drug overdose • Poisoning • Polyneuropathy • Poliomyelitis •

33. 33 Pulmonary edema • ARDS • Tetanus • Foreign body

34. 34 Types of Respiratory Failure According to its duration 1- Acute Respiratory Failure 2- Chronic Respiratory Failure

35. 35 Clinical Presentation Presentation of respiratory failure is dependent on the underlying cause and associated hypoxemia or hypercapnia. Common presentations include: • Dyspnoea • Tachypnoea • Restlessness • Confusion • Anxiety • Cyanosis- central • Tachycardia

36. 36 • Loss of consciousness

37. 37 Signs and symptoms of RF Type I (Hypoxemia) include • Dyspnea, irritability • Confusion, fits • Tachycardia, arrhythmia • Tachypnea • Cyanosis Signs and symptoms of RF Type II (Hypercapnia) include • Change of behavior • headache • Coma • Warm extremities • Astrexis • Papilloedema

38. 38 Diagnostic Studies • History Taking • Physical assessment & Vital signs • ABG analysis • Chest x-ray • CBC, sputum/blood cultures, electrolytes • ECG • Urinalysis

39. 39 Treatment of Respiratory Failure • Supplemental oxygen • Mechanical ventilation • Treatment of the cause • Prevent Complication

40. 40 Nursing Care Plan • Nursing Assessment 1. Physical assessment 2. General Integumentary 3. Respiratory Cardiovascular 4. Gastrointestinal 5. Neurologic 6. Laboratory findings

41. 41 • Nursing diagnosis 1. Impaired gas exchange 2. Ineffective airway clearance 3. Ineffective breathing pattern 4. Risk for fluid volume imbalance 5. Anxiety 6. Imbalanced nutrition: Less than body requirements

42. 42 Nursing Management • Ensure airway clearness • Check oxygen saturation and give O2 if need it. • Check and follow-up Vital signs • Put patient in therapeutic position • Psychological support for patient and patients family. • Assess & cooperation with physician • Assess level of conciseness

43. 43 • Assess body fluid balance • Assess Pain and provide pain management • Provide skin care to prevent pressure ulcer • Provide mouth and eye care • Establish and follow-up all equipment • Follow aseptic technique and infection control • Give Medication as prescribed • Provide wound care

44. 44 • Provide Tracheostomy care • Assess nutritional status and provide good feeding • Apply active or passive or isometric exercise • Assess the patients progression • Documentation • Always follow the priority • Ensure patients safety • Be aware for patients condition

45. 45 • Pulmonary: Complications Pulmonary embolism, pulmonary fibrosis & complications secondary to the use of mechanical devices. • Cardiovascular : Acute MI • GI: Gastric distention, diarrhea, stress ulceration • Nosocomial infections • ARF (Acute Renal Failure)

46. 46 • Nutritional: Malnutrition

47. 47 Thanks for your Attention

48. 48 Nursing Care for Patient with Shock Mr.Goran Ab. Osman 2021

49. 49 Objectives At the end of this lecture you would be able to:  Define shock  Recognize types of shock and their causes  Correlate pathophysiologic changes with clinical features .  Know the broad lines of monitoring and treatment of shock patients  Be familiar with how prevention the shock.

50. 50 Normal Tissue Perfusion Three general conditions must be present: 1. Heart must efficiently pump blood 2. Blood volume sufficient to fill blood vessels 3. Blood vessels intact and functioning normally

51. 51 Definition Shock it is a series critical situation, which is a physiologic state characterized by systemic reduction in tissue perfusion , resulting in decreased tissue oxygen delivery

52. 52 l Pathophysiology of shock I cellular respo n ses ! Inadequate tissue perfusion Decreased oxygen supply Anaerob } i metabolism Accumulation met f bolic waste & lactate l Cellular failure (limited ATP produce)

53. 53 5

54. 54 Types of Shock 1- Hypovolemic etiology Hypovolemic shock is an emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. • Blood loss external e.g haemorrhage Internal e.g GI bleeding • Plasma e.g extensive burn • Body fluid loss e.g Vomiting, Diarrhea, Dehydration,

55. 55 Excessive perspiration

56. 56 2- Cardiogenic etiology Cardiogenic shock occurs when the heart is unable to pump as much blood as the body needs. May due to : • Valvular heart disease • Myocardial infarction • Cardiac arrhythmias • Cardiomyopathy • Myocarditis • Myocardial ischemia

57. 57 3- Distributive shock A- Neurogenic etiology Mechanism: • Loss of autonomic innervation of the cardiovascular system (arterioles) • Results due to the overall dilation of the blood vessels within the cardiovascular system • Decreased blood pressure • Insufficient amounts of O is being transported to 2 Causes: • Spinal cord injury • Regional anesthesia • Neurological disorders

58. 58 B - Septic etiology Septic shock is a serious condition that occurs when a body- wide infection leads to dangerously low blood pressure Most often due to gram-negative & gram-positive septicemia. • The common organisms that are concerned with septic shock are E.coli, klebsiella, aerobactor, proteus, pseudomonas, etc • It occurs in cases of, -Severe septicemia -Peritonitis -Meningitis etc.

59. 59 C - Anaphylactic etiology • Results due to a severe allergic reaction • Acute allergic reaction • Large quantities of histamine • Widespread vasodilatation • Reducing peripheral resistance • Reduction in blood volume • Leading to shock

60. 60 General Clinical Features Depending on the specific cause and type of shock, symptoms will include one or more of the following • Cold clammy extremities • Tachycardia, Hypotension • Pallor • Weak or absent peripheral pulses • Prolonged capillary refill time • Hypothermia • Rapid, Shallow Respiration • Drowsiness, Confusion • Oliguria (Urine Output<30ml/hour)

61. 61 • Multi-Organ Failure

62. 62 Clas s I II III IIII Blood loss (ml) (250 – 750) ml (750 – 1500) ml (1500-2000) ml More than 2000 ml Blood loss (%) 15% 15 – 30 % 30 – 40 % More than 40 % Pulse rate Normal or slightly increased Increased ˃ 100 b/min Increased ˃ 120 b/min Decreased Blood pressure Normal Normal Decreased Decreased Respiratory rate Normal 14 – 20 b/min Increased 20-30 b/min Increased 30–40 b/min Decreased ˂ 25 b/min Capillary refill time Normal ˂ 2 second ˃ 2 second Clammy skin Usually ˃3 second Cool, pale skin ˃3 second Cold, dry skin Urine out put ≥ 30 ml/hr 20-30 ml/hr 5-15 ml/hr Negligible Anuria CNS – mental status Slightly anxious Mildly anxious Anxious and confused Confused and lethargic

63. 63 Fluid replacement Crystalloid Crystalloid Crystalloid + Blood Crystalloid + Blood

64. 64 Stages of Shock There are four (4) stages of shock. A- Initial stage • The cardiac output is insufficient to supply the normal nutritional needs of tissues but not low enough to cause serious symptoms • Vital organ function is maintained • Slightly increase heart contraction and increase peripheral resistance • Blood pressure remain normal

65. 65 B- Compensatory stage: • The cardiac output is reduced further. • Compensatory vasoconstriction • The BP tends to remain within the normal range. • Blood flow to the skin and kidney decrease while blood flow to CNS and myocardium is maintained.

66. 66 C- Progressive stage: • The unfavorable change become more and more apparent falling BP • Decrease cardiac out put • Increased heart rate and oliguria • Lactic acid production is high • Deterioration of organ function .

67. 67 D- Irreversible stage: • In this stage of shock no type of therapy can save the patients life • BP decrease • Temporary BP decline until DEATH occurs • Patient dies due to severe tissue damage to the vital organs of the body

68. 68 • History taking Diagnosis • Physical exam (Vital sings, mental status, skin color, temperature, pulses, etc) • Labs: • CBC • Cardiac Enzymes • ABG • Others diagnostic procedures • Abdominal U/S

69. 69 • Head ST scan,CXR and MRI

70. 70 How to manage the shock patient

71. 71 First Aid for Shock 1. Check for responsiveness, normal breathing and severe 2. 3. Call 122 Have victim lie on back and raise legs so that feet are 4. Put breathing, unresponsive victim (if no suspected 5. Loosen any tight clothing

72. 72 6. Be alert for vomiting; turn victim’s head to drain mouth. 7. Don't let the person eat or drink anything 8. Maintain normal body temperature .

73. 73 Goals of management • Correcting a cause • Improve tissue perfusion • Protect ischemic myocardium • Increase Cardiac Out Put

74. 74 Nursing Care plane

75. 75 Nursing Assessment 1- ABCs : Airway, breathing, and circulation 2- Focused assessment of tissue perfusion – Vital signs – Peripheral pulses – CNS – mental status (Level of consciousness) – Capillary refill – Skin (e.g., temperature, color, moisture) – Urine output

76. 76 3- Assess the patient to other clinical manifestations regarding Shock Such as • Tachypnea • bradypnea • Decreased urine output • Pallor, cool, clammy skin • Anxiety, confusionAbsent bowel sounds • Resp – lung sounds, RR, oxygen sat, ABG • Abd pain, rigidity

77. 77 4- Monitor lab values • ABG with lactate • CBC – RBC • Cardiac Enzyme e.g Troponin • Renal Function test (RFT),, BUN, Creatinine are elevated

78. 78 5- Brief history – Events leading to shock – Onset and duration of symptoms • Details of care received before hospitalization • Allergies

79. 79 Nursing Diagnosis • Hyperthermia related to response of inflammatory process in the body • Ineffective airway clearance • Ineffective tissue perfusion: Renal, cerebral, cardiopulmonary, gastrointestinal, hepatic, and • Fear • Potential complication: Organ ischemia/dysfunction

80. 80 Planning • Goals for patient – Assurance of adequate tissue perfusion – Restoration of normal or baseline BP – Return/recovery of organ function – Avoidance of complications from prolonged states of hypoperfusion

81. 81 Nursing Interventions • Check for patent airway and adequate circulation. • Begin an I.V. infusion with normal saline solution or lactated Ringer’s solution. • Help insert a central venous line. • Insert an indwelling urinary catheter. • Explain all procedures and their purposes to ease the patient’s anxiety.

82. 82 Nursing Interventions • Draw an arterial blood sample to measure ABG levels. • Obtain and record the patient’s blood pressure, pulse and respiratory rates, and peripheral pulse rates. • Monitor the patient’s CVP, as ordered. • Measure the patient’s urine output hourly.

83. 83 Nursing Interventions…. Continue .. • Monitor the patient’s ABG and electrolyte levels frequently as ordered. • Administer blood to the patient • loosen tight clothing for patient • Do not administer anything by mouth; this will help to prevent choking • Stop the bleeding that occurred • Continually monitor the patient’s vital signs

84. 84 Nursing Care for Patient with Head Injury

85. 85 Mr.Goran Ab. Osman 2021

86. 86 Basic Anatomy of the Head • Skin • Scalp • Skull • Meninges (Dura Mater ,Arachnoid ,Pia Mater) • Brain Tissue • CSF and Blood vessels

87. 87

88. 88

89. 89 Head Injury Any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor scalp laceration to serious brain injury. A head injury is particularly dangerous as, at first the injury may appear only minor however major internal

90. 90 injuries have occurred A victim with a suspected head injury should be monitored for a number of days after the incident

91. 91 Risk Population • Males 15-24 years. • Males / females = 2/1 • Infants & Young Children • Elderly • Person under drug abuse and drink alcohol

92. 92 Causes • Motor vehicle accidents • Falls • Physical Assaults (Fighting) • Sports-related injuries • Firearm-related injuries

93. 93 Mechanism • Blunt Injury High Velocity Low Velocity • Penetrating Injury Gunshot Sharp instruments • Acceleration • Deceleration • Coup/Contrecoup

94. 94 • BLUNT INJUR • High Velocity • Low Velocity • PENETRATING INJURY • Gunshot • Sharp instr ments

95. 95

96. 96 Acceleration o Immobile head is struck by a moving object . · Skull moves away from force Brain rapidly accelerates from stationary to in- motion state _ causing cellular damage Acceleration

97. 97 Deceleration Head is moving and hits an immobile object Brain con inues moving in skull towards direction of impact, resulting in significant forces that damage cells Deceleration '

98. 98 Coup/Contrecoup Injury resulting from rapid, violent movement of brain • Coup Injury at site . . of impact • Contrecoup Injury on opposite I side from impact (

99. 99 Morphological Classification • Scalp injuries • Skull fractures • Brain injuries

100. 100 Classification • SCALP INJURY: The scalp has many blood vessels, so any scalp injury may bleed profusely. Control bleeding with direct pressure. • SKULL INJURY: Skull injury includes fracture to cranium and the face. If severe enough there can be injury to the brain. • BRAIN INJURY: Brain injury can be classified as direct or indirect. Direct injuries to the brain can occur in open

101. 101 head injuries

102. 102 Scalp injury (1) laceration or bruises (minor injury) Scalp is highly vascular (children may develop shock) Major complication is infection (2) Scalp hematoma include 3types: Sub- cutaneous

103. 103 Sub- galeal Sub- periosteal

104. 104 Skull Fracture • Linear fractures - Do not require Rx • Depressed skull bone Simple or Open Surgery indicated in: compression (large plate of bone)

105. 105 HEAD INJURY -TYPES OPEN HEAD INJURY: CLOSED HEAD INJURY There is penetration to the skull. There is NO penetration to the skull. - Closed Head Injury

106. 106 Pathophysiology • Primary Brain Injury : - Occurs at the time of impact - Mechanical damage is irreversible - Permanent mechanical cellular disruption - Microvascular injury.

107. 107 • Secondary Brain Injury Occurs at some time after the moment of impact

108. 108 Types of Head Injury There are five main types of head injuries: 1. Lacerations 2. concussion 3. Contusions 4. Hemorrhage 5. Compression 6. Skull Fracture

109. 109 Laceration A laceration is a tear in the skin as a result of an injury. In the case of visible bones or tendons, or excessive bleeding or pain, the casualty should be seen to by a doctor

110. 110 Symptoms of Lacerations • Bleeding • Pain • Numbness • Swelling of Injured

111. 111 Concussion • A concussion is a temporary change in the way the brain works when it is suddenly moved or jarred, it occurs when the brain suddenly shifts inside the skull and knocks against the skulls bony surface. • Concussions can last from a few moments, to an unconscious state for over 3 minutes.

112. 112 Symptoms of a Concussion • Amnesia, short term memory loss • Nausea, vomiting • Headache • Blurred Vision • Confusion • Ringing in Ears • Neck Pain • Dizziness • Unconsciousness • Irritability • Convulsions

113. 113 Cerebral Contusion • A contusion is a bruise to the brain tissue which occurs when a number of small blood vessels leak into brain tissue. • Contusions occur when the brain strikes a ridge in the skull, when the head moves suddenly or hits a solid object with great force.

114. 114 Symptoms of a Contusion • Severe Headache • Dizziness • Nausea / Vomiting • Dilated Pupil • Weakness of limbs • Restless, irritable • Memory Loss • Confusion • Drowsiness • Unconsciousness

115. 115 Hemorrhage A brain or subarachnoid hemorrhage occurs when blood leaks out of the blood vessels and onto the surface of the brain. The blood then damages the brain tissue which, along with the blood loss, can cause serious and potentially life threatening brain damage Symptoms of a Hemorrhage • Sudden and Severe headache • Nausea / vomiting • Unconsciousness • Seizure • Paralysis

116. 116 Cerebral Compression A cerebral compression involves a build up of pressure on the brain and can be life threatening, most often requiring surgery. Cerebral skull or injured brain tissue swells Symptoms of a cerebral compression • Recent head injury • Headache • Slow breathing • Slow pulse • Weakness of paralysis side of body • High temperature • Drowsiness • Change in behavior • Disorientation

117. 117 • Unconsciousness

118. 118 Skull Fracture A skull fracture occurs after a head injury and can be life threatening as the fractured bone may cause damage to Symptoms of a Skull Fracture • Wound of Bruise on head • Depression on scalp • Altered level of response • Blood in the eye • Clear fluid discharge from nose or ear • Bruising around eyes

119. 119 • Bruising or swelling behind an ear

120. 120 Diagnosis • History Taking • Investigations (CBC,ABG….etc) • X-ray • CT scan: standard modality • MRI • Lumber Puncture (CSF test)

121. 121 Management Initial Management A: Airway control including cervical spine immobilization with a stiff collar. B: Breathing C: Circulation D: Dysfunction or Disability E: External Examination

122. 122 Nursing Care for Patient with Head Injury • Assess vitals Signs • Assess neurological injury (GCS) • Assess oxygenation and ventilation • Observe pupils for signs of elevated intracranial pressure • Assess ins and outs fluids • Check nose and ear for CSF leak • Assess if the patient is able to sense or has pain • Encourage coughing

123. 123 • Provide stress ulcer and DVT prophylaxis • Administer IV fluids • Check lab tests • Check the endotracheal tube for position and patency • Suction the airways • Provide skincare and pressure ulcer prophylaxis • Provide a safe environment for the patient • Administer medications as prescribed • Psychological Support to pt. and pts family

124. 124 Complications • Coma • Chronic headaches • Loss of or change in sensation, hearing, vision, taste, or smell • Paralysis • Hydrocephalus • Seizures • Speech and language problems • Death

125. 125 General Head Injury Prevention Tips • Always wear seatbelt and use car seats and booster seats for children. • Never drive under the effect of drugs or alcohol. • Wear a properly fitting helmet when riding a bicycle. • Prevent falls by – Making house safer. For example, install railings on the stairs. – Improving the balance and strength with regular physical activity

126. 126 Nursing Care for Patient with Renal Failure

127. 127 Mr.Goran Ab. Osman 2021

128. 128 Kidneys The kidneys are two bean-shaped organs , each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine.

129. 129 Anatomy of Kidneys

130. 130 A B C Human urin r a y · system

131. 131 k ( Mammalian nephron

132. 132 Definition Acute renal failure is sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes

133. 133 Causes • Pre renal Causes • Intra-renal Causes • Post renal Causes

134. 134 Pre-renal causes • Decreased blood flow example(Heart failure ,shock, bleeding, sever anemia, sever dehydration, sever burn) • Autoimmune disorders • Infections such as acute pyelonephritis or septicemia

135. 135 • Over-exposure to radiographic contrast materials, certain antibiotics, and other medications or substances

136. 136 Intra-renal causes • Tumors • Urinary tract obstruction • Direct injury to the kidney • Severe acute nephritic syndrome

137. 137 Post-renal causes • Kidney stones • Acute tubular necrosis ( ATN ) • Enlargement prostate • Bladder Cancer

138. 138 Risk factors Conditions that can increase your risk of kidney failure include: • Being hospitalized, especially for a serious condition that requires intensive care. • Advanced age. • Diabetes. • High blood pressure. • Heart failure. • Kidney diseases • Family history

139. 139 Clinical Manifestations Early symptoms • Weakness • Anorexia • Nausea • Unexplained anemia • Osteodystrophy • Reduced amount of urine

140. 140 Late manifestations • Gastrointestinal bleeding • Pericarditis • Congestive cardiac failure • Convulsions • Coma • Cardiomyopathy • Edema • Unexplained shortness of breath

141. 141 Kidney Function/GFR Description Stage 1 >90% Normal or High Function Stage 2 60·89% Mildly Decreased Function Stage 3 30·59% Mild to Moderately Decreased Funct ion Stage 4 15·29% Severely Decreased Function

142. 142 Stage 5 < 15 % Kidney Failure

143. 143 • Taking History Diagnosis • Blood tests, which can show how well the kidneys are removing waste from the blood. -Serum creatnine -Blood urea • Advanced imaging, which can show kidney abnormalities or obstructions (blockages). - Ct scan, KUB x-ray • Urine tests, which measure the amount of urine or specific substances in the urine, such as protein or blood. - General Urine Examination

144. 144 Management 1- Treating complications Kidney disease complications can be controlled to make patient more comfortable. Treatments might include: • High blood pressure medications. People with kidney disease can have worsening high blood pressure. • Medications to relieve swelling. People with chronic kidney disease often retain fluids. This can lead to

145. 145 swelling in the legs as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in the body.

146. 146 • Medications to treat anemia. Supplements of the hormone erythropoietin, sometimes with added iron, help produce more red blood cells. This might relieve fatigue and weakness associated with anemia. • Medications to protect bones. Calcium and vitamin D supplements can help prevent weak bones and lower the risk of fracture.

147. 147 • Medications to lower cholesterol levels. The doctor might recommend medications called statins to lower have high levels of bad cholesterol, which can increase the risk of heart disease. • A lower protein diet to minimize waste products in the blood. As the body processes protein from foods, it the blood. To reduce the amount of work the kidneys must do, the doctor might recommend eating less

148. 148 2- Lifestyle and home remedies • As part of the treatment for chronic kidney disease, the doctor might recommend a special diet to help support the kidneys and limit the work they must do:

149. 149 Depending on the situation, kidney function and overall health, dietary recommendations might include the following • Avoid products with added salt. • Choose lower potassium foods. • Limit the amount of protein you eat. • Take vitamin and minerals as supplement • Limit fluid take • Avoid from high fatty diet

150. 150 Treatment for end-stage kidney disease If the kidneys can't keep up with waste and fluid clearance on their own and develop complete or near-complete kidney needs dialysis or a kidney transplant. • Dialysis. Dialysis artificially removes waste products and extra fluid from the blood when the kidneys can no longer • In hemodialysis , a machine filters waste and excess fluids from the blood. • In peritoneal dialysis , a thin tube inserted into solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from body, carrying

151. 151 the waste with it.

152. 152 • Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into the body. Transplanted kidneys can come from deceased or living donors. After a transplant, patient needs to take medications for the rest of his/her life to keep body from rejecting the new organ. No need to be on dialysis to have a kidney transplant

153. 153 Nursing Management • Frequent monitoring – Hydration and output – Cardiovascular function – Respiratory status – Electrolytes – Nutrition • Mental status – Emotional well being • Ensure proper medication regimen • Skin care • Bleeding problems • Care of the shunt

154. 154 • Education to client and family

155. 155 Complications • Azotemia • Metabolic acidosis • Electrolyte abnormalities including hyperkalemia • HTN • Severe anemia • Growth retardation • Increased risk of infections

156. 156 • Seizures

157. 157 Thanks for your attention

158. 158