Renal failure - MEDICAL SURGICAL NURSING

MEDICAL SURGICAL NURSING

1. RENAL FAILURERENAL FAILURE

2. INTRODUCTIONINTRODUCTION
•Renal failure results when the kidneys Renal failure results when the kidneys
cannot remove the body’s metabolic cannot remove the body’s metabolic
wastes or perform their regulatory wastes or perform their regulatory
functions.functions.
•The substances normally eliminated in the The substances normally eliminated in the
urine accumulate in the body fluids as a urine accumulate in the body fluids as a
result of impaired renal excretion- result of impaired renal excretion-
disruption in the disruption in the
Endocrine and metabolic functions Endocrine and metabolic functions

3. DEFINITIONDEFINITION
•Acute renal failure is a reversible clinical Acute renal failure is a reversible clinical
syndrome where there is a sudden and syndrome where there is a sudden and
almost complete loss of kidney function almost complete loss of kidney function
(decreased GFR) over a period of hours to (decreased GFR) over a period of hours to
days with failure to excrete nitrogenous days with failure to excrete nitrogenous
waste products and to maintain fluid and waste products and to maintain fluid and
electrolyte homeostasis.electrolyte homeostasis.

4. ETIOLOGYETIOLOGY
•Pre-renal causesPre-renal causes
•Intra-renal causesIntra-renal causes
•Post-renal causes Post-renal causes

5. Pre-renal causesPre-renal causes
•Volume depletionVolume depletion
1.1.HemorrhageHemorrhage
2.2.Renal losses (diuretic, osmotic diuresis)Renal losses (diuretic, osmotic diuresis)
3.3.Gastro intestinal losses ( vomiting, diarrhea, Gastro intestinal losses ( vomiting, diarrhea,
naso-gastric suction)naso-gastric suction)
•Impaired cardiac-efficiency resulting fromImpaired cardiac-efficiency resulting from
1.1.Myocardial infarctionMyocardial infarction
2.2.DysarrhythmiasDysarrhythmias
3.3.Cardiogenic shock Cardiogenic shock

6. Con…Con…
•Vasodilation resulting fromVasodilation resulting from
1.1.SepsisSepsis
2.2.Anaphylaxis Anaphylaxis
3.3.Anti-hypertensive medications or other Anti-hypertensive medications or other
medications.medications.

7. INTRA-RENAL CAUSESINTRA-RENAL CAUSES
•Prolonged renal ischemiaProlonged renal ischemia
1.1.NephropathyNephropathy
2.2.MyoglobinuriaMyoglobinuria
3.3.Hemoglobinuria Hemoglobinuria
•Nephrotoxic agentsNephrotoxic agents
1.1.Amino glycoside antibiotics Amino glycoside antibiotics
2.2.Heavy metalsHeavy metals
3.3.Solvents and chemicalsSolvents and chemicals

8. Con…Con…
4.NSAIDS4.NSAIDS
5.ACE inhibitors5.ACE inhibitors
•Infections Infections
1.1.Acute pyelonephritisAcute pyelonephritis
2.2.Acute glomerulonephritisAcute glomerulonephritis

9. Post-renal causesPost-renal causes
•Urinary tract obstructionUrinary tract obstruction
1.1.CalculiCalculi
2.2.TumorTumor
3.3.BPHBPH
4.4.StricturesStrictures
5.5.Blood clotsBlood clots

10. PHASES OF ACUTE RENAL PHASES OF ACUTE RENAL
FAILUREFAILURE
•Initiation phaseInitiation phase
•Oliguria phaseOliguria phase
•Diuresis periodDiuresis period
•Recovery periodRecovery period

11. CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
•Lethargic Lethargic
•Skin and mucus membrane are dry from Skin and mucus membrane are dry from
dehydration.dehydration.
•DrowsinessDrowsiness
•HeadacheHeadache
•Twitching seizuresTwitching seizures

12. ASSESSMENT AND DIAGNOSTICASSESSMENT AND DIAGNOSTIC
•Evaluation and changes in urineEvaluation and changes in urine
•Ultra sonographyUltra sonography
•CT scan, MRI scanCT scan, MRI scan
•Serum Na, K, Phosphate, creatinine, CaSerum Na, K, Phosphate, creatinine, Ca
•BUN BUN
•Metabolic acidosisMetabolic acidosis

13. MANAGEMENTMANAGEMENT
•Restore normal chemical balance and Restore normal chemical balance and
prevent complication.prevent complication.
•Maintaining fluid balance avoiding fluid Maintaining fluid balance avoiding fluid
excess or possibly performing dialysis.excess or possibly performing dialysis.
•Dialysis- PD,HD, CRRTDialysis- PD,HD, CRRT

14. PHARMACOLOGICAL PHARMACOLOGICAL
MANAGEMENTMANAGEMENT
•Cat ion- exchange resins- sodium Cat ion- exchange resins- sodium
polystyrene sulfonate.polystyrene sulfonate.
•Iv dextrose 50%, insulin, and calcium Iv dextrose 50%, insulin, and calcium
replacement replacement
•Albuterol sulfate.Albuterol sulfate.
•Phosphate binding agents( aluminium Phosphate binding agents( aluminium
hydroxide) hydroxide)

15. NUTRITIONAL THERAPYNUTRITIONAL THERAPY
•High CHO diet High CHO diet
•Food and fluids containing potassium or Food and fluids containing potassium or
phosphorus.phosphorus.
•High protein, high calorie diet.High protein, high calorie diet.

16. NURSING MANAGEMENTNURSING MANAGEMENT
•Monitor fluid and electrolyte balance.Monitor fluid and electrolyte balance.
•Reducing metabolic rate.Reducing metabolic rate.
•Promoting pulmonary function.Promoting pulmonary function.
•Preventing infectionPreventing infection
•Providing skin care.Providing skin care.
•Providing support.Providing support.

17. CHRONIC RENAL FAILURECHRONIC RENAL FAILURE
•It is a progressive irreversible deterioration It is a progressive irreversible deterioration
in renal function in which the body’s ability in renal function in which the body’s ability
to maintain metabolic and fluid and to maintain metabolic and fluid and
electrolyte balance fails resulting in uremia electrolyte balance fails resulting in uremia
and azotemia.and azotemia.

18. ETIOLOGYETIOLOGY
•Systemic disease- DM, hypertension, chronic Systemic disease- DM, hypertension, chronic
glomerulonephritis, pyelonephritisglomerulonephritis, pyelonephritis
• Obstruction of urinary tract Obstruction of urinary tract
•Hereditary lesionsHereditary lesions
•Vascular disordersVascular disorders
•Infections Infections
•MedicationsMedications
•Toxic agentsToxic agents
•Environmental and occupational agents Environmental and occupational agents

19. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Deterioration and destruction of nephronsDeterioration and destruction of nephrons
GFR falls and clearance is reducedGFR falls and clearance is reduced
Serum urea nitrogen and creatinine levels riseSerum urea nitrogen and creatinine levels rise
Remaining nephrons hypertrophy due to large load Remaining nephrons hypertrophy due to large load
to filter.to filter.

20. Con..Con..
Kidney lose their ability to concentrate urine Kidney lose their ability to concentrate urine
Functioning nephrons declineFunctioning nephrons decline
Accumulation of waste productsAccumulation of waste products
Uremia and deathUremia and death

21. CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
•NEUROLOGICNEUROLOGIC
Weakness and fatigueWeakness and fatigue
ConfusionConfusion
Inability to concentrateInability to concentrate
Tremors Tremors
SeizuresSeizures
RestlessnessRestlessness
Burning of soles of feetBurning of soles of feet

22. INTEGUMENTARYINTEGUMENTARY
•Gray bronze skin colorGray bronze skin color
•PruritisPruritis
•PurpuraPurpura
•EcchymosisEcchymosis
•Coarse thinning hairCoarse thinning hair

23. CARDIOVASCULARCARDIOVASCULAR
•Hypertension Hypertension
•PericarditisPericarditis
•Pericardial tamponadePericardial tamponade
•HyperkalemiaHyperkalemia
•HyperlipidemiaHyperlipidemia
•Engorged neck veinsEngorged neck veins

24. PULMONARYPULMONARY
•Pleuritic pain Pleuritic pain
•Shortness of breathShortness of breath
•TachypnoeaTachypnoea
•Kussumaul type respirationKussumaul type respiration
•Uremic pneumonitisUremic pneumonitis

25. GITGIT
•Ammonia odor to breathAmmonia odor to breath
•Metallic tasteMetallic taste
•Mouth ulcerations and bleedingMouth ulcerations and bleeding
•Anorexia, nausea, vomitingAnorexia, nausea, vomiting
•HiccupsHiccups
•Constipation Constipation
•diarrhoeadiarrhoea

26. Con…Con…
•HEMATOLOGICHEMATOLOGIC
AnemiaAnemia
ThrombocytopeniaThrombocytopenia
•REPRODUCTIVEREPRODUCTIVE
Amenorrhea Amenorrhea
Testicular atrophyTesticular atrophy
infertilityinfertility

27. MUSCULOSKELETALMUSCULOSKELETAL
•Muscle crampMuscle cramp
•Loss of muscle strengthLoss of muscle strength
•Renal osteodystrophyRenal osteodystrophy
•Bone painBone pain
•Bone fractures Bone fractures
•Foot dropFoot drop

28. STAGESSTAGES
•BASED ON GFRBASED ON GFR
1.1.Stage I Stage I
GFR>/ 90ml GFR>/ 90ml
2.2.Stage IIStage II
GFR>/60-89mlGFR>/60-89ml
3. Stage III3. Stage III
GFR>/30-59mlGFR>/30-59ml
4. Stage IV 4. Stage IV
GFR>/15-29mlGFR>/15-29ml
5. Stage V 5. Stage V
GFR < 15mlGFR < 15ml

29. ASSESSMENT AND ASSESSMENT AND
DIAGNOSTICDIAGNOSTIC
•Urine testUrine test
•Imaging of the kidneysImaging of the kidneys
•Serum creatinineSerum creatinine

30. MEDICAL MANAGEMENTMEDICAL MANAGEMENT
•DIETDIET
•MEDICATIONSMEDICATIONS
•DIALYSISDIALYSIS
•RENAL TRANSPLANTATIONRENAL TRANSPLANTATION

31. NURSING DIAGNOSISNURSING DIAGNOSIS
•Excess fluid volume related to decrease urine Excess fluid volume related to decrease urine
output output
•Imbalanced nutrition less than body requirement Imbalanced nutrition less than body requirement
related anorexiarelated anorexia
•Deficient knowledge regarding condition and Deficient knowledge regarding condition and
treatment regimentreatment regimen
•Activity intolerance related to fatigue, anemia, Activity intolerance related to fatigue, anemia,
retention of waste productsretention of waste products
•Risk for situational low self esteem related to Risk for situational low self esteem related to
dependency.dependency.