the client with renal alteration

8/3/2019 The Client With Renal Alteration

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The client with RENALALTERATION:

ACUTE RENAL

FAILURE


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INTRODUCTION

WHAT IS ACUTE RENAL FAILURE?

the sudden loss of our kidneys' ability toperform their main function of eliminatingexcess fluid and salts (electrolytes) as well aswaste material from our blood.

develops rapidly over a few hours or a fewdays.

can be fatal and requires intensive treatment

REVERSIBLE!


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PHASES OF ACUTE RENAL FAILURE

1. Oliguric-anuric phase urine volume less than 400 ml per 24

hours.

increased in serum creatinine, urea,uric acid, organic acids, potassium,and magnesium

lasts 3 to 5 days in infants and children 10 to 14 days in adolescents and

adults.


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2. Diuretic phasebegins when urine output exceeds

500 ml per 24 hours

end when BUN and creatinine levelsstop rising.


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3. RECOVERY PHASE

Asymptomatic

last several months to 1

year


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CAUSES OF ARF

3 categories:1. PRERENAL - A sudden, serious drop in

blood flow to the kidneys.

2. INTRARENAL - Direct damage t thekidneys by inflammation, toxins, drugs,infection or reduced blood supply.

3. POSTRENAL - A sudden blockage thatstops urine from flowing out of thekidneys.


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SIGNS AND SYMPTOMS:

Decreased urine output, although occasionally

urine output remains normal

Fluid retention, causing swelling in your legs,ankles or feet

DrowsinessShortness of breath

Fatigue

ConfusionNausea

Seizures or coma in severe cases

Chest pain or pressure


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TESTS AND DIAGNOSIS:

Urine output measurements

Urine test

Blood test

may reveal rapidly rising levels of ureaand creatinine

Imaging test

ultrasound and computerizedtomography (CT)


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SUMMARY OF THE CASETotoy Bato,65, has had a history of heart

trouble for several years. He is admittedbecause he has urinated very little for twodays, gets dizzy when getting up from ying

down, and cannot get his shoes on becausehis feet are fat. He states that he does notknow what is happening to him. Results of

laboratory test are as follows: BUN,90mg/dL; creatinine, 4mg/dL; urine sodium15mEq/dL and urine specific gravity 1.030.


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ACUTE RENAL

FAILURE

TERMS AND

LEARNING ISSUES


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TERMS HYPOTHESIS INFERENCE CONCLUSION

BUN,

CREATININE

BUN

Blood Urea

Nitrogen

Waste

products

excreted by

the kidneys.

Blood urea nitrogen

(BUN) measures the

amount of ureanitrogen, a waste

product of protein

metabolism, in the

blood. Urea is formed

by the liver and carried

by the blood to thekidneys for excretion.

Creatinine is a break-

down product

of creatine

phosphate in muscle,

and is usually

produced at a fairly

constant rate by the

body (depending on

muscle mass).Reference:

http://en.wikipedia.org/wiki/Creatini

nehttp://www.rnceus.com/renal/renalb

un.html

Partially

accepted.
http://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://www.rnceus.com/renal/renalbun.htmlhttp://www.rnceus.com/renal/renalbun.htmlhttp://www.rnceus.com/renal/renalbun.htmlhttp://www.rnceus.com/renal/renalbun.htmlhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatinine


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URINE

SODIUM

Presence of

sodium in

the urine .

Measureme

nt of

amount of

sodium

excreted in

the urine.

measurement

of the levelof sodium in

the urine.

Reference:

http://en.wikipedia.org/wi

ki/Urine_sodium

Accepted
http://en.wikipedia.org/wiki/Urine_sodiumhttp://en.wikipedia.org/wiki/Urine_sodiumhttp://en.wikipedia.org/wiki/Urine_sodiumhttp://en.wikipedia.org/wiki/Urine_sodium


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URINE

SPECIFICGRAVITY

To measure

urine

concentrat

ion

Urine specific

gravity is alaboratory test

that measures

theconcentration

of all chemical

particles in

the urine.

Reference:

http://www.nlm.nih.gov/medli

neplus/ency/article/003587.ht

m

Accepted

CONCLUSION
http://www.nlm.nih.gov/medlineplus/ency/article/003587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003587.htm


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LEARNINGISSUE

HYPOTHESIS INFERENCE CONCLUSION

1. What is

therelationshi

p of (+)

history of

hearttrouble in

the renal

alteration

of theclient?

When the patient

has renal failure,

there is water

retention in the

body that results

to fluid overload.

This results to an

increase in the

workload of the

heart that leads

to heart trouble.

Renal

vasoconstriction,

which is the narrowing

of the blood vessels

resulting from

contraction of the

muscular wall, is an

early symptom ofcongestive heart

failure. Progressively,

severe hypertension

can do incredible

damage to the kidneys

Reference: Renal Failure & Heart

Disease |

eHow.comhttp://www.ehow.com/abo

ut_5108490_renal-failure-heart-

disease.html#ixzz1OsiO8qIa

REJECTED

LEARNING HYPOTHESIS INFERENCE CONCLUSION
http://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.htmlhttp://www.ehow.com/about_5108490_renal-failure-heart-disease.html


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LEARNINGISSUE


2. Why does the

patient

experience

dizziness

when getting

up from lying

position?

Maybe this is due

to orthostatic

hypotension. The

patient maybe

suddenly gets up

from a lying

position that

causes sudden

decrease in his

blood pressure and

also because of his

age.

Orthostatic hypotension also called postural

hypotension is a formof low blood pressurethat happens when youstand up from sitting orlying down. Orthostatichypotension can make

you feel dizzy orlightheaded, and maybeeven faint. Orthostatichypotension can happento anyone but is morecommon in older adults.

Reference:

http://www.mayoclinic.com/health/ort

hostatic-hypotension/DS00997

ACCEPTED
http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997


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LEARNINGISSUE


4. Why does the

patient

experience

swelling /

edema of the

feet?

Because there is

fluid overload andurinary retention.

Swollen foot indicatesheart failure, kidney

failure. In theseconditions, there is toomuch fluid in the body.

Reference:http://www.nlm.nih.gov/

medlineplus/ency/article/003104.htm

ACCEPTED



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LEARNINGISSUE


5. What are the

risk factors

contributing to

the possible

diagnosis

(acute renal

failure)?

Age, history of heart

trouble, lifestyle andgenetics.

Being hospitalized,especially for a serious

condition that requiresintensive care,Advanced age,Blockages in the bloodvessels in your arms orlegs (peripheral artery

disease),Diabetes, Highblood pressure, Heartfailure, Kidney diseases,Liver disease.Reference:http://www.mayoclinic.co

m/health/kidney-failure/DS00280/DSECTION=risk-factors

ACCEPTED

http://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factorshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=risk-factors


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LEARNINGISSUE


6. What are the

signs and

symptoms of

the possible

diagnosis

(acute renal

failure)?

Urinary retention,

edema, dry skin,hypertension,

dizziness.

Decreased urineoutput, although

occasionally urineoutput remains normalFluid retention, causingswelling in your legs,ankles or feetDrowsiness

Shortness of breathFatigueConfusionNauseaSeizures or coma insevere case

Chest pain or pressureReference:http://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptoms

ACCEPTED

http://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptomshttp://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=symptoms


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LEARNINGISSUE


7. What are the

normal values

of BUN,

creatinine,

urine sodium,

and specific

gravity of the

urine?

BUN = 60-80mg/dLCREATININE= 0.1

1.0 mg/dlLURINE SPECIFICGRAVITY = 0.0010.010URINE SODIUM = 8 10 mEq/L

BUN = 8.00 23.00CREATININE = 0.51

0.95URINE SPECIFICGRAVITY = 1.0021.030URINE SODIUM = 15250 mEq/L

REFERENCE:(PPDs Nursing Drug

Guide 2ndedition)Medical SurgicalNursing by J.B.

Lippincott Company

REJECTED



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LEARNINGISSUE


8. What are the

purpose or

indications of

BUN,

creatinine,

urine sodium

and specific

gravity in the

possible

diagnosis

(acute renal

failure)?

To asses if the

result are withinthe normal and

can be useful in

diagnosing the

patients

condition.

Kidney function testsare common lab tests

used to evaluate howwell the kidneys areworking. These include:BUN, creatinine blood,creatinine clearance,creatinine urine.

Reference:http://www.nlm.nih.gov/medlineplus/ency/article

/003435.htm

ACCEPTED


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ACUTE RENAL

FAILURE

ANATOMYAND

PHYSIOLOGY


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The kidneys are bean-shapedorgans, each about the size of afist. They are located near themiddle of the back, just below the

rib cage, one on each side of thespine. The kidneys aresophisticated reprocessingmachines.


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Every day, a persons kidneys process about 200 quartsof blood to sift out about 2 quarts of waste products andextra water. The wastes and extra water become urine,

which flows to the bladder through tubes called ureters.The bladder stores urine until releasing it throughurination.


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The kidneys remove wastes and water from the blood to

form urine. Urine flows from the kidneys to the bladderthrough the ureters.

Wastes in the blood come from the normal breakdown of

active tissues, such as muscles, and from food. Thebody uses food for energy and self-repairs. After thebody has taken what it needs from food, wastes are sentto the blood. If the kidneys did not remove them, thesewastes would build up in the blood and damage the

body.


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The actual removal of wastes occurs in tiny units insidethe kidneys called nephrons. Each kidney has about a

million nephrons. In the nephron, a glomeruluswhich isa tiny blood vessel, or capillaryintertwines with a tinyurine-collecting tube called a tubule.

The glomerulus acts as a filtering unit, or sieve, andkeeps normal proteins and cells in the bloodstream,allowing extra fluid and wastes to pass through. Acomplicated chemical exchange takes place, as wastematerials and water leave the blood and enter theurinary system.


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ACUTE RENAL FAILURE

PATHOPHYSIOLOGY


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Modifiable Risk Factors

>Age

>History of heart dse.

>Intake of nephrotoxic drugs

Non-modifiable

Risk factors

>lifestyle

Prolonged HPN

Increase Viscosity of blood

Sluggish blood flow

Decrease renal perfussion


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Acute renalfailure

Posturalhypotension

Na,H2o,Urearetention

Blood pressureregulation is impaired

Progressivedeterioration of

nephrons

HPN

RAAS is notactivated

glumerulosclerosis

No release of

renin

IncreaseBUN,Crea

Urine

output

Decrease

GFR

edema


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ACUTE RENAL

FAILURE

LABORATORY

RESULTS

NORMAL Nursing


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ANALYTE RESULTNORMAL

RANGESIGNIFICANCE

Nursing

Consideration

Blood

Urea

Nitrog

en

90

mg/dL

5

25

mg/dl

High.

Indicates reduction in

filtrate formation and

function of the tubular

epithelium and inability of

the kidney to excrete

metabolic waste products

of protein through urine

cause increase in BUN and

Creatinine.

Medical Surgical Nursing

by J.B. Lippincott

Company

1. Assess for

urine ferrous,

odor of breath,

stomatitis and

gastro

intestinal

bleeding.

2. Provide oral

hygiene.

3. Promote skin

care to prevent

uremic frost and

pruritus.

NORMAL Nursing


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RANGESIGNIFICANCE

Nursing

Consideration

Creati

nine

4

mg/dL

0.4

1.2

mg/dl

High.

Indicates reduction in

filtrate formation and

function of the tubular

epithelium and inability of

the kidney to excrete

metabolic waste products

of protein through urine

cause increase in BUN and

Creatinine.Medical Surgical Nursing

by J.B. Lippincott

Company

1. Assess for

urine ferrous,

odor of breath,

stomatitis and

gastro

intestinal

bleeding.

2. Provide oral

hygiene.

3. Promoteskin care to

prevent uremic

frost and

pruritus.

NORMAL Nursing


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RANGESIGNIFICANCE

Nursing

Consideration

Sodium 15

mEq/L

15

250

mEq/L

Within the

normal range.http://www.nlm.nih.gov/medlineplus/enc

y/article/003599.htm

1. Accurate

measurement and

recording of intake

and output.

2. Monitor for

weight gain and

edema.

3. Encouragepatient to remain

within prescribed

fluid restriction.

4. Provide hard

candy and chewinggum on ice cube as

thirst-quenchers.

NORMAL Nursing
http://www.nlm.nih.gov/medlineplus/ency/article/003599.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003599.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003599.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003599.htm


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RANGESIGNIFICANCE

Nursing

Consideration

Specific

Gravity

1.030 1.002

1.030

Within the

normal range.

http://pathcuriel.

swmed.edu/pathdemo/nrrt.htm#ur

ine
http://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htmhttp://pathcuriel.swmed.edu/pathdemo/nrrt.htm


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ACUTE RENAL

FAILURE

NURSING

CARE PLANS

Assessment Diagnosis Planning Intervention Rationale Expected Outcome


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the client with renal alteration

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