report on acute and chronic

8/3/2019 Report on Acute and Chronic

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ACUTE AND CHRONICACUTE AND CHRONICILLNESSILLNESS


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ACUTE ILNESS:ACUTE ILNESS:

AnAn acuteacute illnessillness is anis an illnessillness thatthatonsets very rapidly and is ofonsets very rapidly and is of

short duration. Managementshort duration. Management

ofof acuteacute illnesses requiresillnesses requires

determining what is makingdetermining what is making

someone sick so that asomeone sick so that atreatment plan can betreatment plan can be

developed.developed.


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CHRONIC ILLNESS:CHRONIC ILLNESS:AA chronic diseasechronic disease is ais a diseasedisease

that is longthat is long--lasting orlasting or

recurrent.recurrent. chronicchroniccan refer to acan refer to apersistent and lasting medicalpersistent and lasting medical

condition.condition.ChronicityChronicity is usuallyis usually

applied to a condition that lastsapplied to a condition that lasts

more than three months.more than three months.


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ACUTE RENAL FAILUREACUTE RENAL FAILURE::Is a sudden decline in renal function,Is a sudden decline in renal function,usually marked by increasedusually marked by increased

concentrations of blood ureaconcentrations of blood ureanitrogen (BUN; azotemia) andnitrogen (BUN; azotemia) and

creatinine; oliguria (less than 500 mlcreatinine; oliguria (less than 500 ml

of urine in 24 hours); hyperkalemia;of urine in 24 hours); hyperkalemia;and sodium retention.and sodium retention.


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Acute renal failure areAcute renal failure are

classified into following:classified into following:1) Prerenal failure1) Prerenal failure : results: results

from conditions that interruptfrom conditions that interrupt

the renal blood supply; therebythe renal blood supply; thereby

reducing renal perfusionreducing renal perfusion

(hypovolemia, shock,(hypovolemia, shock,hemorrhage, burns impairedhemorrhage, burns impaired

cardiac output, diuretic therapy).cardiac output, diuretic therapy).


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2)Postrenal failure2)Postrenal failure resultsresultsfrom obstruction of urine flow.from obstruction of urine flow.

3)3) Intrarenal failureIntrarenal failure resultsresultsfrom injury to the kidneysfrom injury to the kidneysthemselves (ischemia, toxins,themselves (ischemia, toxins,

immunologic processes,immunologic processes,systemic and vascularsystemic and vascular

disorders).disorders).


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The disease progressesThe disease progressesthrough three clinically distinctthrough three clinically distinctphase which is oliguricphase which is oliguric--anuric,anuric,

diuretic, and recovery,diuretic, and recovery,

distinguished primarily bydistinguished primarily by

changes in urine volume andchanges in urine volume andBUN and creatinine levelsBUN and creatinine levels..


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Complication of ARF , increasedComplication of ARF , increased

susceptibility to infection,susceptibility to infection,electrolyte abnormalities, GIelectrolyte abnormalities, GIbleeding due to stress ulcers, andbleeding due to stress ulcers, and

multiple organ failure. Untreatedmultiple organ failure. Untreated

ARF can also progress to chronicARF can also progress to chronic

renal failure, endrenal failure, end--stage renal disease,stage renal disease,and death from uremia or relatedand death from uremia or related

causes.causes.


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Assessment:Assessment:1)1)OliguricOliguric--anuric phaseanuric phase: urine: urine

volume less than 400 ml per 24volume less than 400 ml per 24

hours; increased in serumhours; increased in serumcreatinine, urea, uric acid, organiccreatinine, urea, uric acid, organic

acids, potassium, and magnesium;acids, potassium, and magnesium;

lasts 3 to 5 days in infants andlasts 3 to 5 days in infants andchildren, 10 to 14 days inchildren, 10 to 14 days in

adolescents and adults.adolescents and adults.


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2)Diuretic phase2)Diuretic phase: begins when: begins when

urine output exceeds 500 ml perurine output exceeds 500 ml per24 hours, end when BUN and24 hours, end when BUN and

creatinine levels stop rising;creatinine levels stop rising;

length is available.length is available.3)Recovery phase3)Recovery phase::

asymptomatic; last severalasymptomatic; last severalmonths to 1 year; some scarmonths to 1 year; some scar

tissue may remain.tissue may remain.


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4)In prerenal disease4)In prerenal disease::

decreased tissue turgor, drynessdecreased tissue turgor, drynessof mucous membranes, weightof mucous membranes, weight

loss, flat neck veins, hypotension,loss, flat neck veins, hypotension,

tachycardia.tachycardia.5)5)In postrenal diseaseIn postrenal disease::

difficulty in voiding, changes indifficulty in voiding, changes inurine flow.urine flow.


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6)In IntrarenalDisease:6)In IntrarenalDisease:

presentation varies; usually havepresentation varies; usually haveedema, may have fever, skin rash.edema, may have fever, skin rash.

7) Nausea, vomiting, diarrhea,7) Nausea, vomiting, diarrhea,

and lethargy may also occur.and lethargy may also occur.


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Diagnostic EvaluationDiagnostic Evaluation::

1)Urinalysis shows proteinuria,1)Urinalysis shows proteinuria,hematuria, casts. Urine chemistryhematuria, casts. Urine chemistry

distinguishes various forms of ARF(distinguishes various forms of ARF(

prerenal, postrenal, intrarenal).prerenal, postrenal, intrarenal).2)Serum creatinine and BUN levels2)Serum creatinine and BUN levels

are elevated; arterial blood gasare elevated; arterial blood gas(ABG) levels, serum electrolytes(ABG) levels, serum electrolytes

may be abnormal.may be abnormal.


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3)Renal untrasonography3)Renal untrasonography

estimates renal size and rulesestimates renal size and rulesout treatable obstructiveout treatable obstructive

uropathy.uropathy.


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Therapeutic andTherapeutic and

Pharmacologic Interventions:Pharmacologic Interventions:1)Surgical relief of obstruction may1)Surgical relief of obstruction maybe necessary.be necessary.

2)Correction of underlying fluid2)Correction of underlying fluid.excesses or deficits..excesses or deficits.

3)Correction and control of3)Correction and control of

biochemical imbalances.biochemical imbalances.


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4)Restoration and maintenance4)Restoration and maintenance

of blood pressure through I.V.of blood pressure through I.V.fluids and vasopressors.fluids and vasopressors.

5)Maintenance of adequate5)Maintenance of adequate

nutrition: Low protein diet withnutrition: Low protein diet with

supplemental amino acids andsupplemental amino acids andvitamins.vitamins.


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.. Nursing Interventions:Nursing Interventions:1)Monitor 241)Monitor 24--hour urine volume tohour urine volume to

follow clinical course of the disease.follow clinical course of the disease.

2)Monitor BUN, creatinine, and2)Monitor BUN, creatinine, andelectrolyte.electrolyte.

3)Monitor ABG levels as necessary3)Monitor ABG levels as necessary

to evaluate acidto evaluate acid--base balance.base balance.


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4)Weigh the patient to provide an4)Weigh the patient to provide an

index of fluid balance.index of fluid balance.

5)Measure blood pressure at5)Measure blood pressure atvarious times during the day withvarious times during the day with

patients in supine, sitting, andpatients in supine, sitting, and

standing positions.standing positions.

6)Adjust fluid intake to avoid6)Adjust fluid intake to avoidvolume overload and dehydration.volume overload and dehydration.


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7)Encourage the patient to7)Encourage the patient to

report routine urinalysis andreport routine urinalysis and

followfollow--up examinations.up examinations.8) Institute seizure precautions.8) Institute seizure precautions.

Provide padded side rails andProvide padded side rails and

have airway and suctionhave airway and suction


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9)watch for urinary tract9)watch for urinary tractinfection, and remove bladderinfection, and remove bladdercatheter as soon as possible.catheter as soon as possible.


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Meds:Meds:

--Antibiotics.Antibiotics.

--diuretic medicine (lasix)diuretic medicine (lasix)


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Acute GastroenteritisAcute Gastroenteritis:: (also(alsocalled Stomach Flu).called Stomach Flu).

--Acute gastroenteritis is aAcute gastroenteritis is a

sudden condition that causessudden condition that causesirritation and inflammation ofirritation and inflammation of

the stomach and intestines orthe stomach and intestines orthe gastrointestinal tract.the gastrointestinal tract.


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--Viral infection is the mostViral infection is the most

common cause of gastroenteritiscommon cause of gastroenteritis

but bacteria, parasites, and foodbut bacteria, parasites, and food--borne illness (such as shellfish)borne illness (such as shellfish)

can also cause acutecan also cause acute

gastroenteritis.gastroenteritis.


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--Fifty to seventy percent of cases ofFifty to seventy percent of cases of

gastroenteritis in adults are causedgastroenteritis in adults are causedby the noroviruses while rotavirus isby the noroviruses while rotavirus isthe leading cause of infection inthe leading cause of infection in

children. Staphylococcus aureus canchildren. Staphylococcus aureus can

form a toxin that cause foodform a toxin that cause food

poisoning while the residentpoisoning while the residentEscherichia coli can also causeEscherichia coli can also cause

significant problems.significant problems.


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--The severity of gastroenteritisThe severity of gastroenteritisdepends on the immune systemsdepends on the immune systems

ability to resist and fight theability to resist and fight the

infection. Electrolytes, especiallyinfection. Electrolytes, especiallysodium and potassium may besodium and potassium may be

lost if the client continue tolost if the client continue tovomit and experience diarrhea.vomit and experience diarrhea.


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--Most people recover easily from aMost people recover easily from a

short course of vomiting andshort course of vomiting anddiarrhea by drinking lots of fluidsdiarrhea by drinking lots of fluidsand resuming a typical diet. But forand resuming a typical diet. But for

some, especially the young and thesome, especially the young and theold, loss of body fluids withold, loss of body fluids with

gastroenteritis can causegastroenteritis can cause

dehydration, which is a lifedehydration, which is a life--threatening condition unless it isthreatening condition unless it is

treated and fluids are replaced.treated and fluids are replaced.


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Clinical Manifestations:Clinical Manifestations:

--Low grade fever to 100Low grade fever to 100FF(37.8(37.8C)C)

--Nausea with or withoutNausea with or without

vomitingvomiting--Mild to moderate diarrheaMild to moderate diarrhea

--Crampy and painful abdominalCrampy and painful abdominalbloating.bloating.


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More serious symptoms :More serious symptoms :

--Blood in vomit or stoolBlood in vomit or stool

--Vomiting more than 48 hoursVomiting more than 48 hours--Fever higher than 101Fever higher than 101F (40F (40C)C)

--Swollen abdomen or abdominalSwollen abdomen or abdominal

painpain--Dehydration that is manifested byDehydration that is manifested byweakness, lightheadedness,weakness, lightheadedness,

decreased and concentrateddecreased and concentrated

urination, dry skin and poor turgor,urination, dry skin and poor turgor,

and dry lips and mouth.and dry lips and mouth.


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DiagnosticTests:DiagnosticTests:--Blood testBlood test

--Analysis of stool samplesAnalysis of stool samples

--Electrolyte testsElectrolyte tests--Physical examination to rulePhysical examination to rule

other existing conditions such asother existing conditions such as

appendicitis.appendicitis.


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Medical ManagementMedical Management::

Home care:Home care:

--Clear fluids are appropriate for theClear fluids are appropriate for thefirst 24 hours to maintain adequatefirst 24 hours to maintain adequate

hydration.hydration.

--They should be given oralThey should be given oral

rehydration solutions such asrehydration solutions such as

Pedialyte for pediatric patients orPedialyte for pediatric patients orcommercially prepared oralcommercially prepared oral

rehydration solution.rehydration solution.


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For home made ORS, mix 2For home made ORS, mix 2

tablespoons of sugar (or honey)tablespoons of sugar (or honey)

with teaspoon of table salt in 1with teaspoon of table salt in 1liter (1 qt) of clean or previouslyliter (1 qt) of clean or previously

boiled water.boiled water.--After 24 hours without vomiting ,After 24 hours without vomiting ,

begin to offer soft bland foods suchbegin to offer soft bland foods such

as the BRAT diet, which includesas the BRAT diet, which includesbananas, rice, apple sauce withoutbananas, rice, apple sauce without

sugar, toast, pasta, and potatoes.sugar, toast, pasta, and potatoes.


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Hospitalization:Hospitalization:--Hydration through intravenousHydration through intravenousline.line.

--Replacement of fluid lossesReplacement of fluid losses

volume per volume.volume per volume.

--Encourage small, frequentEncourage small, frequentfeedings.feedings.


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Prevention:Prevention:

--Always wash your hands beforeAlways wash your hands beforeeating and after using the comforteating and after using the comfortroom.room.

--Eat only properly cooked andEat only properly cooked andstored food.stored food.

--Bleach soiled linens used.Bleach soiled linens used.

--Have vaccinations for salmonellaHave vaccinations for salmonellatyphi, vibrio cholerae, and rotavirus.typhi, vibrio cholerae, and rotavirus.


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Chronic illness:Chronic illness:

Chronic kidney disease:Chronic kidney disease:

s a progressive loss ins a progressive loss in renalrenal

functionfunction over a period ofover a period ofmonths or years. The symptomsmonths or years. The symptoms

of worsening kidney function areof worsening kidney function are

unspecific, and might includeunspecific, and might include

feelingfeeling generally unwell.generally unwell.


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Chronic Kidney DiseaseChronic Kidney Disease

could be known if thecould be known if thefollowing criteria has met:following criteria has met:

-Kidney damage forequal or more than 3

months, as defined by

structural or

functional

abnormalities of the

kidney, with or without

decreased GFR.


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--GFR


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Stages ofChronic KidneyStages ofChronic Kidney

Disease:Disease:

Stage Description GFR

(mL/min/1.73m2 )

1

K

idney damage withnormal or increasedGFR

Greater than orequal 90

2 Kidney damage withmild decrease of GFR

60-89

3 Moderate decrease ofGFR

30-59

4 Severe decrease of GFR 15-29

5 Kidney Failure Less than 15(dialysis)


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RISK FACTORS:RISK FACTORS:

*Diabetes*Diabetes most common cause ofmost common cause ofchronic kidney disease worldwide; obesity ischronic kidney disease worldwide; obesity is

an additional factor for diabetesan additional factor for diabetes ..

** HypertensionHypertension systolicsystolichypertension is of particularhypertension is of particular

concern. Beginning at around age 50,concern. Beginning at around age 50,

systolic blood pressure rises andsystolic blood pressure rises andcontinues to rise with age.continues to rise with age.


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*Systemic infection.*Systemic infection.

**Urinary stones or lowerUrinary stones or lower

urinary tract obstruction.urinary tract obstruction.

**Exposure to certain toxicExposure to certain toxic

drugsdrugs cyclosporins and othercyclosporins and other

immunosuppressive agentsimmunosuppressive agentsand corticosteriods.and corticosteriods.


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Diagnostic EvaluationDiagnostic Evaluation::1)Urinalysis reveal that casts found1)Urinalysis reveal that casts found

in urine are helpful in determiningin urine are helpful in determining

the type of kidney diseasethe type of kidney disease2)Blood analysis may include levels2)Blood analysis may include levels

of createnine, blood urea nitrogen,of createnine, blood urea nitrogen,

serum electrolytes and PH.serum electrolytes and PH.


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3)Ultrasonography can detect a3)Ultrasonography can detect a

tumor or hydronephrosistumor or hydronephrosis4)Computed tomography and4)Computed tomography andmagnetic resonance imagingmagnetic resonance imaging

demonstrate vessel disordersdemonstrate vessel disorders5)Kidney arteriography and5)Kidney arteriography and

venography can show damage tovenography can show damage to

kidney vasculature.kidney vasculature.


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6)Proteinuria screening6)Proteinuria screening persistent proteinuria is usuallypersistent proteinuria is usuallythe first indicator of kidneythe first indicator of kidney

damage.damage.


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Signs and symptoms:Signs and symptoms:

--swelling, usually of the lowerswelling, usually of the lowerextremities.extremities.--fatiguefatigue

--weight lossweight loss--loss of appetiteloss of appetite

--nausea or vomitingnausea or vomiting

-- change in urination (change inchange in urination (change involume and frequency) .volume and frequency) .


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s/s:s/s:--change is sleep patternchange is sleep pattern

--headachesheadaches

--itchingitching--difficulties in memory anddifficulties in memory and

concentration.concentration.


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Medical Management:Medical Management:

--Peritoneal dialysisPeritoneal dialysis

--HemodialysisHemodialysis

--KidneyTransplantationKidneyTransplantation


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--Peritoneal dialysis:Peritoneal dialysis:

is a treatment for patients withis a treatment for patients withsevere chronicsevere chronic kidney diseasekidney disease. The. Theprocess uses theprocess uses the

patient'spatient's peritoneumperitoneum ininthethe abdomenabdomen as a membrane acrossas a membrane across

which fluids and dissolvedwhich fluids and dissolved

substancessubstances((electrolyteselectrolytes,, ureaurea,, glucoseglucose,, albuminalbumin

and other small molecules) areand other small molecules) are


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PD:PD:exchanged fromexchanged from thethebloodblood. Fluid. Fluid

is introduced through ais introduced through a

permanent tube in the abdomenpermanent tube in the abdomenand flushed out either everyand flushed out either every

night while the patient sleepsnight while the patient sleeps(automatic peritoneal(automatic peritoneal


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dialysis) or via regular exchangesdialysis) or via regular exchanges

throughout the day (continuousthroughout the day (continuous

ambulatory peritonealambulatory peritoneal

dialysis).dialysis). It has comparable risksIt has comparable risksand expenses, with the primaryand expenses, with the primary

advantage being the ability toadvantage being the ability to

undertake treatment withoutundertake treatment withoutvisiting a medical facility.visiting a medical facility.


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The primary complication withThe primary complication with

PD is a risk of infection due toPD is a risk of infection due tothe presence of a permanentthe presence of a permanent

tube in the abdomen.tube in the abdomen.


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PERITONEAL DIALYSIS:PERITONEAL DIALYSIS:


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--HemodialysisHemodialysis::

Is a method for removing wasteIs a method for removing waste

products suchproducts suchasas creatininecreatinine andand ureaurea, as well as, as well as

free water from thefree water from the bloodblood whenwhenthethe kidneyskidneys are inare in renal failurerenal failure..

HemodialysisHemodialysis is one of threeis one of three renalrenal

replacement therapiesreplacement therapies (the other(the othertwo beingtwo being renalrenal

transplanttransplant;;peritonealperitoneal dialysisdialysis).).


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HEMODIALYSISHEMODIALYSIS


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Kidney transplantationKidney transplantation oror renalrenal

transplantation:transplantation: is theis the organorgantransplanttransplant of aof a kidneykidney into a patientinto a patientwithwith endend--stage renal diseasestage renal disease.Kidney.Kidney

transplantation is typically classifiedtransplantation is typically classifiedas deceasedas deceased--donor (formerly knowndonor (formerly known

as cadaveric) or livingas cadaveric) or living--donordonor

transplantation depending on thetransplantation depending on thesource of the donor organ.source of the donor organ.


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KT:KT:

LivingLiving--donor renal transplantsdonor renal transplantsare further characterized asare further characterized as

genetically related (livinggenetically related (living--related)related)

or nonor non--related (livingrelated (living--unrelated)unrelated)transplants, depending ontransplants, depending on

whether a biological relationshipwhether a biological relationshipexists between the donor andexists between the donor and

recipient.recipient.


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KIDNEY TRANSPLANTATIONKIDNEY TRANSPLANTATION


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Nursing Management:Nursing Management:

--Proper assessment for riskProper assessment for riskfactors that might cause a rapidfactors that might cause a rapid

decline.decline.

--Encourage selfEncourage self--managementmanagementsuch a blood pressuresuch a blood pressure

monitoring and glucosemonitoring and glucosemonitoring.monitoring.


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NGS MGT:NGS MGT:

--Administer prescribeAdminister prescribe

medications ( ion exchange resin,medications ( ion exchange resin,

alkalizing agents, antibiotics,alkalizing agents, antibiotics,erytheryth, folic acid supplements)., folic acid supplements).

--Maintain strict fluid control.Maintain strict fluid control.


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NSG MGT:NSG MGT:

--Encourage intake of highEncourage intake of high

biologic value protein (eggs,biologic value protein (eggs,

dairy products and meats)dairy products and meats)

--Encourage adequate rest.Encourage adequate rest.


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CHRONIC Bronchitis:CHRONIC Bronchitis:

Is an infection of the lowerIs an infection of the lowerrespiratory tract that generallyrespiratory tract that generally

follows an upper respiratoryfollows an upper respiratory

tract infection. As a result of thistract infection. As a result of thisviral (most common) orviral (most common) or

bacterial infection, the airwaysbacterial infection, the airwaysbecome inflamed and irritated,become inflamed and irritated,and mucus production increases.and mucus production increases.


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Assessment:Assessment:

Fever, tachypnea, mild dyspnea,Fever, tachypnea, mild dyspnea,pleuritic chest pain (possible).pleuritic chest pain (possible).

Cough with clear to purulentCough with clear to purulent

sputum production.sputum production.DiffuseDiffuse rhonchirhonchi andand

crackles(contrast with localizedcrackles(contrast with localized

crackles usually heard withcrackles usually heard withpneumonia).pneumonia).


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Diagnostic EvaluationDiagnostic Evaluation::

Chest XChest X--ray may rule outray may rule outpneumonia. In bronchitis, filmspneumonia. In bronchitis, films

show no evidence of lungshow no evidence of lung

infiltrates or consolidationinfiltrates or consolidation


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Therapeutic InterventionTherapeutic Intervention::

--Chest physiotherapy toChest physiotherapy tomobilize secretions, if indicated.mobilize secretions, if indicated.

--Hydration to liquefy secretions.Hydration to liquefy secretions.


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Pharmacologic Interventions:Pharmacologic Interventions:

--Inhaled bronchodilators to reduceInhaled bronchodilators to reducebronchospasm and promote sputumbronchospasm and promote sputumexpectoration.expectoration.

--A course of oral antibiotics such asA course of oral antibiotics such asa macrolide may be instituted, but isa macrolide may be instituted, but is

controversial.controversial.

--Symptom management for feverSymptom management for feverand cough.and cough.


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Nursing InterventionsNursing Interventions::

--Encourage mobilization ofEncourage mobilization ofsecretion through ambulation,secretion through ambulation,

coughing, and deep breathing.coughing, and deep breathing.

--Ensure adequate fluid intake toEnsure adequate fluid intake toliquefy secretions and preventliquefy secretions and prevent

dehydration caused by fever anddehydration caused by fever andtachypnea.tachypnea.


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NSG INT:NSG INT:

--Encourage rest, avoidance ofEncourage rest, avoidance ofbronchial irritant, and a goodbronchial irritant, and a good

diet to facilitate recovery.diet to facilitate recovery.--Instruct the patient to completeInstruct the patient to complete

the full course of prescribedthe full course of prescribed

antibiotics and explain the effectantibiotics and explain the effectof meals on drug absorption.of meals on drug absorption.


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--Caution the patient on using overCaution the patient on using over--

thethe--counter cough suppressants,counter cough suppressants,antihistamines, and decongestants,antihistamines, and decongestants,which may cause drying andwhich may cause drying and

retention of secretions. However,retention of secretions. However,cough preparations containing thecough preparations containing the

mucolytic guaifenesin may bemucolytic guaifenesin may beappropriate.appropriate.


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NSG INT:NSG INT:

--Advise the patient that a dry coughAdvise the patient that a dry coughmay persist after bronchitis becausemay persist after bronchitis because

of irritation of airways. Suggestof irritation of airways. Suggest

avoiding dry environments and usingavoiding dry environments and usinga humidifier at bedside. Encouragea humidifier at bedside. Encourage

smoking cessation.smoking cessation.

--Teach the patient to recognize andTeach the patient to recognize andimmediately report early signs andimmediately report early signs andsymptoms of acute bronchitis.symptoms of acute bronchitis.

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