the client with renal alteration
TRANSCRIPT
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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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PHASES OF ACUTE RENAL FAILURE
2. Diuretic phasebegins when urine output exceeds
500 ml per 24 hours
end when BUN and creatinine levelsstop rising.
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PHASES OF ACUTE RENAL FAILURE
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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TERMS HYPOTHESIS INFERENCE CONCLUSION
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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TERMS HYPOTHESIS INFERENCE CONCLUSION
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
HYPOTHESIS INFERENCE CONCLUSION
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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LEARNING HYPOTHESIS INFERENCE CONCLUSION
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LEARNINGISSUE
HYPOTHESIS INFERENCE CONCLUSION
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
LEARNING HYPOTHESIS INFERENCE CONCLUSION
http://www.nlm.nih.gov/medlineplus/ency/article/003104.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003104.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003104.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003104.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003104.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003104.htm -
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LEARNINGISSUE
HYPOTHESIS INFERENCE CONCLUSION
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
LEARNING HYPOTHESIS INFERENCE CONCLUSION
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
HYPOTHESIS INFERENCE CONCLUSION
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
LEARNING HYPOTHESIS INFERENCE CONCLUSION
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
HYPOTHESIS INFERENCE CONCLUSION
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
LEARNING HYPOTHESIS INFERENCE CONCLUSION
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LEARNINGISSUE
HYPOTHESIS INFERENCE CONCLUSION
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
http://www.nlm.nih.gov/medlineplus/ency/article/003435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003435.htm -
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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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ANALYTE RESULTNORMAL
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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ANALYTE RESULTNORMAL
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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ANALYTE RESULTNORMAL
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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