Care Of Patient With Renal Failure

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Care Of Patient With Renal Failure
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Objectives

• Define acute chronic renal failures.
• Identify causes of ARF CRF.
• List the signs and symptoms.
• Describe the management care.
• List the complications.
• Discuss relevant patient / family education.

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Acute Chronic

• Alternative names   
• Renal failure - acute Kidney failure Kidney
  failure - acute Renal failure Arf

• Alternative names   
• Kidney failure - chronic Renal failure -
  chronic Chronic renal insufficiency CRF
  Chronic kidney failure

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Definition

• Definition   
• Acute renal failure is sudden loss of the ability
  of the kidneys to excrete wastes, concentrate
  urine, and conserve electrolytes. ("Acute" means
  sudden, "renal" refers to the kidneys.)

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

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White Nail Syndrome (CRF)
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Causes ( ARF )

• Decreased blood flow
• Severe acute nephritic syndrome
• Acute tubular necrosis (ATN)
• Direct injury to the kidney
• Myoglobinuria (myoglobin in the urine)

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Causes ( ARF )

• Urinary tract obstruction
• Infections such as acute pyelonephritis or
  septicemia
• Disorders of the blood
• Autoimmune disorders

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Causes (ARF)

• Over-exposure to metals, solvents, radiographic
  contrast materials, certain antibiotics, and
  other medications or substances
• In young children, hemolytic uremic syndrome

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Causes (CRF)

• Decreased blood flow is one cause of kidney
  damage
• Acute tubular necrosis
• Direct injury to the kidney
• Disorders of the blood

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Causes (CRF)

• Infections
• Urinary tract obstruction
• Tumors
• Kidney stones

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Symptoms (ARF)

• Decreased urine output
• Decreased urine volume (oliguria)
• No urine output (anuria)
• Urination, excessive at night (can occur in some
  types of renal failure)

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Symptoms (ARF)

• Generalized swelling, fluid retention
• Decrease in sensation, especially the hands or
  feet
• Slow, sluggish, movements
• Ankle, feet, and leg swelling

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Symptoms (ARF)

• Seizures
• Hand tremor
• Nausea, vomiting
• May persist for days
• Morning sickness
• Vomiting blood

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Symptoms (ARF)

• Prolonged bleeding, bruising easily
• Stools, bloody
• Nosebleed
• Growth, slow (child 0-5 years)

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Symptoms (ARF)

• Changes in mental status or mood
• Agitation
• Drowsiness, lethargy
• Delirium or confusion
• Coma
• Fluctuating mood
• Difficulty paying attention (attention deficit)
• Hallucinations

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Symptoms (ARF)

• Flank pain
• Fatigue
• Ear noise/buzzing
• Breath odor
• Breast development in males
• Blood pressure, high

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Symptoms (CRF)

• Initial symptoms may include the following
• Unintentional weight loss
• Nausea, vomiting
• General ill feeling
• Fatigue
• Headache

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Symptoms (CRF)

• Frequent hiccups
• Generalized itching (pruritus)
• Later symptoms may include the following
• Increased or decreased urine output

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Symptoms (CRF)

• Need to urinate at night
• Easy bruising or bleeding
• May have blood in the vomit or in stools
• Decreased alertness
• Drowsiness, somnolence, lethargy
• Confusion, delirium
• Coma

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Symptoms (CRF)

• Muscle twitching or cramps
• Seizures
• Uremic frost -- deposits of white crystals in and
  on the skin
• Decreased sensation in the hands, feet, or other
  areas

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Symptoms (CRF)

• Additional symptoms that may be associated with
  this disease
• Excessive nighttime urination
• Excessive thirst

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Symptoms (CRF)

• Abnormally dark or light skin
• Paleness
• Nail abnormalities
• Breath odor
• High blood pressure
• Loss of appetite
• Agitation

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Signs  (ARF)

• Lab values may change suddenly (within a few days
  to 2 weeks)
• Urinalysis may be abnormal.
• Serum creatinine may increase by 2 mg/dl or more
  over a 2-week period.
• Creatinine clearance may be decreased.

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Signs  (ARF)

• BUN may increase suddenly.
• Serum potassium levels may be increased.
• Arterial blood gas and blood chemistries may show
  metabolic acidosis.

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Signs  (ARF)

• Kidney or abdominal ultrasound is usually the
  best test, but abdominal x-ray, abdominal CT scan
  or abdominal MRI may also reveal the cause of
  acute renal failure. Kidney size is usually
  normal or slightly large.

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Signs  (ARF)

• Chemical tests of blood and urine may also help
  to distinguish the causes. A clean catch urine
  specimen will indicate if the cause is infection
  within the urinary tract.

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Signs  (ARF)

• Renal angiography (renal arteriography) may be
  used to diagnose causes within the blood vessels
  of the kidney.

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Signs (CRF)

• Blood pressure may be high, with mild to severe
  hypertension. A neurologic examination may show
  polyneuropathy. Abnormal heart or lung sounds may
  be heard with a stethoscope.

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Signs (CRF)

• A urinalysis may show protein or other
  abnormalities. An abnormal urinalysis may occur 6
  months to 10 or more years before symptoms
  appear.
• Creatinine levels progressively increase.

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Signs (CRF)

• BUN is progressively increased.
• Creatinine clearance progressively decreases.
• Potassium test may show elevated levels.
• Arterial blood gas and blood chemistry analysis
  may show metabolic acidosis.

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Signs (CRF)

• Changes that indicate chronic renal failure,
  including both kidneys being smaller than normal,
  may be seen on
• Renal or abdominal x-ray.
• Abdominal CT scan.
• Abdominal MRI.
• Abdominal ultrasound.

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Signs (CRF)

• This disease may also alter the results of the
  following tests
• Urinary casts
• Renal scan
• Pth
• Serum magnesium - test
• Erythropoietin

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Care Management (ARF)

• The goal of treatment is to identify and treat
  any reversible causes of the kidney failure
  (e.G., Use of kidney-toxic medications,
  obstructive uropathy, volume depletion).

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Care Management (ARF)

• Treatment also focuses on preventing excess
  accumulation of fluids and wastes, while allowing
  the kidneys to heal and gradually resume their
  normal function. Hospitalization is required for
  treatment and monitoring.

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Care Management (ARF)

• Your fluid intake may be severely restricted to
  an amount equal to the volume of urine you
  produce. You may be given specific dietary
  modifications to reduce build-up of toxins
  normally handled by the kidneys, including a diet
  plan high in carbohydrates and low in protein,
  salt, and potassium.

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Care Management (ARF)

• Antibiotics may be used to treat or prevent
  infection. Diuretics may be used to remove fluid
  from the kidney.

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Care Management (ARF)

• A major priority in treatment is to control
  dangerous hyperkalemia (increased blood potassium
  levels). A variety of different medications may
  be used, including IV (intravenous) calcium,
  glucose/insulin, and oral or rectal
  administration of potassium exchange resin
  (kayexalate).

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Care Management (ARF)

• Dialysis may be used to remove excess waste and
  fluids. This often makes the person feel better
  and may make the kidney failure easier to
  control. Dialysis may not be necessary for all
  people, but is frequently lifesaving,
  particularly if serum potassium is dangerously
  high.

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Care Management (ARF)

• Common symptoms that require the use of dialysis
  include decreased mental status, pericarditis,
  increased potassium levels, total lack of urine
  production, fluid overload, and uncontrolled
  accumulation of nitrogen waste products (serum
  creatinine gt 10 mg/dl and BUN gt 120 mg/dl).

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Care Management (CRF)

• Treatment focuses on controlling the symptoms,
  minimizing complications, and slowing the
  progression of the disease.

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Care Management (CRF)

• Associated diseases that cause or result from
  chronic renal failure must be controlled.
  Hypertension, congestive heart failure, urinary
  tract infections, kidney stones, obstructions of
  the urinary tract, glomerulonephritis, and other
  disorders should be treated as appropriate.

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Care Management (CRF)

• Blood transfusions or medications such as iron
  and erythropoietin supplements may be needed to
  control anemia.Fluid intake may be restricted,
  often to an amount equal to the volume of urine
  produced. Dialysis or kidney transplant may be
  required eventually.

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Care Management (CRF)

• Dietary protein restriction may slow the build-up
  of wastes in the bloodstream and control
  associated symptoms such as nausea and vomiting.
  Salt, potassium, phosphorus, and other
  electrolytes may be restricted.

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Complications (ARF)

•   increased risk of infections
• gastrointestinal loss of blood
• chronic renal failure
• End-stage renal disease
• Damage to the heart or nervous system
• Hypertension

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Complications (CRF)

• End-stage renal disease
• Pericarditis
• Cardiac tamponade
• Congestive heart failure

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Complications (CRF)

• Hypertension
• Platelet dysfunction
• Decreased immune response

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Complications (CRF)

• Loss of blood from the gastrointestinal tract
• Ulcers
• Hemorrhage
• Anemia
• Hepatitis B, hepatitis C, liver failure
• Decreased functioning of white blood cells

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Complications (CRF)

• Increased incidence of infection
• Peripheral neuropathy
• Seizures
• Encephalopathy, nerve damage, dementia
• Weakening of the bones
• Fractures

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Complications (CRF)

• Joint disorders
• Changes in glucose metabolism
• Electrolyte abnormalities including hyperkalemia
• Decreased libido, impotence
• Miscarriage, menstrual irregularities,
  infertility
• Skin dryness, itching/scratching with resultant
  skin infection

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Patient / Family Education

• Call your health care provider if decreased urine
  output or other symptoms indicate the possibility
  of acute renal failure.
• Call your health care provider if nausea or
  vomiting persists for more than 2 weeks.
• Call your health care provider if decreased urine
  output or other symptoms of chronic renal failure
  occur..

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Any Question ?