renal failure
TRANSCRIPT
Renal FailureRenal Failure
Sanjay Kumar KulchaniaSanjay Kumar Kulchania (LECTURER)(LECTURER)
GURU NANAK COLLEGE OF GURU NANAK COLLEGE OF NURSING, DHAHAN KALERANNURSING, DHAHAN KALERAN
ObjectivesObjectivesAnatomyAnatomyFunctionFunctionAcute Renal Failure (ARF)Acute Renal Failure (ARF)– CausesCauses– SymptomsSymptoms– ManagementManagement
Chronic Renal Failure (CRF)Chronic Renal Failure (CRF)– CausesCauses– SymptomsSymptoms
DialysisDialysis
Kidney FunctionKidney FunctionDetoxify bloodDetoxify bloodIncrease calcium absorptionIncrease calcium absorption– calcitriolcalcitriol
Stimulate RBC productionStimulate RBC production– erythropoietinerythropoietin
Regulate blood pressure and Regulate blood pressure and electrolyte balance electrolyte balance – reninrenin
ClassificationsClassifications
Acute versus chronicAcute versus chronic
Pre-renal, renal, post-renalPre-renal, renal, post-renal
Anuric, oliguric, polyuricAnuric, oliguric, polyuric
Acute Versus ChronicAcute Versus ChronicAcute Acute – sudden onsetsudden onset– rapid reduction in urine outputrapid reduction in urine output– Usually reversibleUsually reversible– Tubular cell death and regenerationTubular cell death and regeneration
Chronic Chronic – ProgressiveProgressive– Not reversibleNot reversible– Nephron lossNephron loss
75% of function can be lost before its 75% of function can be lost before its noticeablenoticeable
Acute Renal FailureAcute Renal Failure
Pre-renal = 55%Pre-renal = 55%
Renal parenchymal (intrinsic)= 40%Renal parenchymal (intrinsic)= 40%
Post-renal = 5-15%Post-renal = 5-15%
Causes of ARFCauses of ARF
Pre-renal =Pre-renal =– vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and
heart failure heart failure – cardiac failure, liver dysfunction, or septic shock cardiac failure, liver dysfunction, or septic shock
Intrinsic Intrinsic – Interstitial nephritis, acute glomerulonephritis, tubular necrosis, Interstitial nephritis, acute glomerulonephritis, tubular necrosis,
ischemia, toxinsischemia, toxins
Post-renal =Post-renal =– prostatic hypertrophy, cancer of the prostate or cervix, or prostatic hypertrophy, cancer of the prostate or cervix, or
retroperitoneal disorders retroperitoneal disorders – neurogenic bladder neurogenic bladder – bilateral renal calculi, papillary necrosis, coagulated blood, bilateral renal calculi, papillary necrosis, coagulated blood,
bladder carcinoma, and fungus bladder carcinoma, and fungus
Symptoms of ARFSymptoms of ARFDecrease urine output (70%)Decrease urine output (70%)Edema, esp. lower extremityEdema, esp. lower extremityMental changesMental changesHeart failureHeart failureNausea, vomitingNausea, vomitingPruritusPruritusAnemiaAnemiaTachypenicTachypenicCool, pale, moist skinCool, pale, moist skin
Acute Renal Failure Acute Renal Failure ManagementManagement
Make/think about the diagnosisMake/think about the diagnosisTreat life threatening conditionsTreat life threatening conditionsIdentify the cause if possibleIdentify the cause if possible– HypovolemiaHypovolemia– Toxic agents (drugs, myoglobin)Toxic agents (drugs, myoglobin)– ObstructionObstruction
Treat reversible elementsTreat reversible elements– HydrateHydrate– Remove drugRemove drug– Relieve obstructionRelieve obstruction
ARF: Life Threatening ARF: Life Threatening ConditionsConditions
HyperkalemiaHyperkalemia
Volume overloadVolume overload
Vascular accessVascular access
Hyperkalemia SymptomsHyperkalemia SymptomsWeaknessWeakness
LethargyLethargy
Muscle crampsMuscle cramps
ParesthesiasParesthesias
Hypoactive DTRsHypoactive DTRs
DysrhythmiasDysrhythmias
Hyperkalemia & EKGHyperkalemia & EKGK > 5.5 -6K > 5.5 -6
Tall, peaked T’sTall, peaked T’s
Wide QRSWide QRS
Prolong PRProlong PR
Diminished PDiminished P
Prolonged QTProlonged QT
QRS-T merge – sine QRS-T merge – sine wavewave
Hyperkalemia TreatmentHyperkalemia Treatment
Calcium gluconate (carbonate)Calcium gluconate (carbonate)
Sodium BicarbonateSodium Bicarbonate
Insulin/glucoseInsulin/glucose
KayexalateKayexalate
Lasix Lasix
AlbuterolAlbuterol
HemodialysisHemodialysis
Chronic Renal FailureChronic Renal Failure
150–200 cases per million people = 150–200 cases per million people = new cases each yearnew cases each year
Chronic renal failure and ESRD affect Chronic renal failure and ESRD affect more than 2 out of 1,000 people in more than 2 out of 1,000 people in the U.Sthe U.S
Mortality = 20%Mortality = 20%
Chronic Renal Failure CausesChronic Renal Failure Causes
Diabetic NephropathyDiabetic Nephropathy
HypertensionHypertension
GlomerulonephritisGlomerulonephritis
HIV nephropathyHIV nephropathy
Reflux nephropathy in childrenReflux nephropathy in children
Polycystic kidney diseasePolycystic kidney disease
Kidney infections & obstructionsKidney infections & obstructions
CRF SymptomsCRF SymptomsMalaiseMalaise
WeaknessWeakness
FatigueFatigue
NeuropathyNeuropathy
CHFCHF
AnorexiaAnorexia
NauseaNausea
VomitingVomiting
SeizureSeizureConstipationConstipationPeptic ulcerationPeptic ulcerationDiverticulosisDiverticulosisAnemiaAnemiaPruritusPruritusJaundiceJaundiceAbnormal Abnormal hemostasishemostasis
Acute Problems in CRFAcute Problems in CRF
Relating to underlying diseaseRelating to underlying disease
Relating to ESRDRelating to ESRD
Dialysis related problemsDialysis related problems
Problems Related to ESRDProblems Related to ESRD
Metabolic – K/CaMetabolic – K/Ca
Volume overloadVolume overload
Anemia, platelet disorder, GI bleedAnemia, platelet disorder, GI bleed
HTN, pericarditisHTN, pericarditis
Peripheral neuropathy, dialysis Peripheral neuropathy, dialysis dementiadementia
Abnormal immune functionAbnormal immune function
DialysisDialysis½ of patients with CRF eventually ½ of patients with CRF eventually require dialysisrequire dialysisDiffuse harmful waste out of bodyDiffuse harmful waste out of bodyControl BPControl BPKeep safe level of chemicals in bodyKeep safe level of chemicals in body2 types 2 types – HemodialysisHemodialysis– Peritoneal dialysis Peritoneal dialysis
HemodialysisHemodialysis
3-4 times a week3-4 times a week
Takes 2-4 hours Takes 2-4 hours
Machine filters Machine filters
blood andblood and
returns it toreturns it to
bodybody
Types of AccessTypes of AccessTemporary siteTemporary site
AV fistulaAV fistula– Surgeon constructs by combining an artery and Surgeon constructs by combining an artery and
a veina vein– 3 to 6 months to mature3 to 6 months to mature
AV graftAV graft– Man-made tube inserted by a surgeon to Man-made tube inserted by a surgeon to
connect artery and veinconnect artery and vein– 2 to 6 weeks to mature2 to 6 weeks to mature
What This Means For YouWhat This Means For You
No BP on same arm as fistulaNo BP on same arm as fistula
Protect arm from injuryProtect arm from injury
Control obvious hemorrhageControl obvious hemorrhage– Bleeding will be arterialBleeding will be arterial– Maintain direct pressureMaintain direct pressure
No IV on same arm as fistulaNo IV on same arm as fistula
A thrill will be felt – this is normalA thrill will be felt – this is normal
Access ProblemsAccess ProblemsAV graft thrombosis AV graft thrombosis AV fistula or graft bleedingAV fistula or graft bleedingAV graft infectionAV graft infectionSteal PhenomenonSteal Phenomenon– Early post-opEarly post-op– Ischemic distallyIschemic distally– Apply small amount of pressure to Apply small amount of pressure to
reverse symptomsreverse symptoms
Peritoneal DialysisPeritoneal Dialysis
Abdominal lining filters bloodAbdominal lining filters blood
3 types3 types– Continuous ambulatoryContinuous ambulatory– Continuous cyclicalContinuous cyclical– Intermittent Intermittent
EMS ConsiderationsEMS ConsiderationsMake sure the dressing remains Make sure the dressing remains intactintactDo not push or pull on the catheterDo not push or pull on the catheterDo not disconnect any of the Do not disconnect any of the catheterscathetersAlways transport the patient and Always transport the patient and bags/catheters as one piecebags/catheters as one pieceNever inject anything into catheterNever inject anything into catheter
Dialysis Related ProblemsDialysis Related ProblemsLightheaded –give fluidsLightheaded –give fluidsHypotensionHypotensionDysrhythmiasDysrhythmiasDisequilibration SyndromeDisequilibration Syndrome– At end of early sessionsAt end of early sessions– Confusion, tremor, seizureConfusion, tremor, seizure– Due to decrease concentration of blood Due to decrease concentration of blood
versus brain leading to cerebral edemaversus brain leading to cerebral edema