renal failure (abeer 1)

8/3/2019 Renal Failure (Abeer 1)

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Kidney Failure

Prepared by:

Dr. Abeer M. Aly


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Dr. Abeer M. Aly 2

Definition:

Renal failure means, inabilityof the renal system to

perform its normal functions.

What are the normal functionsof the renal system???


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Dr. Abeer M. Aly 3

Functions of urinary system:

1. Regulate blood volume andcomposition.2. Help regulate blood pressure.3. Regulation of blood glucose level.4. Excretion of wastes and foreignsubstances.5. Regulation of blood PH.6. Production of hormones(Erythropoietin, Calcitriol)


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Blood pressure forces water, glucose, aminoacids and urea from capillaries into

nephron

Glucose and amino acids are reabsorbed intoblood from nephron

Some water is reabsorbed into blood

Urine is urea and salt concentrated in water

Urine Formation by Nephron


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Definition:The inability of nephrons to:

Maintain fluid, electrolyte, & acid-

base balance,Excrete nitrogen waste products,

Regulate calcium in bones,

Produce erythropoietin.


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Dr. Abeer M. Aly 10

Acute Renal Failure

Acute Renal FailureIs a sudden, usually reversible

deterioration in normal renalfunction.


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Dr. Abeer M. Aly 11

Causes of acute renal failure:


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Dr. Abeer M. Aly 12

Causes of renal failure:

1. Prerenal causes:

a. Hypovolemia.

b. Impaired cardiac efficiency.

c. Vasodilatation.


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2. Postrenal obstruction:a. Urinary tract obstruction.

b. Tumors.3. Intrarenal:

a. Acute nephritis.

b. Antibiotics.c. NSAIDs.


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Dr. Abeer M. Aly 14

Causes of acute renal failure:-

Pre Renal Renal Post Renal

Hypovolemia

Drugs

Toxins

Multiple-organfailure

polycystic

kidney disease

A.pyelonephritis

A.gloumerulnephritis

Tumor

Calculi

Stricture

Prostatichypertrophy


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Dr. Abeer M. Aly 15

Phases:-

Initiation phase:- (1-2 days)

The time from renal insult torecognition of decrease

Glomerular Filtration Rate (GFR).


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Oliguric phase ( maintenancephase 1-2 week)

-The period of time during which oliguriapersists .

- It is most life threatening period(Hyperkalemia)


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Dr. Abeer M. Aly 17

Polyuric phase:- Diuretic phase

Progressive increase in urine

volume.


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Dr. Abeer M. Aly 18

Functional recovery phase:-

3-12 months, The patientrepairing the renal injury &return to normal.


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Dr. Abeer M. Aly 19

Chronic Renal Failure:-

Is progressive , irreversible

deterioration in renal

function.


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Dr. Abeer M. Aly 20

Acute- sudden onset

- reversible- Tubular cell death

and regeneration

oChronic

oProgressive

oNot reversible

oNephron loss

Acute Versus Chronic


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Dr. Abeer M. Aly 21

Signs & Symptoms:-

Urine analysis.

Hydration condition.

Vital Signs.

GIT manifestations..

Investigations.

CNS manifestations..


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Dr. Abeer M. Aly 22

Investigation:

A urine analysislevels progressively increase Creatinine

is progressively increased BUN

progressively decreases Creatinine clearance

may show elevated levels Potassium test

Arterial blood gas and blood chemistryanalysis may show metabolic acidosis
http://www.nlm.nih.gov/medlineplus/ency/article/003474.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003611.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003484.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003484.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003611.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003474.htm


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Dr. Abeer M. Aly 23

Radiological investigations

Abdominal ultrasounds

Abdominal CT scan

Abdominal MRI scan


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Dr. Abeer M. Aly 24

Management:-

1. prevention.

Treatment:-

1. Renal replacement therapy.

2. Monitor serum electrolyte level.

3. Control hemodynamic condition.


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Dr. Abeer M. Aly 25

Nursing Diagnosis:-

Activity Intolerance.

Fluid Volume Excess & electrolyteimbalance

Self esteem disturbance.

Knowledge Deficit.

Altered nutrition less than bodyrequirement.


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Dr. Abeer M. Aly 26

Diet.

Activity.

Care of the vascular access.

Personal Hygiene.

Follow up.

Psychological Care.


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Dr. Abeer M. Aly 27

An optimum dietary program is

important for patients onRenal failure.

The diet usually involves some

adjustment or restriction of :-

Protein , Sodium , Potassium or fluidintake.

Diet

Increase CHO in diet

A ti it


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Activity:-

The nurse should inform patient about:-

Importance of exercise.

Type of exercise, ( flexibility ex.,

strengthening ex., aerobic or

endurance ex.)

Frequency & duration of Ex.

When exercise must be stopped.


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Preparation for of the vascular access.

Personal Hygiene.

Psychological&

spiritual care Care.

C li i


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Complications

-End- stage renal diseasePericarditis

Cardiac tamponade

Congestive he0art failure

Hypertension

Platelet dysfunctionLoss of blood from the gastrointestinal tract
http://www.nlm.nih.gov/medlineplus/ency/article/000500.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000182.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000194.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000158.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000194.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000182.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000500.htm


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Ulcers

Hemorrhage

Anemia

Hepatitis B, Hepatitis C, liver failure

Decreased functioning of white blood cells

Decreased immune response

of infection Increased incidence

Peripheral neuropathy
http://www.nlm.nih.gov/medlineplus/ency/article/003228.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000560.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000279.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000284.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000821.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002387.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000593.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000593.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002387.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000821.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000284.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000279.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000560.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003228.htm


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Seizures

Encephalopathy, nerve damage, dementia

Weakening of the bones

FracturesJoint disorders

metabolism Changes in glucose

abnormalities including Electrolyte

hyperkalemia
http://www.nlm.nih.gov/medlineplus/ency/article/003200.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000739.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000001.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002257.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002350.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001179.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001179.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002350.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002257.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000001.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000739.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003200.htm


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Miscarriage, menstrual irregularities,

infertility

Decreased libido,impotence

Skin dryness, itching/scratching with

resultant skin infection .
http://www.nlm.nih.gov/medlineplus/ency/article/001488.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003263.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001191.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003164.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003217.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003217.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003164.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001191.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003263.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001488.htm


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renal failure (abeer 1)

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