ACUTE RENAL FAILURE

 ACUTE RENAL FAILURE

a) Define acute renal failure 5%

It is a sudden decline in renal function due to kidney damage Characterized azotemia

b) Causes of acute renal failure

(i). Prerenal causes 10%

Extra renal causes or disorders cause inadequate renal perfusion as a result cardiac out put and vascular volume is decreased. Some of the causes are Haemorrhage, shock, and cardiac failure, severe dehydration in burns, occlusion of renal artery by a thrombus or abdominal mass.

(ii). Intrarenial causes 10%

This is a disorder in which there is kidney irritation and destruction of the nephrone. It occurs in conditions like gromerular nephritis, acute tubular necrosis, acute pyelonephritis, chemical biological products and infections. 

(iii). Post renal causes 5%

These include condition which obstructs the flow of urine from the kidney to the bladder and to the exterior. Some of the conditions are neoplasms, calculi, prostatic hypertrophy and pregnancy.

C) STATE THREE INVESTIGATIONS (15% FOR ANY 3)

  History and physical  examination for oedema and other related features

  Blood for levels of BUN, and serum electrolytes

  Urinalysis, check for proteins, cats, sodium. Urinary output should be determine.

  Renal ultrasound --to detect damage to the glomerulus

  Renal scan may be indicated.

  Retrograde pyelogram.

D)I MEDICAL TREATMENT 15%

  Treat specific causes e.g. urinary structure surgical intervention may be sought (Antibiotics /Diuretics)

  Fluids intake should be restricted to about 600 ml per day.

  Sodium, potassium and phosphate should be restricted

  Nutrition, patient should take adequate proteins 0.6 to 2g/kg per day.

D) II NURSING CARE  40%

Altered urinary output 6%

  Goal to restore homeostasis

  Action: assist in removing the cause, gastric lavage may be done. Observe hourly urine output. Give specific prescribed drugs for the diseases.

  Prepare for dialysis if need arise

  Rationale: To prevent metabolic deterioration and correct biomedical disorders.

ii) Altered nutrition status 5%

Goal: To preserve protein stores until normal function in gained.

Action: Give the patient 100g of carbohydrates daily, small frequent  meals, give 50% dextrose IV, Restrict sodium, potassium and Phosphate intake. Proteins should also be reduced.

Rationale: To prevent metabolism of tissue protein. Fat and sodium are restricted to reduce Na ,K  serum levels.

iii)  Potential impairment of the oral mucosa and skin integrate 5%

Goal:  Maintain oral mucus and prevent skin destruction.

Action:  Frequent oral care with prescribed antiseptic e.g. Diluted H2 O. Apply lemon juice or linsing  the mouth before and after a meal.

Rationale:  Stimulate salivation and moisten mucus membrane

 To prevent skin breakage and maintain it intact.

IV) Fluid volume increase 5%

Goal: To maintain adequate hydration and prevent over hydration.

Action:  Limit fluid intake

Educate the patient on importance of fluid restriction. Prescribed amount should be taken daily

 Evaluation intake and output fluids using fluid balance chart.

                      To prevent worsening the oedema and other complications.

V) Reduced or impaired activity 5%

Goal: To reduce fatigue

Action: Assists patient with all activities. Encourage ambulation. Do passive and active exercise 

Rationale: To promote rest and comfort.

Evaluation: Patients activities are expected to be within the normal range and fatigue reduced.

vii) Anxiety 6%

Goal:  To ally anxiety

Action: Explain all procedure carried out to the patient and relatives. Explain the disease process to them as well(give examples).

 Care provider should be empathetic

 Encourage patient to take part in his care.

OTHER NURSING PROBLEMS/NEEDS (8% for any 4)

  Health education 

  Fluid volume deficit in dieresis stage

  Prevention of complications

  Risks of injury due to dizziness

  Nausea/vomiting, diarrhea

  Torching and convulsions

  fever