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PATHOPHYSIOLOGY OF ACUTE RENAL FAILURE
acute renal failure case study pdf
ACUTE KIDNEY INJURY
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Acute Renal Failure
Acute renal failure is the inability of your kidneys to function properly. When acute renal failure occurs the kidneys lose the ability to remove waste and the ability to balance fluids and electrolytes.
The functional and structural changes, otherwise known as the pathophysiologic changes, associated with acute renal failure (ARF) involve changes in renal hemodynamics, nephron function and cell metabolism. ARF can lead to symptoms such as the sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance. Interactions of tubular and vascular events result in ARF and the leading cause of ARF is ischemia, which is the restricted supply of blood to tissues. This decline of renal blood flow causes cells of the kidney to die. The three phases of acute renal failure are prerenal, intrarenal and postrenal.
The most common type of ARF is prerenal acute renal failure and accounts for approximately 55% of all ARF cases. Prerenal ARF is caused by a complication of any condition, medication or disease that causes a rapid decrease of blood flow to the kidneys, which in turn causes a loss of kidney function. In prerenal ARF the kidneys are usually fully functional before the reduction of blood flow. Prerenal ARF can be caused by major cardiac or abdominal surgery, severe infection (sepsis), or injury; medicines that interfere with the blood supply to the kidneys, such as ACE inhibitors and NSAIDs; severe dehydration caused by excessive fluid loss; severe burns; pancreatitis and liver diseases that create fluid shifts in the abdomen (Hudson 2003). A timely correction of the underlying problem results in the kidneys returning to full normal funct...
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Hudson, K. RN MSN CCRN, (2003). Acute Renal Failure - 3 Nursing CEs. Retrieved from
http://dynamicnursingeducation.com/class.php?class_id=131&pid=18
Miller, S. M.D. (2011). Kidney Transplant. Retrieved from
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Schiffl, H. M.D., Lang, S. M.D., and Fischer, R. M.D. (2002). Daily Hemodialysis and the Outcome of Acute Renal Failure. Retrieved from
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There are two types of glomerulonephritis—acute renal failure (ARF) and chronic kidney disease (CKD). The ACF form generally develops suddenly as a result of an infection or illness, such as, group A streptococci bacteria, hepatitis, or in diseases such as lupus or HIV (Mathias, 2013). This type may require dialysis to replace renal function while it lasts, however, kidney function usually returns after the primary illness is treated. Many acute patients will not have any other complications as no permanent damage is done. Whereas CKD is found in a person that has had glomerulonephritis for months to years in some cases and may be asymptomatic until the kidney has become irreversibly damaged. ARF can evolve to become chronic if the glomeruli do not respond to
The article has been well organized and written. Mackay clearly states her rationale for writing the article and provides a valid reason to hold up her article with sources. Within the introduction section, the authors present worrying statistics of Americans affected by kidney disorders. Moreover, the author provides the disadvantages of dialysis with only Kidney transplantation being the only option. The author relates the topic to the readers...
According to the Mayo Clinic Staff (2012), acute kidney renal failure occurs abruptly when your kidneys lose their filtering abilities and cannot filter waste products from your blood. This is also known as acute renal failure or acute kidney injury. When this happens, high levels of waste may become accumulated in your blood and will alter your bloods chemical make up causing them to get out of balance. This failure or injury could happen rapidly over a few hours or a few days and can become fatal. Mostly people who are hospitalized and who are critically ill will need intensive care. If you take care of your body, acute kidney may be reversible and you may recover normal kidney function.
Some may think that they words acute kidney injury and chronic kidney disease mean the same thing, but that is incorrect. Kidney failure results from the kidneys not being able to eliminate metabolic waste products and water, which can also disturb all other organs of the body. Acute kidney injury (AKI) is a sudden and rapid loss of kidney function that usually occurs over hours to days due to acute tubular necrosis. Acute tubular necrosis is a process where ischemia affects parts of the kidneys and disrupts the basement membrane and the tubular epithelium. Chronic kidney disease (CKD) has a gradual onset and can take place over many years. CKD is seen in many diabetic patients due to diabetic neuropathy. AKI is a much more serious issue and should be taken very seriously.
Acute renal failure is a steady and fast deterioration of the functioning of the kidneys. This happens when there is a high level of the waste from the kidneys is left unattended. Acute renal failure occurs when the kidney fails to push out the waste or the everyday toxins out of the body in the form of urine. Simply put the kidneys have stopped working, they have lost their ability to filter water and waste from the blood. The kidneys remove the waste products help balance salt, water, and other minerals in our blood. With acute renal failure the kidneys lose the ability to remove waste and concentrate urine without losing electrolytes.
The renal disease are common nowadays .The acute renal failure is a medical term means that the kidneys stopped from working and not able to clear toxins from body ,not able to maintained a stable electrolyte balance inside the body and not able to secret the extra fluid as urine outside the body. The renal replacement therapy (RRT) or dialysis has been discovered on 1913 by Able, Rowntree and Turner in London, UK.
According to the Mayo Clinic, Kidney Failure occurs when the kidneys are suddenly unable to filter waste products from the blood. This occurring, results in the body beginning to accumulate high levels of dangerous waste, which eventually leads to a chemical imbalance in the blood. Symptoms of the kidney’s inability to
Dorthea Elizabeth Orem’s Nursing Theory as it Applies to Patients With End Stage Renal Disease and Hemodialysis Treatment
Healthy kidneys clean the blood by filtering out extra water and wastes. They also make hormones that keep your bones strong and blood healthy. When both of your kidneys fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in your body. Your body doesn't make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.
If the patient has a urinary catheter, and most ICU patients do, he or she may not have any reportable symptoms. Therefore, good assessment of urinary elimination, done in relation to a patient’s signs, symptoms, urine amount, intake and output, and lab values, is important. The lab values are discussed in Chapter 5. Acute and chronic renal failure can cause numerous systemic symptoms and altered homeostasis ( Collins, 2011). See Table 3-10 for abnormal urinary elimination.
Acute Hemodialysis Nurses and Advanced Practitioners with the Long Term Acute Care Facility (LTACH), are often faced with legal-ethical situations that require informed healthcare decisions. Patients within these facilities are often severely sick, non-verbal, non-responsive, and unstable, which places decision making on the next of kin/patient's family. Invasive procedures, such as dialysis are often ordered despite the hemodynamic stability of the patient. Families and loved ones who consent the patient for hemodialysis, typically for preservation of life. Hemodialysis can produce excessive stress on the body when combined with issues such as low blood pressure, elevated temperature, cramping, increased
Renal replacement therapy (aka dialysis) is often required in patient with acute or chronic kidney disease (CKD) to facilitate the removal of undesirable waste products from the body. In the US more than 10% (more than 20 million) of adults may have CKD.1 Chances of having CKD increase after age 50 yrs and is most common among adults older than 70 yrs. Approximately 5%-6% Intensive care unit (ICU) patients have acute renal failure during their ICU stay.2
Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of hypovolaemic shock, as some of the signs and symptoms could have been attributed to her kidney failure (Macintosh and Moore, 2011; Murphy and Byrne, 2009).
The local renal satellite services offer patients treatment of haemodialysis 3 times a week. This is a treatment for patients whose kidneys have failed and it is to remove toxins and waste from the blood (Levy et al 2009). Patients are often unwell when they attend the unit and also have other issues that affect their health. These are linked either to their kidney failure, or to other co-morbidities. Cardiac problems often become a major complication for dialysis patients (Harnett et al). This assignment will be discussing a patient who attended the dialysis unit feeling unwell on arrival. It will cover the initial assessment of the patient and the challenges faced in transferring them to the main renal unit inpatients ward. It will also look at assessing whether the renal ward or another specialist area would be the appropriate care environment. The discharge process should normally commence as soon as a patient is admitted. This to identify the different needs of the patient and to help make it a smooth transition (Corman 2005). Unlike wards, satellite renal units do out-patient haemodialysis only. Patients are admitted to the unit on their arrival that day for dialysis and also discharged the same day. However when a patient presents a serious medical problem, they will not be discharged home as normal unless it is medically safe to do so. Transferring a patient or discharging is a very complex issue and involves a multidisciplinary team (MDT) (Department of Health 2010) to work as one unit, to achieve a safe outcome for the patient. The scenario chosen is of Lewis Whittle as he will be known to protect his identity (NHS Code of Practice 2010). Lewis’ case is being used because of the complex nature that he presented with at...
Chronic Kidney Disease. Mayo Foundation for Medical Education and Research, 2014. Web. 20 May 2014.