Learning Outcomes
At the end of this lecture, students will be able to:
Define renal failure and discuss its pathophysiological
changes.
Describe the categories of acute renal failure (ARF).
Recognise the clinical manifestations of ARF.
Discuss the assessment and diagnostic findings associated
with ARF.
Describe the medical management of a patient with ARF.
Discuss the nursing interventions designed to meet specific
goals associated with ARF.
Renal Failure
Renal failure results when the kidneys cannot remove the bodys metabolic
wastes (urea) or perform their regulatory functions. The wastes accumulate
in the body fluids, leading to a disruption in endocrine and metabolic
functions as well as fluid, electrolyte, and acidbase disturbances. Renal
failure is a systemic disease and is a final common pathway of many
different kidney and urinary tract diseases.
Clinical Manifestations
Almost every system of the body is affected when there is
failure of the normal renal regulatory mechanisms.
The patient may appear critically ill and lethargic [] ,
with persistent nausea, vomiting and diarrhea. The skin and
mucous membranes are dry from dehydration, and the breath
may have the odor of urine. Central nervous system signs and
symptoms include drowsiness, headache, muscle twitching
[], and seizures [] . Next slide summarizes
some common clinical findings for all three categories of ARF.
Characteristics
Prerenal
Intrarenal
Postrenal
Etiology
BUN value
Hypoperfusion
Increased
Parenchymal damage
Increased
Obstruction
Increased
Creatinine
Increased
Increased
Increased
Urine output
Decreased
Varies, may be
decreased, or
sudden anuria
Urine sodium
Decreased to
<20 mEq/L
Urine specific
gravity
Increased
Varies
Medical Management
The kidney has a remarkable ability to recover from insult.
The objectives of treatment of ARF are to restore normal
chemical balance and prevent complications.
The medical management includes maintaining fluid balance,
avoiding fluid excesses, or possibly performing dialysis.
Maintenance of fluid balance is based on daily body weight,
serial measurements of central venous pressure, serum and urine
concentrations, fluid losses, blood pressure, and the clinical
status of the patient. The parenteral and oral intake and the
output, including insensible loss, are calculated and are used as
the basis for fluid replacement.
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Pharmacologic Therapy
[Hyperkalemia]
Hyperkalemia is a life-threatening condition. Therefore, the
patient is monitored for:
Serum potassium levels
Electrocardiogram (ECG) changes (tall, tented, or peaked T
waves) (next slide)
Signs and symptoms (muscle weakness, diarrhea, abdominal
cramps)
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Peaked T waves
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15
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