Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Copyright 2008 Lippincott Williams&Wilkins.,Management of Patients With Renal Disorders,1,Functions of the Kidney,Urine formation,Excretion of wastes,Regulation of electrolytes,Regulation of acid-base balance,Control of water balance,Control of blood pressure,Renal clearance,Regulation of red blood cell formation,Synthesis of vitamin D to active form,Secretion of prostaglandins,Regulates calcium and phosphorus balance,Activates growth hormone,2,Common Fluid and Electrolyte Disturbances in Renal Disorders,Fluid volume loss or excess,Protein deficit,Electrolyte abnormalities including Na,+,K,+,Ca,+,Mg,+,bicarbonate,and phosphorus,See table 47-3,3,Glomerular Diseases,An inflammation of the glomerular capillaries,The glomerulus is a tuft of capillaries forming part of the nephron through which filtration occurs,The nephron is the functional unit of the kidney responsible for urine formation and removal of unnecessary substances,Antigen-antibody complexes form in the blood and become trapped in the glomerulus and induce inflammatory response,Acute glomerulonephritis,Chronic glomerulonephritis,Nephrotic syndrome,4,Acute Glomerulonephritis,Complications include,Hypertensive encephalopathy,Heart failure,Pulmonary edema,Renal failure,Prognosis-Most recover fully,6,Acute Glomerulonephritis,Medical management includes supportive care-treat hypertension,edema,rest,sodium and fluid restriction,Dietary modifications(high carb,low protein;,Treat cause,if appropriate,using antibiotics,possibly corticosteroids,7,Sequence of Events in Acute Glomerulonephritis,8,Chronic Glomerulonephritis,Causes include repeated episodes of acute glomerular nephritis,hypertensive nephrosclerosis,hyperlipidemia,and other causes of glomerular damage,Secondary causes may include diseases with systemic effects(eg,SLE,Goodpatures,diabetes),Some patients are asymptomatic for years;as glomerular damage increases,signs and symptoms of renal insufficiency and renal failure develop,Abnormal laboratory test results include urine with fixed specific gravity,casts,and proteinuria;electrolyte imbalances;and hypoalbuminemia,10,Chronic Glomerulonephritis,Medical management,HTN management,Sodium/water restriction,diuretics,Adequate nutrition intake,high value protein,Early initiation of dialysis,11,Nephrotic Syndrome,Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins,Results in hypoalbuminemia and anasarca,Hallmark proteinuria(3.5 g/day),Causes include chronic glomerulonephritis,diabetes mellitus with glomerulosclerosis,amyloidosis,lupus,multiple myeloma,and renal vein thrombosis,(table 46-10),Medical management includes drug and dietary therapy,13,15,Sequence of Events in Nephrotic Syndrome,16,Causes of Acute Renal Failure(ARF),table 47-1,Prerenal,The result of impaired blood flow,leading to hypoperfusion of kidney,Volume depletion,impaired cardiac function,vasodilation(eg,shock),Intrarenal,Result of actual parenchymal damage to glomeruli or tubules-impaired nephron function,Nephrotoxic agents,infectious process,renal ischemia,18,Causes of Acute Renal Failure,Postrenal,Due to mechanical obstruction somewhere distal to the kidney(eg,calculi,tumors,strictures),19,Phases of ARF,Initiation,Oliguria,Diuresis,Recovery,20,ARF Assessment and Findings,Urine output scant to normal,low specific gravity,Ultrasound may show anatomic changes,Elevated BUN and creatinine,Creatinine increases as in conjunction with decrease in GFR,If oliguric,risk of hyperkalemia,Progressive metabolic acidosis,Changes in calcium and phosphate,21,ARF prevention,Careful history to assess for risk factors,BUN/Creatinine monitoring for patients on nephrotoxic agents,Adequate hydration,Prompt treatment of shock,Prompt treatment of hypotension,Prompt treatment of infections,To prevent toxic drug effects,monitor renal function,drug dose and duration,Recognize potential for radiocontrast-induced nephropathy,22,Nursing Management,Daily weights,strict I/Os,Monitor fluid and lyte balance,Reducing metabolic rate,Promoting pulmonary function,Preventing infection,Providing skin care,Technical aspects of care,24,Dialysis for ARF,Used to remove fluid and uremic wastes when kidneys cannot,Indicated in hyperkalemia,fluid overload,increasing acidosis,severely elevated BUN or severe confusion,Hemodialysis,If patient can tolerate large volumes of fluid removal at a time,Continuous renal replacement therapies,Indicated for patients who are too clinically unstable for hemodialysis,Does not produce rapid fluid shifts,Managed by critical care nurse,25,Treatment Options for Acute Renal Failure,Hemodialysis,Continuous renal replacement therapies(CCRT),26,Hemodialysis Catheter,28,Internal Arteriovenous Fistula and Graft,29,Nursing Management of the Hospitalized Patient on Dialysis,Protect vascular access;assess site for patency and s