NCP Acute Renal Failure

NCP Acute Renal Failure - RENAL FAILURE: ACUTE Acute renal...

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RENAL FAILURE: ACUTE Acute renal failure (ARF) has four well-defined stages: onset, oliguric or anuric, diuretic, and convalescent. Treatment depends on stage and severity of renal compromise. ARF can be divided into three major classifications, depending on site: Prerenal: Prerenal failure is caused by interference with renal perfusion (e.g., blood volume depletion, volume shifts [“third-space” sequestration of fluid], or excessive/too-rapid volume expansion), manifested by decreased glomerular filtration rate (GFR). Disorders that lead to prerenal failure include cardiogenic shock, heart failure (HF), myocardial infarction (MI), burns, trauma, hemorrhage, septic or anaphylactic shock, and renal artery obstruction. Renal ( or intrarenal ) : Intrarenal causes for renal failure are associated with parenchymal changes caused by ischemia or nephrotoxic substances. Acute tubular necrosis (ATN) accounts for 90% of cases of acute oliguria. Destruction of tubular epithelial cells results from (1) ischemia/hypoperfusion (similar to prerenal hypoperfusion except that correction of the causative factor may be followed by continued oliguria for up to 30 days) and/or (2) direct damage from nephrotoxins. Postrenal: Postrenal failure occurs as the result of an obstruction in the urinary tract anywhere from the tubules to the urethral meatus. Obstruction most commonly occurs with stones in the ureters, bladder, or urethra; however, trauma, edema associated with infection, prostate enlargement, and strictures also cause postrenal failure. Note: Iatrogenically induced ARF should be considered when failure develops during or shortly after hospitalization. The most common causative factor is administration of potentially nephrotoxic agents. CARE SETTING Inpatient acute medical or surgical unit RELATED CONCERNS Metabolic acidosis (primary base bicarbonate deficiency) Fluid and electrolyte imbalances Psychosocial aspects of care Renal dialysis Renal failure: chronic Sepsis/septicemia Total nutritional support: parenteral/enteral feeding Upper gastrointestinal/esophageal bleeding Patient Assessment Database ACTIVITY/REST May report: Fatigue, weakness, malaise May exhibit: Muscle weakness, loss of tone CIRCULATION May exhibit: Hypotension or hypertension (including malignant hypertension, eclampsia/pregnancy- induced hypertension) Cardiac dysrhythmias Weak/thready pulses, orthostatic hypotension (hypovolemia) Jugular venous distension (JVD), full/bounding pulses (hypervolemia); flat neck veins (diuretic phase) Generalized tissue edema (including periorbital area, ankles, sacrum) Pallor (anemia); bleeding tendencies ELIMINATION May report: Change in usual urination pattern: Increased frequency, polyuria (early failure and early recovery), or decreased frequency/oliguria (later phase) Dysuria, hesitancy, urgency, and retention (inflammation/obstruction/infection) Abdominal bloating, diarrhea, or constipation
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NCP Acute Renal Failure - RENAL FAILURE: ACUTE Acute renal...

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