Through this assignment we will explore the causes, the diagnostic exams, subjective and objective signs and symptoms, the dietary modifications a nurse should teach, the medical management of acute renal failure, and finally the short and long term goals a nurse should make for their client.
There are three causes of acute renal failure; prerenal causes, renal causes, and post renal causes. Prerenal causes are due to such factors as dehydration i.e... vomiting diarrhea, or sweating, or poor fluid intake. Other factors could also include weak or irregular blood flow to and from the kidneys because of an obstruction in the renal artery or vein. Intrarenal kidney failure is damage directly to the kidney. Causes include sepsis (the body is overwhelmed by infection and shuts down) multiple myeloma (acute glomerulonephritis or inflammation of the kidneys filtering system) as well as rhabdomyolysis (the body has broken down muscles and these fibers clog the filtering system). Post renal causes are factors that affect the outflow of urine. Such factors include tumors which may surround the ureters, prostate cancer which could prevent emptying the bladder, as well as kidney stones. Kidney stones can only cause failure if there is only one present. Because we know the causes, now we can explore by performing exams that would tell us the next best course of action.
The first step in any client consult is taking a look at their medical history as well as a physical exam. The first exam is known as a serum creatine exam. If the cause of failure is prerenal then the creatine in the blood will increase. Another test is the blood urea nitrogen exam. If your kidney cannot excrete waste products, then your BUN levels will increase. If the kidney is believed to be infected than the nurse or doctor will administer an erythrocyte sedimentation rate exam. In the intrarenal phase ESR is increased. The easiest of all exams in the urinalysis exam. A urinalysis checks for color, clarity, odor, specific gravity, ptt, protein, glucose, crystals, bacteria, leukocyte esterase in the urine. Azotemia is an increase of nitrogen and creatine as a result of renal failure. However in prerenal phase azotemia is decreased from circulatory disturbances causing decreased renal perfusion. In intrarenal azotemia continues to decrease when more of the nephrons are non-functional. Lastly and least preferred by the client is kidney biopsy. A needle is pierced through the skin and into the kidney. This is then sent out for testing. The majority of these tests will be determined by the signs and symptoms the client is displaying.
Some of the signs and symptoms for acute renal failure are asthenia, uremia, oliguria, and anuria. Uremia is both subjective and objective. Uremia can cause nausea, confusion, seizures, irregular heart rhythm and fluid in the lungs. Asthenia is subjective because the client. Symptoms include lethargy and lack of energy and...