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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.
Urine sodium
Increased to >40 mEq/L Varies, often decreased to 20 mEq/L or less Low normal, 1.010 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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Peaked T waves
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