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Dr.Salwa Elbadry
Dr.Salwa Elbadry
Dr.Salwa Elbadry
Dr. Salwa Elbadry
Dr.Salwa Elbadry
Dr.Salwa ElbadryUrinary system
Dr.Salwa ElbadryThe Kidney
Dr.Salwa Elbadry
Kidney
Dr.Salwa ElbadryNephron
Dr.Salwa Elbadry
Nephron
Dr.Salwa Elbadry
Nephron
Dr.Salwa Elbadry
Kidney
Dr.Salwa Elbadry
Complications of Kidney failure
•Fluid retention. This may lead to
swollen tissues, congestive heart
failure or fluid in your lungs (pulmonary
edema).
Dr.Salwa Elbadry
•A sudden rise in potassium levels :
This could impair the heart's
ability to function and may
be life-threatening.
•Weak bones that fracture easily.
Dr.Salwa Elbadry
•Anemia.
•Stomach ulcers.
•Damage the central
nervous system.
Dr.Salwa Elbadry
Definition :-
Renal failure is a gradual and
progressive loss of the ability of the
kidneys to:-
.Excrete wastes,
.Concentrate urine,
.and conserve electrolyte.
Renal Failure
Causes of acute renal failure:-
Dr.Salwa Elbadry
Causes of acute renal failure:-
Pre Renal Renal Post Renal
•Hypovolemia
•Drugs
•Toxins•Multiple-organ failure
•polycystic kidney disease
•A.pyelonephritis
•A.gloumerulnephritis
•Tumor
•Calculi
•Stricture
•Prostatic hypertrophy
Dr.Salwa Elbadry
Phases:-
•Initiation phase:- (1-2 days)
The time from renal insult to recognition
of decrease GFR.
•Oliguric phase ( maintenance phase 1-2 week)
The period of time during which oliguria persists .
-It is most life – threatening period
Hyperkalemia
Dr.Salwa Elbadry
•Polyuric phase:- Diuretic phase
Progressive increase in urine volume
•Functional recovery phase:-3-12 months
The patient repairing the renal injury &
return to normal.
Dr.Salwa Elbadry
Signs & Symptoms:-
•Urine analysis………….
•Hydration condition……….
•Vital Signs………….
•GIT manifestations………..
•Investigations…………….
•CNS manifestations…………..
Dr.Salwa Elbadry
Chronic Renal Failure:-
Is progressive , irreversible
deterioration in renal function.
Dr.Salwa Elbadry
Investigation
•A urine analysis
Creatinine levels progressively increase.
BUN is progressively increased.
Creatinine clearance progressively decreases.
Potassium test may show elevated levels.
•Arterial blood gas and blood chemistry analysis may show metabolic acidosis
Acute Versus Chronic• Acute
– sudden onset– rapid reduction in urine output– Usually reversible– Tubular cell death and regeneration
• Chronic – Progressive– Not reversible– Nephron loss
• 75% of function can be lost before its noticeable
Dr.Salwa Elbadry
Radiological investigations
•Abdominal ultrasounds
•Abdominal CT scan
•Abdominal MRI scan
Dr.Salwa Elbadry
Management:-
1. prevention………………….
Treatment:-
1. Renal replacement therapy.
2. Monitor serum electrolyte level.
3. Control hemodynamic condition.
Dr.Salwa Elbadry
Nursing Diagnosis:-
Activity Intolerance.
Fluid Volume Excess & electrolyte imbalance
Self esteem disturbance.
Knowledge Deficit.
Altered nutrition – less than body requirement.
Dr.Salwa Elbadry
• Diet.
• Activity.
• Care of the vascular access.
• Personal Hygiene.
• Follow up.
• Psychological Care.
Dr.Salwa Elbadry
An optimum dietary program is
important for patients on Renal failure.
The diet usually involves some
adjustment or restriction of :-
Protein , Sodium , Potassium or fluid intake.
Diet
Increase CHO in diet
Dr.Salwa Elbadry
• Activity:-
•The nurse should inform patient about:-
Importance of exercise.Type of exercise, ( flexibility ex.,
strengthening ex., aerobic or
endurance ex.)
Frequency & duration of Ex.
When exercise must be stopped.
Dr.Salwa Elbadry
•Preparation for of the vascular access.
•Personal Hygiene.
•Psychological&
• spiritual care Care.
Dr.Salwa Elbadry
Complications :-
•End-stage renal disease
•Pericarditis
•Cardiac tamponade
•Congestive heart failure
•Hypertension
•Platelet dysfunction
•Loss of blood from the gastrointestinal tract
Dr.Salwa Elbadry
•Ulcers
•Hemorrhage
•Anemia
•Hepatitis B, Hepatitis C, liver failure
•Decreased functioning of white blood cells
•Decreased immune response
•Increased incidence of infection
•Peripheral neuropathy
Dr.Salwa Elbadry
•Seizures
•Encephalopathy, nerve damage, dementia
•Weakening of the bones
•Fractures
•Joint disorders
•Changes in glucose metabolism
•Electrolyte abnormalities including
hyperkalemia
Dr.Salwa Elbadry
•Miscarriage, menstrual irregularities,
infertility
•Decreased libido, impotence
•Skin dryness, itching/scratching with
resultant skin infection .
Dr.Salwa ElbadrySalwa Elbadry
Dr.Salwa Elbadry
Dr.Salwa Elbadry
