Você está na página 1de 8

Acute kidney failure (ARF) occurs when

your kidneys suddenly become unable to filter


waste products from your blood. When your
kidneys lose their filtering ability, dangerous
levels of wastes may accumulate, and your
blood's chemical makeup may get out of
balance.
Acute kidney failure — also called acute
renal failure or acute kidney injury — develops
rapidly, usually in less than a few days. Acute
kidney failure is most common in people who
are already hospitalized, particularly in
critically ill people who need intensive care.
Acute kidney failure can be fatal and requires intensive treatment. However, acute
kidney failure may be reversible. If you're otherwise in good health, you may recover
normal or nearly normal kidney function.

Acute kidney failure can occur when:


 Pre-renal ARF - You have a condition that slows blood flow to your kidneys
 Intrarenal ARF -You experience direct damage to your kidneys
 Postrenal ARF -Your kidneys' urine drainage tubes (ureters) become blocked and
wastes can't leave your body through your urine

Risk factors
Acute kidney failure almost always occurs in connection with another medical condition
or event. Conditions that can increase your risk of acute kidney failure include:
 Being hospitalized, especially for a serious condition that requires intensive care
 Advanced age
 Blockages in the blood vessels in your arms or legs (peripheral artery disease)
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver diseases
 Certain cancers and their treatments

As for Patient Rio’s case, he is 90 years old which means he is in the advanced age.
He was also diagnosed with Acute Renal Failure secondary to Hypertension, which
means that the cause of his ARF was due to high blood pressure. Over time, uncontrolled
high blood pressure can cause arteries around the kidneys to narrow, weaken or harden.
These damaged arteries are not able to deliver enough blood to the kidney tissue.
Symptoms
Signs and symptoms of acute kidney failure may include:
 Decreased urine output, although occasionally urine output remains normal
 Fluid retention, causing swelling in your legs, ankles or feet
 Shortness of breath
 Fatigue
 Confusion
 Nausea
 Weakness
 Irregular heartbeat
 Chest pain or pressure
 Seizures or coma in severe cases

As for Patient Rio’s case, he manifested fluid retention as evidence by pitting edema
on both upper and lower extremities, weakness, and tachycardia. Although he had a
normal urine output.

Complications
Potential complications of acute kidney failure include:
 Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs,
which can cause shortness of breath.
 Chest pain. If the lining that covers your heart (pericardium) becomes inflamed,
you may experience chest pain.
 Muscle weakness. When your body's fluids and electrolytes — your body's blood
chemistry — are out of balance, muscle weakness can result.
 Permanent kidney damage. Occasionally, acute kidney failure causes permanent
loss of kidney function, or end-stage renal disease. People with end-stage renal
disease require either permanent dialysis — a mechanical filtration process used
to remove toxins and wastes from the body — or a kidney transplant to survive.
 Death. Acute kidney failure can lead to loss of kidney function and, ultimately,
death.

ARF staging
Guidelines for staging ARF
* Stage 1: SCr 1.5-1.9 times baseline or greater than/equal to 0.3 mg/dL increase with
urine output of less than 0.5 mL/kg/h for 6-12 hours.
* Stage 2: SCr 2.0-2.9 times baseline and urine output of less than 0.5 mL/kg/h for
greater than/equal to 12 hours.
* Stage 3: SCr 3.0 times baseline or increase in SCr to greater than/equal to 4.0 mg/dL;
or initiation of RRT; or in patients <18 years, decrease in estimated glomerular filtration
rate (eGFR) to <35 mL/min per 1.73 m2 and urine output less than 0.3 mL/kg/h for 24
hours or more; or anuria for 12 hours or more.
Phases of ARF
Phase Characteristic features Duration
 Symptoms of the underlying illness causing AKI may be Hours to
Kidney injury
present. days
Oliguric or Progressive deterioration of kidney function Generally < 2
anuric phase Reduced urine production (oliguria) weeks
 Increased retention of urea and creatinine
 Complications: fluid retention (pulmonary edema),
hyperkalemia, metabolic acidosis, uremia, lethargy,
asterixis
Polyuric  Glomerular filtration returns to normal, thus increasing ∼ 3 weeks
phase urine production (polyuria), while tubular reabsorption
remains disturbed.
 Complications: loss of electrolytes and water
(dehydration, hyponatremia, and hypokalemia)
Recovery  Kidney function and urine production normalize. Up to 2 years
phase
Patients have a higher risk of secondary infection throughout all phases (most common
reason for a fatal outcome).

Diagnosis

Kidney biopsy
If your signs and symptoms suggest that you have
acute kidney failure, your doctor may recommend
certain tests and procedures to verify your diagnosis.
These may include:

 Urine output measurements. Measuring how


much you urinate in 24 hours may help your doctor determine the cause of your
kidney failure.

 Urine tests. Analyzing a sample of your urine (urinalysis) may reveal abnormalities
that suggest kidney failure.

 Blood tests. A sample of your blood may reveal rapidly rising levels of urea and
creatinine — two substances used to measure kidney function.
 Imaging tests. Imaging tests such as ultrasound and computerized tomography
may be used to help your doctor see your kidneys.

 Removing a sample of kidney tissue for testing. In some situations, your doctor
may recommend a kidney biopsy to remove a small sample of kidney tissue for lab
testing. Your doctor inserts a needle through your skin and into your kidney to
remove the sample.

Treatment

Treatment for acute kidney failure typically requires a hospital stay. Most people with
acute kidney failure are already hospitalized. How long you'll stay in the hospital
depends on the reason for your acute kidney failure and how quickly your kidneys
recover.

In some cases, you may be able to recover at home.

Treating the underlying cause of your kidney injury

Treatment for acute kidney failure involves identifying the illness or injury that originally
damaged your kidneys. Your treatment options depend on what's causing your kidney
failure.

Treating complications until your kidneys recover

Your doctor will also work to prevent complications and allow your kidneys time to heal.
Treatments that help prevent complications include:

 Treatments to balance the amount of fluids in your blood. If your acute kidney
failure is caused by a lack of fluids in your blood, your doctor may recommend
intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have
too much fluid, leading to swelling in your arms and legs. In these cases, your
doctor may recommend medications (diuretics) to cause your body to expel extra
fluids.

 Medications to control blood potassium. If your kidneys aren't properly filtering


potassium from your blood, your doctor may prescribe calcium, glucose or sodium
polystyrene sulfonate (Kionex) to prevent the accumulation of high levels of
potassium in your blood. Too much potassium in the blood can cause dangerous
irregular heartbeats (arrhythmias) and muscle weakness.

 Medications to restore blood calcium levels. If the levels of calcium in your blood
drop too low, your doctor may recommend an infusion of calcium.

 Dialysis to remove toxins from your blood. If toxins build up in your blood, you may
need temporary hemodialysis — often referred to simply as dialysis — to help
remove toxins and excess fluids from your body while your kidneys heal. Dialysis
may also help remove excess potassium from your body. During dialysis, a
machine pumps blood out of your body through an artificial kidney (dialyzer) that
filters out waste. The blood is then returned to your body.

Treatment is focused on removing the cause of the kidney failure.

Medications and other products the patient ingests will be reviewed. Any that might
harm the kidneys will be eliminated or the dose reduced.

Other treatments will be offered, with the following goals:

 Correct dehydration: Intravenous fluids, with electrolyte replacement if needed

 Fluid restriction: For those types of kidney failure in which excess fluid is not

appropriately eliminated by the kidneys

 Increase blood flow to the kidney: Usually related to improving heart function or

increasing blood pressure

 Correct chemical (electrolyte) abnormalities: Keeps other body systems working

properly

Meds given to pt:


 Erythropoietin 4000 units (Tuesday)
 Biofluid 500ml x 12hrs
 Human Albumin 25% + 40mg Furosemide 30mg q12
 Lactulose 30ml ODHS + vit 10ml q8 x3
 Clopidogrel 75mg tab ODPC
 Enoxaprin Na 0.2cc SQ OD
 N-Acetyl Cysteine OD HS
 Duavent q8 PRN
 Rosuvastatine 30mg/tab ODHS
 Paracetamol tab q8 PRN
 Peptamen 6 scoops in H2O TID

Nursing Interventions and Rationales:

1. Strict intake and output measurement


o It is important if the kidney’s are not functioning to measure the patient’s
I&Os. Notify the physician if there is a deficit greater than 5-10%.
2. Medications to watch: Statins, NSAIDS, Aspirin
o Be mindful of medications that can become toxic when the kidneys aren’t
functioning at their prime.

Try to limits these drugs, watch labs and antibiotic troughs. Look out for
signs
3. Statins NSAIDS Aspirin Acetaminophen Insulin Some antibiotics Herbal
supplements
o Be mindful of medications that can become toxic when the kidneys aren’t
functioning at their prime.

Try to limits these drugs, watch labs and antibiotic troughs. Look out for
signs and symptoms of overdose.

Here are the most common signs and symptoms of overdose. *note this is
not a comprehensive list*

Statins: muscle pain and weakness.

NSAIDS: N/V, headache, dizziness and blurred vision.

Aspirin: ringing in the ears (tinnitus), decreased hearing.

Acetaminophen: N/V/D, irritability, convulsions, coma.

Insulin: Hyperinsulinemia from the body building up resistance to insulin.

Some antibiotics: Neuro symptoms like seizures, confusion, neuropathy.

Herbal supplements: Various, depends on the herbal supplement.


4. Monitor lung sounds and edema
o You want to make sure fluid balance is carefully monitored. A backup in
the lungs would cause crackles and a back up systemically would cause
pitting edema in the legs.
5. Diuretic administration: Furosemide (Lasix) Bumetanide (Bumex) Spironolactone
(Aldactone)
o This is very important… diuretics are going to make the patient PEE… lots
and lots of PEE. Do not under any circumstances administer a diuretic
without a bathroom plan. And a word to the wise, have a backup plan.
Meaning if you have a walkie talkie patient with functioning arms and a
strong call light finger, I still would set up a bedside commode just.in.case.
I walk them to the bathroom or assist them in any way needed, but it is
possible that they do not know how urgent their situation is and I can clean
up pee, but you can’t clean up that patients dignity.

Diuretics work on different parts of the nephrons. The goal of diuretics is to


help the kidneys rid the body of salt (notice I didn’t say sodium (Na+)?)
and fluids. It is important to note for every Na+ molecule there is a
compound of one water (H20) that follows it. Psssst: potassium is a salt...

There are three kinds of diuretics: Loop, Thiazide, and potassium sparing.

Loop: works on the loop of henle and excretes Na+, K+, and Ca-. (Yikes!
Watch your patient’s electrolytes!)

Thiazide: Works on the distal convoluted tubule and blocks the Na+/Cl-
symporter (which reabsorbs...you guessed it Na+ and Cl-). This symporter
is responsible for about 5% of Na+ reabsorption. So monitor your patient’s
sodium and chloride. Oh, and your K+...Why? Because K+, Cl- and Na+
have direct relationships!

Potassium-Sparing: Works on the Na+/K+ pumps in the collecting ducts of


the kidney by blocking the effects of aldosterone at that site. Aldosterone
has the collecting ducts reabsorbing Na+ and thus water, and for ever Na+
absorbed, one molecule of K+ is excreted. So this diuretic does the
opposite of that, saves a K+ and excretes a Na+ and H20.

Most commonly used diuretics in acute kidney failure:


-Furosemide: Loop
-Bumetanide: Loop
-Spironolactone: Potassium-Sparing
6. Monitor Potassium Potassium (K+) Normal range: 3.5 - 5.0 mEq/L
o As Furosemide is the front line and best treatment for kidney failure,
nurses must be careful to watch the patient’s potassium levels
(Remember: Furosemide is potassium wasting).
Potassium (K+): is the most abundant intracellular cation and plays a vital
role in the transmission of electrical impulses in cardiac and skeletal
muscle. It plays a role in acid base equilibrium. In states of acidosis
hydrogen with enter the cell as this happens it will force potassium out of
the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+
7. Diet changes and control Fluid restriction Salt restriction
o Educating the patient on decreased sodium intake as well as strict fluid
intake is vital when in any sort of kidney failure.

However, if patient is on a potassium wasting diuretic, educate about


potassium (bananas, sweet potatoes, etc.)
8. Monitor Kidney Labs Blood Urea Nitrogen (BUN) Normal Range: 7-20 mg/dL
Creatinine (Cr) Normal Range: 0.7-1.4 mg/dL
o This measures how well treatment is working, you want the labs to be
moving back to normal limits.

Blood Urea Nitrogen (BUN): measures the amount of urea in the blood.
When protein is broken down ammonia is formed. Ammonia is converted
to urea in the liver and is eventually excreted in the kidneys.

Creatinine (Cr): is a byproduct of creatine metabolism, and it is excreted


by the kidneys. Creatinine is created in proportion to muscle mass and
usually stays stable.

Possible Nursing Diagnosis for ARF


 Fatigue related to decreased Hgb count.
 Excess fluid volume related to inability of the kidney to excrete waste products
 Knowledge deficit related to disease condition
 Imbalanced nutrition less than body requirements related to disease condition
 Impaired urinary elimination related to disease condition
 Fluid Volume Excess related to inability of the kidney to excrete waste products

Você também pode gostar