Question

ADULT HEALTH NURSE II

CASE STUDY IV:

ACUTE RENAL FAILURE

J.T. age 45 was admitted to the emergency room following a major automobile accident in which her husband was killed. She had a massive abdominal injuries and a fractured femur. She was taken immediately to surgery for repair of lacerated liver and perforated ileum. She had two units of blood during surgery and two units while in recovery room. On the day of surgery, her urine output declined to 10-20 ml/hr. Fluid intake with plasma expanders and blood did not increase her urine output.   

Lab Results: BUN 70 mg/dl, serum creatinine 4 mg/dL, and potassium 6.0 mg/dL

Day 3: Urine output 20-25 ml/hr BP 190/120

Physician Order: Stat Hemodialysis with external cannula.

1. What are the possible causes of acute renal failure?

2. JT is in what phase of renal failure?

3. What are the critical nursing assessments indicated when caring for JT?

4. Identify two priority nursing diagnosis for JT.

5. JT wants to know if she is going to be on hemodialysis for the rest of her life. How would you answer this question?

6. Do you believe JT is at risk for depression? Please explain.

Answer 1

What are the possible causes of acute renal failure?

The possible causes of acute renal failure are trauma that causes acute tubular necrosis, elevated serum potassium level which causes decreased extracellular fluid and hypovolemia, transfusion reaction of blood products, damage of the liver due to toxicity.

JT is in what phase of renal failure?

JT urine output is less than 30mL/hr. This indicates that she is in the oliguric phase of renal failure.

What are the critical nursing assessments indicated when caring for JT?

• Monitor the daily weight to know the fluid status.
• Replace the fluid to maintain a positive balance.
• Monitor the serum potassium level.
• Administer medication to control the blood potassium levels.
• Dialysis to remove the excess potassium and toxins from the blood.

Identify two priority nursing diagnosis for JT.

• Altered tissue perfusion related to hypovolemia as evidenced by oliguria.
• Risk for electrolyte imbalance related to hyperkalemia as evidenced by the toxicity of the liver

JT wants to know if she is going to be on hemodialysis for the rest of her life. How would you answer this question?

It depends upon your body responds to the treatment. If everything settles and back to the normal function of kidney there is no need for further dialysis. But in case of the acute condition become chronic then the hemodialysis to be continued in the rest of the life.

Do you believe JT is at risk for depression? Please explain.

Yes. Her clinical condition and hemodialysis increase the risk of depression. She has to be assessed more frequently for angry, depression, fear, harming of herself or having any negative thoughts. Provide health education and counseling to lead the rest of the life more effectively.