Question

Case Study Chapter 26, Acute Renal Failure and Chronic Kidney Disease A nurse is caring for an 80-year-old patient who was admitted to the hospital with a diagnosis of dehydration The patient stated he had been vomiting for 2 days and had been unable to take food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On physical examination, the nurse notes the patient's skin is dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient's urine is dark amber with a specific gravity of 1.028. His urine output was 30 cc/hour for the past 4 hours since admission. When reviewing the patient's laboratory results the nurse notes the BUN is 60 and a creatinine of 1.2. What type of renal failure is most often seen with dehydration? 2. What signs and symptoms noted by the nurse are characteristic of renal failure? If the blood pressure continued to drop in this patient and the patient developed acute tubular necrosis, what would happen to the kidney tubule? What are the three phases of acute tubular necrosis? Identify two important nursing interventions for each phase.

Answer 1

1. Acute kidney injury is the most often seen in patients with dehydration .It is defined as a sudden irreversible damage done to kidney due to various reasons .It is also known as ARF.It is a potential life threatening problem.It may be proved fatal to the patients .It is common to all those who have hospitalised in the hospital for care .It is a condition were the kidneys are not able to perform the filter of the waste from the blood .There are tree major categories of ARF. They are 1. Pre-renal 2. Intra -renal 3.Post Renal .It is the impaired blood flow that leads to hypo-perfusion of the kidney and a decrease in Glomerular Filtration rate  .
2. Signs and symptoms of renal failure : includes

• The patient may appear to be critically
• ILL and lethargic
• Mucous membranes are dry from dehydration
• Skin is having decreased turgor and Dry
• Presence of hypotension since Blood pressure is 90/60 mmHg
• Decreased Urine output

3. If the blood pressure continues to drop the kidney tubule will be affected badly which leads to irreversible loss of kidney function and acute tubular necrosis .It is a condition where injury is caused to the kidney tubule which fails to absorb the minerals and fluid from urine .As a result of low blood pressure there is damage to the whole body functions and also will lead to infection throughout the body.

4.Three phases of acute tubular necrosis are

• Prodromal phase - Injury has occurred ,There will be decreased urine output and increased in Blood urea Nitrogen (BUN) and Creatinine .Nursing Intervention will monitoring of the Intake output chart hourly and Sending the blood sample for the lab to find out the results of BUN & SR.Creatinine .
• Oliguric phase - It presents with oliguria ,Volume overload, Hyperkalemia ,Azotemia and metabolic acidosis .Nursing intervention will be Continous monitoring of the blood pressure and Administering the IV fluids to replace the minerals that are lost and to check the Edema present .
• Post oliguric phase - There will be fluid volume deficit and the lab results began to normalise .Nursing Intervention will be Fluid and electrolyte balance and providing skin care to prevent skin breakdown .