Nursing Emergencies: Renal Failure Lecture Notes

Introduction

• Presenter: David Woodruff
• Topic: Renal Failure in Nursing Emergencies
• Objective: Make complex topics like renal failure easy to understand

Risks for Renal Dysfunction

• Age: Very young and very old are at higher risk due to weaker immune responses
• Shock: Can damage renal structures
• Vasopressors: Cause vasoconstriction, reducing kidney perfusion
• Volume Depletion & Nephrotoxic Drugs: Direct damage to nephrons
• Diabetes & Hypertension: Long-term damage leading to scarring and dysfunction

Types of Renal Failure

• Acute vs. Chronic Renal Failure: Chronic often results from untreated acute renal failure
• Intra-renal: Damage to the nephron itself
• Pre-renal: Reduced blood flow to kidneys (e.g., hypovolemic shock, renal artery issues)
• Post-renal: Urinary obstruction causing backup and pressure on kidneys

Phases of Renal Failure

Oliguric Phase

• Symptoms: Decreased urine output, nausea, vomiting, decreased consciousness, GI bleeding
• Electrolyte Imbalances: Increase in potassium, acidosis, hypervolemia
• Treatments: Dialysis, fluid restrictions, renal diet

Diuretic Phase

• Signs: Increase in urine output indicating kidney recovery
• Issues: Inability to concentrate urine or filter wastes, potential hypokalemia
• Treatment: Continue dialysis, possibly replace fluids and electrolytes

Course of Renal Failure

• Initiation Phase: Sudden increase in BUN and creatinine
• Maintenance Phase: High BUN and creatinine
• Recovery Phase: Diuretic phase, gradual normalization of BUN and creatinine

Chronic Renal Failure Stages

Decreased Renal Reserve

• Symptoms: Increase in BUN and creatinine, asymptomatic
• Intervention: May not be needed unless additional kidney stress occurs

Renal Insufficiency

• Symptoms: Asymptomatic increase in BUN and creatinine
• Intervention: Lifestyle changes

Renal Failure

• Symptoms: Symptomatic BUN and creatinine increase
• Intervention: Possibly intermittent dialysis or CRRT

End-Stage Renal Disease

• Treatment: Chronic hemodialysis
• Risks: Bleeding, cardiovascular issues, hypotension

Hemodialysis vs. Continuous Renal Replacement Therapy (CRRT)

• Hemodialysis: Rapid waste removal, requires vascular access, systemic heparinization
• CRRT: More gentle, continual process, used in ICU, systemic heparinization

Key Takeaways

• Recognition: Acute renal failure requires significant damage before symptoms
• Monitoring: Watch for changes in GFR and subtle renal function changes
• Role of Dialysis: Protect kidneys and remove waste
• Adaptive Response: Healthy nephrons can hypertrophy to maintain function

Conclusion: Understanding and early detection of renal dysfunction are crucial in managing nursing emergencies related to renal failure.