ACUTE BIOLOGICAL CRISIS

these are conditions that may result to patient mortality if left unattended in a brief period of time. These are conditions that warrants immediate attention for the reversal of disease process & prevention of further morbidity & mortality.

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Conditions: 1. Cardiac failure & dysrhythmias 2. Respiratory failures & ARDS 3. Renal Failure & ESRD 4. Burns 5. Hepatic coma 6. Diabetic ketoacidosis 7. Thyroid crisis & adrenal crisis 8. Multisystem organ failure & shock

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6/20/2012

ACUTE BIOLOGICAL CRISIS

Ms. Jenneth E. dela Cerna, R.N.3

RENAL FAILURE4

RENAL FAILURE Results when the kidneys are unable to remove the bodys metabolic wastes or perform their regulatory functions. Substances normally eliminated in the urine accumulate in the body.

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ACUTE RENAL FAILUREis a sudden and almost complete loss of kidney function [decreased GFR] over a period of hours to days. Reversible

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Prerenal [hypoprefusion of kidneys] Volume depletion Impaired cardiac performance Vasodilation6

Categories of Acute Renal Failure:

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Intrarenal [actual damage of kidney tissues] Prolonged renal ischemia Nephrotoxic agents Infectious processesPostrenal [obstruction of urine flow] Calculi Tumors BPH Strictures Blood clots

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PHASES OF ACUTE RENAL FAILURE:1.

INITIATION PERIODBegins with the initial insult & ends when oliguria develops.

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PERIOD OF OLIGURIAAccompanied by a rise in serum concentration of substances usually excreted by the kidneys. Appearance of uremic symptoms & hyperkalemia

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PERIOD OF DIURESISGradual increase in urine output Laboratory values stop rising Observed closely for dehydration

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PERIOD OF RECOVERYSignals the improvement of the renal function 3-12 months Normal laboratory values Permanent 1-3% of reduction in GFR

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Clinical manifestations: Oliguria to anuria Edema Dry mucous membrane Uremic fetor & uremic frost Nausea and vomiting Drowsiness, headache, seizures (azotemia) Ill & lethargy Cardiac dysrhythmias Anemia Hypertension Pruritus

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Diagnostic Findings: Urine changes hematuria/proteinuria Hyperkalemia Increased BUN & creatinine level Metabolic acidosis Electrolyte imbalance Anemia ECG changes

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Medical managementDetermine the cause Dialysis may be indicated in severe azotemia Fluid balance diuretic can be prescribe if edema is present. Kayexalate/Insulin/Calcium Gluconate Low dose of dopamine Sodium bicarbonate Aluminum hydroxide High carbohydrate, potassium and sodium restricted diet. Low protein during oliguric phase, high protein during recovery phase12

Nursing management Monitoring Fluid and electrolytes Reducing metabolic rate Promoting pulmonary function Preventing infection Providing skin care

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CHRONIC RENAL FAILUREis a progressive, irreversible deterioration in renal function in which the bodys ability to maintain metabolic and fluid and electrolyte balance fails, resulting to uremia or azotemia. kidney sustain irreversible damage. Fatal without treatmentCAUSES: Diabetes mellitus (leading cause) Hypertension Acute Glomerulonephritis Pyelonephritis Obstruction

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Clinical Manifestations: hypertension edema and pulmonary edema pruritus uremic frost anorexia, nausea and vomiting altered level of consciousness, restlessness seizure creatinine and BUN increase (decreased GFR) metabolic acidosis anemia and bleeding tendencies electrolytes imbalance oliguria to anuria15

Stages of Chronic Renal failure1.

Decrease renal reserve [60-89%] asymptomatic homeostasis Renal insufficiency [30-59%] Renal failure [15-29%] ESRD or End Stage Renal Disease [