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Common Genitourinary

Disease

February 1, 2010

Prepared by Group 56

BSN 4B2-4

Acute and Chronic Renal Failure

Abina, Sheln Kayzl Agravante, Maricel Barrios, Cr istineBenito, Ma. Janelyn Garino, Mell ie Rose Idos, Marie JoyMariano, Efren Marquez, Cristina Nadres, RowenaReyes, Rhey Anthony Santos, Irene Tiffany

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Acute Renal Failure- Is defined as an abrupt or rapid decline

in renal function. A rise in serum

blood urea nitrogen (BUN) or serumcreatinine concentration, with or without a decrement in urine output,is usually evidence of ARF.

-The condition is often transient and

completely reversible.

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3 Main categoriesPRERENAL

INTRARENAL POSTRENAL

DHN AGN BPH

Shock Antibiotics,Aminoglycosides

Prostate Cancer 

Vomiting & Diarrhea Sepsis Bladder Cancer  

Surgery Acute Pyelonephritis Calculi

Cardiac Failure Aneurysms Fecal impaction

Diuretics Cholesterol embolus Urethral strictures

 NSAIDs Allergic response to

radio contrast media

Gynecological cancers

ACE inhibitors Diabetic Nephropathy

Hypotension

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Signs and Symptomsü Generalized swelling (ankle, feet, leg)

ü Excessive urination at night

ü Breath odor 

üLeft ventricular failure

ü High blood pressure

ü Seizures

ü Slow, sluggish movements

ü Anorexia

ü Coma

ü Muscle crampü Epistaxis

ü Persistent hiccups

ü GI hemorrhage

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Diagnostic testsü Urinalysis

ü BUN

ü Serum creatinine

ü Serum potassium

ü Creatinine clearance

ü Kidney ultrasound

ü Abdominal X-ray, CT scan, & MRI

üBlood test

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TreatmentüDiet

üDiuretics

üDialysis

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 Nursing ManagementüMonitoring fluid and electrolyte balance

üReducing metabolic rate thru bed rest

üPromoting pulmonary function

üPreventing infection

üProviding skin care

üProviding support

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Chronic Renal Failure/End-

stage Renal Disease-is a progressive, irreversible,

deterioration in renal function in

which the body’s ability tomaintain metabolic and fluid andelectrolyte balance fails, resulting

in uremia.

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Stages of Chronic Renal

FailureStage 1 Stage 2 Stage 3 Stage 4 Stage 5GFR ≥ 90mL/min/

1.73m2

GFR =60-89

mL/min/1.73m2

GFR =30-59

mL/min/1.73m2

GFR= 15-29

mL/min/1.73m2

GFR <15mL/min/

1.73m2

Kidney

damagewithnormal or incrasedGFR 

Mild

decreasedin GFR 

Moderate

decreasedin GFR 

Severe

decreasedin GFR 

Kidney

failure

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Signs and SymptomsØ Gradual onset

Ø Hypertension

Ø Increased serum phosphate

Ø Decreased serum Ca

Ø Metabolic Acidosis

Ø Generalized edema

Ø Fatigue & drowsiness

Ø Nonspecific changes

Ø Nausea & Vomiting

Ø Anorexia

Ø Wt. Loss

Ø Decreased GFR

Ø Anemia

Ø Pruritus

Ø Altered mental status

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Diagnostic TestsØAbdominal ultrasound

ØGlomerular Filtration Rate

ØCBC

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TreatmentPharmacologic Therapy

 – Phosphate binding agents

 – Calcium supplements – Antihypertensives

 – Cardiac medications

 – Seizure medications

 – Epogen (erythropoietin)DialysisKidney Transplant

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 Nursing ManagementØ Assess fluid status and help patient limit fluid

intake to prescribed limit.

ØAssess nutritional status and address factorscontributing to nutritional imbalance.

Ø Assess the patients understanding about thecondition and treatment , explain renalfunction, and assist patient to identify ways

to incorporate lifestyle changes related toillness and treatment.

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Cont. nursing management

ØAssess factors contributory to fatigue.

ØAssess patient and family’s responseand reaction on illness and

treatment. Encourage opendiscussion of concerns aboutchanges produced by disease andtreatment.

ØMonitor for complication.

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END