Pathologic Conditions
- Definition: Failure of kidneys to perform essential functions.
- Pathophysiology: Renal hypoperfusion results in changes in the glomerular-capsular membrane permeability, causing interference with normal glomerular filtration and resulting in inability of the kidneys to perform normal functions, including excretion of toxins, fluids, electrolytes, and hydrogen ions (may be acute or chronic).
- Etiology: Decreased cardiac output, renal obstruction, trauma, inflammatory/immunologic factors, chemical or bacterial toxins, tubular necrosis, severe dehydration.
- Manifestations: Oliguria (decreased urine production), abnormal UA, signs of dehydration or edema (depending on stage), weight gain, elevated BP, elevated CVP, tachycardia, BUN: Creatine ratio >10:1, electrolyte abnormalities, serum K+ grossly elevated, blood pH <7.35, anemia, mental changes, failure to respond to fluid bolus and/or diuretics.
- Med Tx: Hemodialysis or peritoneal dialysis, glucose and insulin to drive K+ into cells or Kayexelate enema to remove K+ via the GI tract, antihypertensives, fluid and nutritional restrictions, renal transplant in chronic cases.
- Nsg Dx: Fluid volume deficit or excess, altered nutrition, potential for infection, altered thought processes and resultant potential for injury, knowledge deficit, fear.
- Nsg Care: Maintain strict compliance with I&O monitoring. Make frequent VS and neuro checks. Assess weight daily. Assist with and monitor response to medical regimen. Educate patient and family. Monitor lab values. Encourage patient to express fears.
- Prognosis: Varies greatly with cause, age, promptness of diagnosis, coexisting problems and complications, treatment, and compliance with treatment regimen.