Care patients with acute renal failure

Care patients with acute renal failure

1. Care patients with acute renal failure

- Know the clinical assessment, clinical stages of acute renal failure.

- Know the questions can be found the cause.

- Detection of the complications that can occur.

- Prepare and implement plans to take care of one patient with acute renal failure.

2.identified:

2.1. Clinical Commentary:

- Identify abnormalities in patients: in accordance skin, cornea, cost, difficulty breathing, coughing up pink foam, disorders of consciousness, traction, purple, sweating, SpO2 reduced ....

- Consciousness, M, HA, T0, heart rate monitor (known arrhythmias due to hyperkalemia, such as ventricular, tall pointed T waves, ventricular fibrillation)

- Weight former, current relevance.

- Urine / Day: oliguria ≤ 400 ml/24gio, anuria <100 ml/24gio, diabetes more> 3000ml / d, color and nature.

- Symptoms: vomiting, diarrhea, bleeding, abdominal pain, seizures, ...

- Signs suggest reasons: volume, shock, urinary system diseases, causes toxicity (rat, fish density, bee stings, etc.)

- Identify patients with acute renal failure at any stage.

- Nutritional status.

- Renal replacement techniques are being implemented: intermittent hemodialysis, continuous, abdominal membrane filtration.

- Relevant history: medications (antibiotics, agree to, shoot IV contrast, fish density), chemical exposure (heavy metals, chemicals ..), lagged HA, anaphylaxis, urinary tract infections , fibroids, prostate, urinary system stones

2.2. Subclinical Verdict: getting tested for abnormalities.

- Urea, creatinine, potassium, electrolyte disorders on the map.

- CBC: HC, Hb, BC, TC, Hct

- Arterial blood gas

- X-ray lung.

- EKG.

- Tests related causes (toxins, loss of blood, etc.)

3. Care planning:

3.1. In the acute phase: radio, oliguria

- Follow signs of excess volume: edema, weight gain, shortness of breath increased, pink sputum conscious change, CVP increased.

- Detection of hyperkalemia: arrhythmia, sharp high T waves, cardiac arrest.

- Monitor vital signs general: conscious, M, HA, urine, respiratory, heart rate

- Patients on hemodialysis: follow-up in the technical implementation process

- Subscribe to the expression of infection or infectious disease hospital, noted in patients with vascular intervention.

- Nutrition, water and electrolyte for acute renal failure.

- Perform medical doctor's orders.

3.2. During diabetes, diabetes more:

- Weight and balance of water, electrolytes, signs of dehydration, hypotension.

- Electrolyte disturbances: low blood sodium, increased, reduce blood K. Detect hyperkalaemia due to pee more but not concentrated urine.

- Nutrition and diet for patients with acute renal failure.

4. Implementation of the care plan:

4.1 multitude phase, oliguria.

4.1.1. Monitoring vital signs according to the command.

4.1.2. Subscribe signs of excess volume

- Daily weight, gain or lose weight.

- Detection of cerebral edema: consciousness, Glasgow.

- The effect on the heart:

+ Pulmonary edema: dyspnea rose, purple, drag, sweating, bronchial (red), low SpO2.

+ Subscribe to M, HA: increase in the case of excess water, rapid pulse, or vascular collapse, coma.

+ CVP increased.

- The input-output fluid balance:

+ General:

+ Translate + smoking transmits TM + pills.

+ Dining,

+ Total loss:

+ Urine / 24hours

+ Loss of skin, breathing from 0.5 to 0.6 ml / kg / hour, 600-720 ml / day (50 kg)

+ Loss through digestion, the fluid through the tube.

+ Fever: 10C take an additional 13% water

+ Translation from the artificial kidney.

4.1.3. Electrolyte balance, acid-base: clinical and test results.

* Subscriptions:

+ Increased blood potassium, low blood calcium,: on electrolytes or blood gas

+ Metabolic acidosis: the blood gas

+ Disorder breathing, deep breathing, drop in BP, vascular collapse.

* Implementation:

- Limiting potassium in the food and drug supply

- By ordering tests, detecting abnormalities when taking tests ..

- ECG, detection of arrhythmias and high T waves.

- Take a potassium ion-exchange drug as directed, if necessary

- Carry out technical dialysis as directed

4.1.4. Specific diet:

* Subscriptions: body mass index, degree of weight reduction, consistent nutrition, decreased protein, blood albumin.

* Implementation:

- Diets for acute renal failure:

+ Energy from glucide total energy of 30-35 kcal / kg / day (without increased catabolism)

+ Restriction of protein and amino acids: 0.65-1 g / kg / day. Dialysis patients have levels and increased catabolism of 1.2-1.5 g / kg / day

- For mouth, or eat milk, soup through catheters stomach or line TM

- Control of hygiene and nutrition: formula, milk, soup.

4.1.5. Subscribe to the risk of infection:

* Subscribe

- Circuits, central temperature

- The quality of information, the substance in the tube: the unusual nature

* Implementation:

- Monitor the temperature every three hours

- Care Respiratory: tracking secretions, wife shaking, avoid congestion caused by years

- Clinical Monitoring, secretions, the fluid drained if in doubt.

- Implementation of technical care, instead of gas, to the sterile

- Ensure sterile placement needle daily care, detection of infection.

- Comprehensive care of leather and other natural cavities.

4.2. Phase urine.

- Subscribe to the daily HA, HA is lower due to diabetes dehydration.

- Follow-up, assessment of water balance surplus or deficit

- Newspaper in time when fluid balance changes.

- Implementation tracking ordering, daily tests, detection of complications.

- Subscribe to bleeding, infection at the for dialysis catheter location.

- Follow the diet, total calories and protein / kg / day, in blood creatinine descending stage, renal failure and nitrogen balance, increase protein / kg / day.

5. Evaluating patients after CS:

- The vital signs, the period of acute renal failure, complications (electrolyte disorder, full control, respiratory, etc.)?

- Balancing the translation and the signs of excess.

- Nutritional status and diet

- The status of infection.

- The technique is done: Category technical htuat, efficiency, safety, complications ..