ACUTE RENAL FAILURE CASE STUDY #1 .ppt

ACUTE RENAL FAILURE: CASE STUDY #1 ? QUESTIONS FOR DISCUSSION? Answers to #1 1. What are the possible causes of acute tubular necrosis that Joyce developed? Trauma= hyperkalemia (inc. K+ in main intracellular fluid) Transfusion reaction Hypovolemia Toxicity in the liver 2. What clinical indicators that Joyce has in the oliguric phase of acure renal failure? Decrease urine output 30 cc/hr 3. What are the critical nursing assessments indicated when caring for Joyce? Replace fluid by: 10 = 240 cc/24 hrs. 20 = 480 cc/24 hrs. 24 hr urine output + 500 cc (insensible loss) = 740 cc fluid replacement Monitor daily weights (weight is a good evaluator of fluid status) 4. What are the priority nursing diagnosis for Joyce? FVE, FVD, Altered tissue perfusion, High risk for bleeding, Toxicity r/t hyperkalemia, Pain, Impaired gas exchange, Ineffective airway clearance r/t increase sputum secretions. Answers to #1 5. How could you assist Joyce in dealing with her depression? Need psych consult, ask patient if she has suicidal ideation (plan of hurting herself), need frequent checks. 6. What are the usual indications for using hemodialysis in the management of acute renal failure? Decrease creatinine clearance, hyperkalemia, transfusion reaction . 7. Joyce wants to know if she is going to be on hemodialysis for the rest of her life. How would you answer this question? Be honest with the patient. “We don’t know.” (Acute condition can become chronic) 8. What is the nursing care of the external cannula when not in use? It’s a large catheter and big vessel watch for bleeding, maintain sterile technique when changing dressing ( Q3rd day), watch for S/Sx of infection ( errythema, drainage,fever) 9. What is the goal of medical and nursing management of this patient? Maintain fluid balance and maintain perfusion. Goal: to stop and reverse ARF Focus: