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Critical Care Nursing A Holistic Approach Part 6.

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Presentation on theme: "Critical Care Nursing A Holistic Approach Part 6."— Presentation transcript:

1 Critical Care Nursing A Holistic Approach Part 6

2 Anatomy and Physiology of the Renal System Chapter 28

3 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

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10 Hormones Antidiuretic Renin hormone Aldosterone Calcitriol Erythropoietin

11 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Functions of the Renal System Renal clearance Regulation –Electrolyte concentration

12 Patient Assessment: Renal System Chapter 29

13 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. History Other diseases that contribute to renal failure –Diabetes mellitus –Systemic lupus erythematosus –Hypertension –Sickle-cell anemia Other causes of renal injury –Recent illness including surgery or infection –Exposure to nephrotoxic agents

14 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Assessment of Costovertebral Angles

15 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Site of Renal Bruits

16 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Diagnostic Tests Urinalysis Creatinine and creatinine clearance Blood urea nitrogen (BUN) Osmolality Radiological studies Renal biopsy Renal angiogram

17 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Assessment of Fluid Balance Daily weight Intake and output Lab studies Hemodynamic monitoring

18 Patient Management: Renal System Chapter 30

19 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Patient Access Vascular catheter A-V fistula Synthetic vascular graft

20 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Hemodialysis Removes urea, creatinine, and uric acid Removes excess water Restores the body buffer system Maintains appropriate levels of electrolytes

21 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

22 Complications of Dialysis Dysequilibrium – Removal of uric acid too quickly Hypovolemia Hypotension/Hypertension Muscle cramps – Removal of fluid too quickly Dysrhythmias Angina

23 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Continuous Renal Replacement Therapies (CRRT) Similar to hemodialysis Removes waste product slowly Requires more time Used when uric acid needs to be aggressively managed

24 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Peritoneal Dialysis The peritoneum is used as the semipermeable membrane Osmosis is used to remove fluid Peritoneal catheter is placed in surgery Used for patients who do not live close to a dialysis center

25 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Peritoneal Dialysis Advantages –Less complicated equipment and supplies –Less adverse effects because fluid and electrolyte change is slower Disadvantages –Requires more time –Peritonitis

26 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

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28 Renal Failure Chapter 31

29 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Causes of Acute Renal Failure Prerenal –Physiological event causing hypoperfusion Intrarenal –Acute damage to renal parenchyma Postrenal –Obstruction to flow of urine out of the kidney

30 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

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33 Chronic Renal Failure Slow, progressive, irreversible Progressive destruction of nephrons Diabetes mellitus and hypertension are the most common causes More common in African Americans, Hispanics, and Native Americans

34 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition. Chronic Renal Failure Slow the rate of nephron damage –Avoid nephrotoxins Aminoglycosides IV contrast agents –Strict blood glucose control –Reduction in hyperlipidemia –Control of hypertension Use of ACE inhibitors

35 Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

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