Acute renal failure - Essay Example

Running head: ACUTE RENAL FAILURE Acute Renal Failure Affiliation Table of Contents Oliguria 3 Signs and Symptoms 3 Diagnostic Tests 4 To ascertain the presence of acute renal failure in patients, the following diagnostic tests are required: Blood tests that include "CBC, blood urea nitrogen (BUN), creatinine, electrolytes (including Ca and PO4); Urine tests include Na and creatinine concentration and microscopic analysis of sediment; acidosis, hyperkalemia, hyponatremia, and anemia." (Merck Manuals, 2005) The physician may also order an ultrasound scan to determine the degree of obstruction or damage to the kidneys. 4 Medical Intervention 5 Nursing Care Plans 6 Nursing Diagnosis: Excess Fluid Volume: related to acute renal failure 6 Nursing Diagnosis: Risk for impaired skin Integrity: related to oedema 6 Nursing Diagnosis: Risk for impaired gas exchange: related to pulmonary congestion 7 Nursing Diagnosis: Activity Intolerance: related to fluid volume excess, fatigue, and weakness. 8 In-Patient Pharmacological Treatment 8 References 9 Acute Renal Failure Oliguria Oliguria or the reduced urine output may occur in postrenal or intrinsic renal acute causes. The case did not state whether Mrs. Rainer was diagnosed with postrenal or intrinsic renal cause. In any case, there are several possibilities associated with oliguria. In postrenal causes, a probable cause of oliguria comes from an obstructed urinary tract. The obstructed urinary tract could be caused by "1) a blocked urethral catheter; 2) calculi/blood clot in single kidney; or 3) pelvic malignancy" (Cumming, n.d.). In intrinsic renal causes, the most common occurrences of oliguria are in acute tubular necrosis (ATN). There are two principal types of ATN: Ischaemic tubular necrosis and Nephrotoxic ATN (Cumming, n.d.) With Ischaemic tubular necrosis, "the renal blood flow is below 20% the normal level and the endothelial cells of glomerular and peritubular capillaries are swollen and oedema of the interstitium." (Cumming, n.d.) In Nephrotic ATN, the same condition holds except the sequence of deterioration was initiated by toxicity of the causative agent (drugs) to tubular cells like "aminoglycoside antibiotics, pentamidine, acyclovir, paracetamol, amphotericin, cisplatin, and cyclosporin." (Cumming, n.d.) Signs and Symptoms The signs and symptoms of oliguria is also present in prerenal causes. However, after discounting prerenal causes as the probable cause, the postrenal causes could be determined next. After the patient has been voided, a "urethral catheter is placed or a bedside ultrasound is used to determine the residual urine in the bladder." (Merck Manuals, 2005) If the postvoiding urine residue registers a ">200 ml urine output, this suggests bladder obstruction." (Merck Manuals, 2005) Other clues to probable cause of oliguria could be obtained from urinary sediment. If injury to renal tubes is suspected, the sample would contain "tubular cells, tubular cell casts, and many brown pigmented granular casts." (Merck Manuals, 2005) In general, oliguria is present if urine output " Read More