Major Kidney Ouch | Acute Renal Failure Sucks |Case Study and Laboratory Findings and Care of Patient With Urinary System Diseases

Recent Major Testing Laboratory and Clinical findings associated with acute renal failure follows this line of sequence; clinical problem, mechanism and then clinical considerations. Good laboratory findings, lead to a fast and effective and proper/good diagnosis which should of course result to a proper care, depending on the Kidney pathology as well as its magnitude.

Nitrogenemia Elevated BUN levels  
Mechanism- Ongoing protein catabolism and significantly decreased excretion. When these are confirmed, the possible clinical considerations are, Lower rate of production in neonates and person with depleted protein stores. Increased in situations involving large amounts of necrotic tissue or extravasated blood.

Elevated plasma creatinine levels  
Mechanism- Continued production and significantly decreased excretion. Clinical considerations are; production is less affected by other factors. More sensitive measure of intensity of azotemia. Low in neo nate because of small muscle mass relative to size.

Metabolic acidosis 
Mechanism- Continued endogenous acid production. Significantly decreased excretion. Depletion of extracellular and intracellular fluid buffers. Clinical considerations could be compensatory hyperventilation, opisthotonos and major threat to Life.

Hyponatremia 
Mechanism- Dilution of extracellular fluid. Decreased excretion of water. Clinical consideration- may develop cerebral signs.

Hyperkalemia 
Mechanism-Ongoing protein catabolism. Decreased excretion compounded by metabolic acidosis. Clinical consideration - Most important electrolyte to be considered in acute renal failure. May contribute to cardiac arrhythmia, With ECG changes, major threat to Life. Maybe lost from gastrointestinal tract.

Hypocalcemia 
Mechanism- Associated with metabolic acidosis and hyperphosphatemia. Clinical consideration- During alkali therapy, may cause tetany.

It is very important to know the peculiarities of nursing the child with kidney disorders because any mistake can lead to development of renal failure, which is one of the most dangerous conditions.

Nursing care plan includes accurate measurement and record of fluid intake and output, daily weighting, measuring blood pressure, collecting specimen for laboratory examinations, administration of prescribed medicines (antibiotics, diuretics, steroids, etc), strict control for the diet (provide restriction of sodium, proteins, water, administer supplementary vitamins and iron as ordered) and balance of rest and activity (maintain bed rest initially if severely edematous). In severe cases, careful monitoring of blood pressure, pulse and respiration and neurologic function is needed as well as assisting with hemodialysis or peritoneal dialysis.

Control edema 
1. Weigh daily, measure abdominal girth at umbilicus 
2. Measure accuracy intake and output 
3. Test Urine for specific gravity, albumins 
4. Take blood pressure 
5. Prevent skin breakdown; provide meticulous skin care, cleanse and powder opposing skin surfaces several times daily, separate skin surfaces with soft cotton, support edematous organs, such as scrotum, cleanse edematous eyelids with warm saline wipes

Prevent further edema formation  
1. Provide salt-restricted diet 
2. Limit fluids if ordered.  
3. Administer diuretics and/or steroids if prescribed

Establish good nutrition  
1. Administer high-protein, high carbonate diet (restrict sodium during edema) 
2. Administer supplementary vitamins and iron as ordered.

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