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1、CriticalCareNursing AHolisticApproach Part6AnatomyandPhysiologyoftheRenalSystemChapter28HormonesAntidiureticReninhormoneAldosteroneCalcitriolErythropoietinFunctionsoftheRenalSystemRenalclearanceRegulationElectrolyteconcentrationPatientAssessment: RenalSystemChapter29HistoryOtherdisease
2、sthatcontributetorenalfailureDiabetesmellitusSystemiclupuserythematosusHypertensionSickle-cellanemiaOthercausesofrenalinjuryRecentillnessincludingsurgeryorinfectionExposuretonephrotoxicagentsAssessmentofCostovertebralAnglesSiteofRenalBruitsDiagnosticTestsUrinalysisCreatinineandcreatini
3、neclearanceBloodureanitrogen(BUN)OsmolalityRadiologicalstudiesRenalbiopsyRenalangiogramAssessmentofFluidBalanceDailyweightIntakeandoutputLabstudiesHemodynamicmonitoringPatientManagement: RenalSystemChapter30PatientAccessVascularcatheterA-VfistulaSyntheticvasculargraftHemodialysisRemove
4、surea,creatinine,anduricacidRemovesexcesswaterRestoresthebodybuffersystemMaintainsappropriatelevelsofelectrolytesComplicationsofDialysisDysequilibrium–RemovalofuricacidtooquicklyHypovolemiaHypotension/HypertensionMusclecramps–RemovaloffluidtooquicklyDysrhythmiasAnginaContinuousRenalRep
5、lacementTherapies(CRRT)SimilartohemodialysisRemoveswasteproductslowlyRequiresmoretimeUsedwhenuricacidneedstobeaggressivelymanagedPeritonealDialysisTheperitoneumisusedasthesemipermeablemembraneOsmosisisusedtoremovefluidPeritonealcatheterisplacedinsurgeryUsedforpatientswhodonotlivecloset
6、oadialysiscenterPeritonealDialysisAdvantagesLesscomplicatedequipmentandsuppliesLessadverseeffectsbecausefluidandelectrolytechangeisslowerDisadvantagesRequiresmoretimePeritonitisRenalFailureChapter31CausesofAcuteRenalFailurePrerenalPhysiologicaleventcausinghypoperfusionIntrarenalAcuteda
7、magetorenalparenchymaPostrenalObstructiontoflowofurineoutofthekidneyChronicRenalFailureSlow,progressive,irreversibleProgressivedestructionofnephronsDiabetesmellitusandhypertensionarethemostcommoncausesMorecommoninAfricanAmericans,Hispanics,andNativeAmericansChronicRenalFailureSlowthe
