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Paediatric Renal Nursing Care

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To outline the definition of acute renal failure linked to basic physiology ... Drugs antacid phosphate binders Vit D. Nursing Considerations (3) ... – PowerPoint PPT presentation

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Title: Paediatric Renal Nursing Care


1
Paediatric Renal Nursing Care Principles of
Treatment
  • Cathy Poole
  • Lecturer Practitioner

2
AIMS
  • To outline the definition of acute renal failure
    linked to basic physiology
  • To define the causes of acute renal failure
  • To discuss the principles of management of
    children with acute renal failure

3
OBJECTIVES
  • At the end of this session you should be able to
  • Discuss the definition and causes of acute renal
    failure
  • Describe the management of children in acute
    renal failure

4
DEFINITIONS OF ARF
  • The syndrome is characterised by a sudden in
    parenchymal function which is usually but not
    always reversible
  • This produces disturbance of water, electrolyte,
    acid base balance and nitrogenous waste products
    blood pressure.

5
PATHOPYSIOLOGY(1)
  • Severe reduction in renal blood flow (RBF)
  • Often occurs despite normal systemic arterial
    pressure
  • This leads to reduced GFR and renal cortical
    blood flow
  • This stimulates renin and aldosterone secretion

6
PATHOPHYSIOLOGY(2)
  • Na and H20 are retained
  • Thus decreasing urinary output

7
Mortality and Morbidity
  • Outcomes of ARF in paeds viewed as potentially
    reversible.
  • Mortality rates lt than those in adults.
  • Mortality is related to the nature of the primary
    disease process as opposed to the renal failure
    itself.

8
(No Transcript)
9
ORIGINS Of ARF
  • Prerenal origins compromise renal perfusion
    leading to a GFR.
  • Intrarenal failure is the result of damage to the
    renal parenchymal cells. (acute tubular necrosis
    ATN)
  • Post renal ARF arises from urine out flow
    obstruction

10
PRERENAL(1)
  • Hypovolaemia
  • Hypotension
  • Hypoxia

11
INTRARENAL(1)
  • GlomerulonephritisSLE
  • Vascular Disorders
  • Tumours
  • Acute Tubular Necrosis (ATN)
  • Acute Interstitial Nephritis
  • Developmental Abnormalities

12
? Pathophysiology of ATN
  • NB. This is not completely understood
  • related events include-
  • induction by hypoxia of nitric oxide synthases
    with increased production of nitric oxide
  • vasoconstriction
  • liberation of toxic endothelial factors
  • tubular obstruction by desquamated cells and
    casts..

13
POST RENAL
  • Obstructive Uropathy
  • Vesico-ureteric Reflux (bilateral)
  • Acquired

14
Investigations in ARF (1)
  • Dipstick Blood protein
  • Microscopy RBC, WBC, casts crystals
  • Culture sensitivity
  • Na, SG/osmolality

15
Investigations in ARF (2)
  • Plasma urea, creatinine, Na, K, Cl, Ca
  • Blood gases
  • FBC Film
  • Ultrasound of abdomen
  • X-ray chest

16
Management of ARF
  • Fluid balance
  • Electrolyte disturbances
  • Acid-base disturbances
  • Drugs
  • Nutrition
  • Family Centred Care..

17
Water Balance emergent care.
  • ? Fluid depletion IV saline 5 ml/kg/bolus
    rapidly, repeated until adequate circulating
    volume
  • ? Fluid overload loop diuretic in escalating
    doses up to max. 10 mg/kg. If unsuccessful,
    dialysis or haemofiltration.

18
Fluid Requirements
  • Insensible losses
  • Preterm30 ml/kg/day
  • Infants 20 ml/kg/day
  • Children15 ml/kg/day
  • Urine output
  • GIT losses
  • Other losses, e.g. 10-14 increase for each 1?C
    fever

19
Prevention is better than cure..
  • Be alert for potential acute renal failure
    related to-
  • Poor systemic perfusion
  • Inadequate renal perfusion

20
Nursing Care
  • Hourly intake / output record
  • output lt1-2 ml/kg/hr
  • ? Catheterise for accuracy
  • ? Repeat samples for osmolality / SG
  • Monitor colour of urine
  • Assess systemic perfusion...

21
  • i.e. Warm skin
  • Strong peripheral pulses
  • Brisk capillary refill
  • Mucous membranes should be pink moist
  • Support cardiovascular function as needed
  • ? Fluid challenge
  • ? Colloid
  • ? Inotropic agents or vasodilators if systemic
    perfusion does not improve

22
  • Digoxin, dobutamine or dopamine
  • Which increase myocardial contraction
  • Tension development relaxation occur fast with
    relatively little increase in O2 demand
  • ? administer diuretic agents

23
Nursing Considerations (1)
  • Potential fluid volume excess related to-
  • Oliguria
  • Excessive fluid administration
  • Sodium water retention

24
Nursing Care
  • Input/output
  • ? Fluid restriction 300ml/m2 BSA/day plus urine
    output
  • Minimise fluid utilisation i.e flushing lines,
    diluting medication
  • Administer diuretics
  • Monitor for signs of hypervolaemia

25
Nursing Considerations (2)
  • Potential electrolyte imbalance related to-
  • Decreased renal potassium excretion
  • Increased renal sodium excretion
  • Decreased renal excretion of phosphate,
    calcium-phosphate precipitation decreased renal
    activation of Vitamin D

26
Nursing Care (a)
  • Monitor UEs
  • Watch K intake
  • Monitor for signs of hyperkalaemia
  • ? Peaked T wave
  • Arrythmias
  • Muscle weakness
  • Action needed to reduce serum K
  • ? dialyse

27
Nursing Care (b)
  • Watch for hyponatraemia
  • change in consciousness
  • muscle cramps
  • anorexia
  • abnormal reflexes
  • Cheyne-stokes respiration
  • or seizures

28
Nursing Care (c)
  • Watch for hypocalcaemia
  • muscle tingling or changes in muscle tone
  • Seizures
  • Tetany
  • ve Chvostek sign ( twitching of side of face
    when the facial nerve is tapped in front of the
    ear)
  • Drugs antacid phosphate binders Vit D

29
Nursing Considerations (3)
  • Potential metabolic acidosis related to-
  • Poor systemic perfusion associated with pre-renal
    failure
  • Decreased renal ability to excrete hydrogen ions

30
Nursing Care (a)
  • Assist with arterial blood gases
  • Administer medication i.e. Na Bicarbonate
  • Reassess serum K

31
Nursing Considerations (4)
  • Potential drug toxicity related to-
  • Reduced renal excretion of drugs or drug
    metabolites

32
Nursing Care (a)
  • Review patients drug doses and administration
    schedule
  • Note clinical signs of toxicity
  • Document report

33
Nursing Considerations (5)
  • Potential for infection related to-
  • Multiple invasive catheters
  • Compromised nutritional intake
  • Poor nutritional status ?

34
Nursing Care (a)
  • Meticulous hand washing by all !!!!!!
  • Adhere to unit policy for all dressing changes
  • Monitor temp WBC
  • Assess all skin puncture sites
  • Swabs, blood cultures urine etc if infection
    suspected
  • Administer antibiotic therapy if prescribed

35
Nursing Considerations (6)
  • Potential pain related to-
  • Multiple invasive catheters treatments
  • Neuropathies associated with electrolyte
    imbalances

36
Nursing Care (a)
  • Assess for evidence of pain using local pain
    assessment tool
  • Assess severity
  • Administer analgesia as prescribed
  • Careful positioning
  • Family support

37
Nursing Consideration (7)
  • Skin integrity, impaired related to-
  • Uraemia
  • Nursing Care-
  • Keep skin warm dry
  • Change patients position frequently
  • Nursing aids ?..

38
Nursing Considerations (8)
  • Nutrition, altered, less than body requirements
  • Nursing Care-
  • Dietetic involvement
  • Record intake
  • Observe restrictions
  • J. Kennedy Renal Disorders

39
Drug Therapies
  • In pairs
  • List the medications commonly used in ARF Rx
  • Feed back

40
Treatment goals
  • Elimination of K
  • Correction of Na imbalance
  • Maintenance of normal calcium Phosphate
  • Correction of metabolic acidosis
  • Maintain Bp
  • Treat convulsions
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