Renal Failure as Emergency Situation

Emergency Situation and Specific Criteria: Renal

Acute kidney failure (AKF) is one of the scenarios that require immediate assistance. Seeing that the factors causing kidney failure are very numerous, it is crucial to diagnose the problem in a manner as accurate as possible; otherwise, the patient’s life may be in danger. For instance, renal may occur due to dehydration, disruption in blood flow, etc. (Papadakis, McPhee, & Rabow, 2014). Furthermore, when diagnosing the issue, one must keep in mind that the following characteristics are typically viewed as criteria of AKF:

• At least a threefold increase in creatinine levels (or creatinine ≥4 mg/dL);
• Urine output <0.3 mL/kg/h (× 24 h or Anuria × 12 h).

The lower the UO levels are, the greater the threat to the patient’s health is (Sharifipour et al., 2013).

Patient Signs, Symptoms, and Pathophysiology

When considering the signs and symptoms of AKF, one must bear in mind that swelling resulting from water retention combined with a reduced urine output are typically viewed as the primary indicators of the problem. The rest of the symptoms, such as fatigue, nausea, drowsiness, shortness of breath, etc., are also characteristic of AKF, yet the former two should be identified to make sure that the patient suffers from AKF (Carrero et al., 2013). Furthermore, the victim of AKF will exhibit the following symptoms:

• Digital ischemia;
• Maculopapular rash;
• Jaundice;
• Hypertension;
• Signs of Diabetes mellitus;
• Hearing loss;
• Irregular cardiorhythms;
• Pulsatile mass in the abdomen, etc. (Medscape, 2017b).

As far as the pathophysiology of the disease is concerned, a drop in the glomerular filtration rate (GFR) is expected. The reason for the identified phenomenon to occur is that changes in the glomerular pressure levels hinge on the renal blood flow (RBF). Therefore, once obstructed, it triggers a decrease in GFR levels. The identified issue also reduces the filtration driving force (Medscape, 2017a).

Determining the Patient’s Final Diagnosis: Steps and Rationale

To produce a final diagnosis and state whether the patient has AKF, a nurse must run several tests. First, the urine output levels must be evaluated. Afterward, a urine test will have to be carried out so that the abnormalities that are typical of kidney failure could be determined.

Taking blood tests is the next step toward identifying the problem and making sure that the diagnosis is correct. Particularly, the test results may reveal that the patient has unusually high levels of urea or creatinine in the blood. Seeing that both are viewed as markers for the presence of renal issues, particularly, AKF, it will be essential to test the patient’s blood for the identified elements.

Imaging tests are also viewed as a possible tool for determining AKF. Ultrasound may serve as the foundation for locating the issue. Similarly, a tomography may become the means of proving the presence of AKF.

Finally, the significance of taking a sample of the kidney tissue needs to be mentioned. The biopsy will show whether the patient has AKF or not. Particularly, the renal biopsy will help make a histological diagnosis (Leaf et al., 2016).

The reasons for the identified steps to be taken are quite simple. Since most of the AKF symptoms are characteristic of other diseases as well, it is crucial to make sure that no mistake has been made. Thus, it is essential to run several tests including taking the blood sample, carrying out the urine test, etc.

Specialists and Ancillary Staff: Identification and Rationale

To meet the needs of patients with AKF, one will have to consider offering the services of a nephrologist. The latter addresses kidney-related disorders and determines the treatment type. The assistance of nurses will also be crucial (Stern, Cifu, & Altkorn, 2015).

Plan of Care: Clinical Guidelines Discussion

Either peritoneal dialysis or hemodialysis must be viewed as a necessity to create the environment in which the patient will feel comfortable. It should be noted that hemodialysis is typically viewed as extremely exhausting, yet peritoneal dialysis poses a threat to the patient’s well-being since it exposes them to infections.

Advanced Practice Procedures: Definition and Rationale

The use of the traditional hemodynamic monitoring strategy should be viewed as the foundation for observing the patient’s progress. However, it will also be crucial to use a digital remote monitoring tool to reduce the risks. As a result, the threat of an infection or a similar issue will be prevented.

Evidence-Based Care Plan: Steps

1. Assessment: running blood tests, urine tests, and (if needed) a biopsy.
2. Expected outcomes: a significant drop in urine levels in the patient’s blood.
3. Nursing interventions: regular dialysis procedures, pain control assessment, maintenance of patient-controlled analgesia.
4. Rationale: the necessity to reduce the water retention rates and the pressure on kidneys.
5. Evaluation: urine tests and blood tests.

The reasons for adopting the strategy mentioned above are quite basic. First, it is necessary to identify the problem and the desirable results, which the first two steps offer. Next, the suggested interventions must be carried out with a substantial reason behind them in accordance with the existing guidelines, as in steps three and four. Finally, the assessment of the intervention and its effects will have to be conducted to make sure that the current outcomes meet the expected ones.

References

Carrero, J. J., Stenvinkel, P., Cuppari, L., Ikizler, T. A., Kalantar-Zadeh, K., Kaysen, G.,… Franch, H. A. (2013). Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). Journal of Renal Nutrition, 23(2), 77-90.

Leaf, D. E., Srivastava, A., Zeng, X., McMahon, G. M., Croy, H. E., Mendu, M. L. … & Waikar, S. S. (2016). Excessive diagnostic testing in acute kidney injury. BMC Nephrology, 17(1), 9.

Medscape. (2017a). Acute kidney injury: Pathophysiology. Web.

Medscape. (2017b). Acute kidney injury: Practice essentials. Web.

Papadakis, M., McPhee, S. J., & Rabow, M. W. (2014). Current medical diagnosis and treatment: 2015 (54th ed.). New York, NY: McGraw-Hill.

Sharifipour, F., Hami, M., Naghibi, M., Zeraati, A. A., Arian, S., & Azarian, A. A. (2013). RIFLE criteria for acute kidney injury in the intensive care units. Journal of Research in Medical Sciences, 18(5), 18(5), 435-437.

Stern, S. D. C., Cifu, A. S., & Altkorn, D. (2015). Symptom to diagnosis: An evidence-based guide (3rd ed.). New York, NY: McGraw-Hill Education.