Introduction

A.
Acute renal failure (ARF) refers to the abrupt loss of kidney function. Over a period of hours to a few days, the glomerular filtration rate (GFR) falls, accompanied by concomitant rise in serum creatinine and urea nitrogen. A healthy adult eating a normal diet needs a minimum daily urine output of approximately 400 ml to excrete the bodys waste products through the kidneys. An amount lower than this indicates a decreased GFR. The numerous causes of acute kidney injury are commonly categorized into prerenal, intrinsic, and postrenal. Prerenal causes of AKI are those that decrease effective blood flow to the kidney. Sources of damage to the kidney itself are dubbed intrinsic. Postrenal AKI is a consequence of urinary tract obstruction Acute renal failure may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects to other organ systems. Management includes supportive care, such as renal replacement therapy, as well as treatment of the underlying disorder. Acute renal failure is common among hospitalized patients. It affects some 3-7% of patients admitted to the hospital, 2% to 5% during the hospital stay, 4% to 15% after cardiopulmonary bypass surgery, 10% of cases occurs in isolation, and approximately 25-30% of patients in the intensive care unit. In world statistics, the United States is the top one with the most deaths resulting from renal failure. In the Philippines, renal failure is the 9th top cause of death in the country. Nationwide, there are 8,708 patients who started their therapy in 2009, according to the Philippine Renal Registry in connection with the Department of Health (DOH). Depending on the cause, a proportion of patients will never regain full renal function, thus having end-stage renal failure requiring lifelong dialysis or a kidney transplant. Renal replacement therapy, such as with hemodialysis, may be instituted in some cases of ARF. A systematic review of the literature in 2008 demonstrated no difference in outcomes between the use of intermittent hemodialysis and continuous venovenous hemofiltration (CVVH). Among critically ill patients, intensive renal replacement therapy with CVVH does not appear to improve outcomes compared to less intensive intermittent hemodialysis.

B. Reason for choosing such Case Study

We chose Acute Renal Failure as our case study because it is a critical condition that need immediate interventions. It is relevant to the topics in our present course critical and emergency nursing; considering all of these things, it became a great opportunity for us do such case study. By this, we will be able to acquire more knowledge which may be applicable for times to come.

C. Objectives

 General Objective: This case study aim towards familiarizing and developing effective nursing approach to patients with Acute Renal Failure through the study of the patient's health history, the disease process, and appropriate medical and nursing management. Specific Objectives: Student Centered: To perform and present a thorough health assessment utilizing Nursing Health History, Gordon's Typology of Functional Patterns and Physical Assessment. To discuss the Anatomy and Physiology of the system affected, the Pathophysiology of the disease process, identifiable precipitating factors, its signs and symptoms, and possible complications. To gain knowledge about the client's medications and be familiarize with it. To formulate a workable Nursing Care Plan based on the subjective and objective cues gathered. To impart knowledge to the client through Health Teaching. Client Centered: To develop related learning skills and apply them effectively in the clinical area. To apply appropriate nursing interventions appropriate for a patient with sepsis. To apply and practice critical thinking skills essential to the clients condition.

PATHOPHYSIOLOGY

Modifiable Factors: Exposure to infection Meningitis

Non-modifiable Factors: Age Gender

Injury to the Brain

Acquired Cerebral Palsy

Vesicoureteral reflux-Tubular back leak

Urinary Retention

Infection

Ischemia

Carsolemmal Calcium Permeability

 Calcium-calmodulin activation of myosin light chain kinase

Hypersensitivity to renal nerve stimulation

constriction of glomerular afferent arterioles and mesangial cells

renal vascular resistance

Glomerular capillary surface area and permeability

Loss of renal autoregulation

Oliguria

Glomerular filtration rate Intermittent cell injury and tubular debris

Tubular obstruction
Acute renal failure erthropoetin production

Water Retention

Accumulation of waste products in the blood Pruritus

Edema
Creatinine, BUN

Anemia

Fatigue