Urinary system: Renal failure

Renal failure happens when the kidneys don’t function at all or function at a low capacity, meaning that they are unable to filter blood properly.

As a result, a lot of waste products along with fluid build up in the body, affecting other organs in the body including the heart.

In kidney failure, the individual can become very sick very quickly, especially if treatment is delayed.There are two types of renal failure: acute and chronic.

Acute renal failure, or acute kidney injury, happens when there’s a sudden loss of kidney function. One cause of acute kidney injury is when there’s a decreased blood flow to the kidneys, which can happen in the case of bleeding, severe diarrhea, or burns.

Other causes of acute kidney injury include severe infections; severe allergic reactions; poisoning with substances, like antifreeze; or ingesting certain medications that can damage the kidneys, such as large quantities of nonsteroidal anti-inflammatories, like Ibuprofen.

Chronic kidney failure, or chronic kidney disease, happens when there’s a progressive decrease in kidney function, meaning that the number of functioning nephrons are gradually lost.

Common causes of chronic kidney disease are diabetes mellitus and hypertension. Both these conditions damage the blood vessels in the glomerulus.

Other causes include chronic infections, such as chronic pyelonephritis; infection of the kidneys; or blockage in the urinary system, like when there’s a large kidney stone or tumor.

One of the signs of renal failure is dehydration, which happens due to excessive loss of fluid. This usually happens pretty early in acute kidney injuries because the kidneys aren’t able to reabsorb water back into the bloodstream.

Another sign is swelling, caused by the build-up of fluid in the tissues of the body. This usually happens later in chronic kidney disease, when the kidneys aren’t able to excrete the excess fluid.

Another sign is hypertension, which happens mostly due to fluid overload in the bloodstream. Finally, there’s oliguria or anuria.

Oliguria is when an individual urinates less than 400 milliliters in 24 hours, and anuria is when someone urinates less than 100 milliliters, or no urine in 24 hours.

Now, keep in mind that renal failure, especially chronic kidney disease, can affect every body system, so other signs and symptoms can include nausea, vomiting, loss of appetite, fatigue, weakness, sleep problems, decreased mental alertness, muscle cramps, itchy skin, chest pain, and shortness of breath.

Individuals suffering from kidney failure often need dialysis to survive. Dialysis is the process through which waste products and fluids are removed from the body.

Basically, dialysis takes over the kidney’s job. An individual with acute kidney injury may temporarily need dialysis until their kidneys recover from the injury and start functioning normally.However, an individual with severe chronic kidney disease must remain on dialysis for a long period of time or until they can have a kidney transplant.

There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, there’s a machine that contains filters and solutions that are able to clean the blood of waste products and remove excess fluid.

The machine used in hemodialysis is sometimes called an artificial kidney. In order for it to work, the individual’s blood is drawn intravenously, passed through the machine, and then returned to the person’s body through another vessel.

To make this process easier, an individual receiving long-term hemodialysis usually needs surgery to create a fistula to connect an artery directly to a nearby vein.

Another option is a surgical graft, where a tube is used to connect the two vessels. Either way, blood will flow from the artery into the vein, causing it to expand and bulge and making it easier to access.

The increased blood flow will also make the dialysis process quicker. In peritoneal dialysis, the peritoneal membrane, a membrane that lines the peritoneal cavity, is used as a filter to remove excess fluid and waste products.

In order to do so, a solution that can absorb waste products is placed into a person’s abdomen through a tube that’s been surgically inserted.

In order for the solution to work and absorb waste products, it has to remain in the abdominal cavity for a specific period of time.

Afterwards, this solution is drained into a collecting bag and then discarded. In order to keep waste products and excess fluid away, both types of dialysis must be performed several times a week for a certain period of time.

Hemodialysis usually lasts for 4 hours. Individuals with chronic kidney disease need it at least 3 times per week, and it’s usually done at a healthcare center designed to perform this service.

Peritoneal dialysis is usually done 4 times a day, every 6 hours for about 30 minutes, and usually the individual is trained to do it at home.

However, as a nursing assistant, you might be asked to monitor vital signs frequently after your client has undergone dialysis.

In order to offer the best care for an individual with renal failure, there are some guidelines you need to follow. First, you need to carefully monitor an individual’s urine output and provide accurate information.

That’s because the physician can use this information to get an idea about how well the individual’s kidneys are working.

Second, you’ll assist with collecting urine samples as needed. That’s because urine analysis is also important for knowing how well the kidneys are functioning.

Third, you need to monitor fluid intake as well as food intake. That’s because when a person has renal failure, the healthcare provider will want to prescribe a diet that’s more compatible with the client’s kidney function, like one with reduced fluid, salt and protein intake.

Fourth, you will be monitoring vital signs according to the individual’s care plan and report any changes to the nurse. That’s because after dialysis, there can be changes in fluid balance, which can influence an individual’s blood pressure.

Fifth, you must be very careful when measuring the blood pressure of an individual on dialysis treatment. The recommendation is that blood pressure should never be taken on the arm that has a fistula or a graft.

That’s because pressure on the arm with the fistula or graft can lead to decreased blood flow, which can further lead to clots, making the fistula or graft unusable.

So, make sure to always check for fistulas, grafts, or shunts before taking the blood pressure. Sixth, you need to provide frequent skin care in order to prevent skin irritation and itching, which can be caused by the failing kidneys.

Seventh, when you assist a person on peritoneal dialysis with bathing or dressing, you need to be extra careful to not dislodge the tube used for peritoneal dialysis.

That’s because if the tube is accidentally dislodged, it needs to be reinserted for the dialysis to work. Finally, you might need to help the individual with impaired mobility with repositioning or exercise to prevent complication of immobility.

Now, keep in mind that there are some situations when you immediately need to inform the nurse. One of these situations includes dehydration, where the individual feels dizzy, has very dry skin, has a rapid heartbeat, rapid breathing, and either a low urine output or very dark urine.

Another situation is when the individual appears very puffy due to the swelling caused by fluid overload in renal failure.

Also, report if an individual has very high blood or very low blood pressure, especially after dialysis treatment. You also need to inform the nurse if the volume of urine excreted has changed.

Symptoms like decreased level of consciousness, confusion, nausea, vomiting, muscle cramps, chest pain, or shortness of breath should be reported, too.

Finally, you need to inform the nurse right away if the tube used for peritoneal dialysis was accidentally dislodged during the procedure or if you notice anything unusual about the client’s fistula or graft.

All right, as a quick recap... Renal failure happens when the kidneys don’t function at all or function at a low capacity, meaning that they are unable to filter blood properly.

Renal failure can be either acute, in which case it’s called acute kidney injury and happens suddenly, or chronic, in which case it’s called chronic kidney disease and happens gradually.

Common signs and symptoms of renal failure include dehydration, fluid overload, hypertension, oliguria, or anuria. Some individuals with renal failure need dialysis to survive.

Hemodialysis uses a machine to filter the blood, while peritoneal dialysis uses the peritoneal membrane as a filter. Always remember the guidelines when caring for an individual with renal failure and report to the nurse if you observe any unusual signs or symptoms.