Question

A nurse is caring for an 80-year-old patient who was admitted to the hospital with a diagnosis of dehydration. The patient stated he had been vomiting for 2 days and had been unable to take food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On physical examination, the nurse notes that the patient’s skin is dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient’ urine is dark amber with a specific gravity of 1.028. His urine output was 30cc/hr for the past 4 hours since admission.

1. What type of renal failure is most often seen with dehydration? What signs and symptoms noted by the nurse are characteristic of renal failure?

2. If the blood pressure continued to drop in this patient and the patient developed acute tubular necrosis, what would happen to the kidney tubule?

3. What are the three phases of acute tubular necrosis? Identify two important nursing interventions for each phase.

Answer 1

Ans 1 : Pre- renal Acute Renal failure is often seen with dehydration.

Characteristic features are :

1. Decreased urine output

2. Dryness

3. Low bp

4. Specific gravity of urine less than 1.20

Ans 2 : destruction of tubular epithelial cell occurs when patient develop tubular necrosis due to continue decrease of bp

Ans 3 : nursing interventions in 3 phases of acute tubular necrosis :

1. Initiation. The initiation period begins with the initial insult, and ends when oliguria develops.
2. Oliguria. The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by kidneys.
3. Diuresis. The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover.
4. Recovery. The recovery period signals the improvement of renal function and may take 3 to 12 months.

• Oligouria and diuresis phase often come under maintenance phase.
• Nursing interventions for tubular necrosis are :

1. ​​​​​​​monitor fluid and electrolyte balance in all three phases
2. rest to reduce metabolic rate should be done in all three phases
3. measure to prevent patient from infect should be done in all three phases
4. Hydration by oral or i.v in oligouria phase
5. Diuresis is controlled by control the use of diuretic administration and intake of diuretic foods too
6. Maintenance of hydration and monitoring is done n recovery phase