critical care nursing a holistic approach课件

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1、CriticalCareNursingAHolisticApproachPart6AnatomyandPhysiologyoftheRenalSystemChapter28HormonesAntidiureticReninhormoneAldosteroneCalcitriolErythropoietinFunctionsoftheRenalSystemRenalclearanceRegulationElectrolyteconcentrationPatientAssessment:RenalSystemChapter29HistoryOtherdisease

2、sthatcontributetorenalfailureDiabetesmellitusSystemiclupuserythematosusHypertensionSickle-cellanemiaOthercausesofrenalinjuryRecentillnessincludingsurgeryorinfectionExposuretonephrotoxicagentsAssessmentofCostovertebralAnglesSiteofRenalBruitsDiagnosticTestsUrinalysisCreatinineandcreatini

3、neclearanceBloodureanitrogen(BUN)OsmolalityRadiologicalstudiesRenalbiopsyRenalangiogramAssessmentofFluidBalanceDailyweightIntakeandoutputLabstudiesHemodynamicmonitoringPatientManagement:RenalSystemChapter30PatientAccessVascularcatheterA-VfistulaSyntheticvasculargraftHemodialysisRemove

4、surea,creatinine,anduricacidRemovesexcesswaterRestoresthebodybuffersystemMaintainsappropriatelevelsofelectrolytesComplicationsofDialysisDysequilibrium–RemovalofuricacidtooquicklyHypovolemiaHypotension/HypertensionMusclecramps–RemovaloffluidtooquicklyDysrhythmiasAnginaContinuousRenalRep

5、lacementTherapies(CRRT)SimilartohemodialysisRemoveswasteproductslowlyRequiresmoretimeUsedwhenuricacidneedstobeaggressivelymanagedPeritonealDialysisTheperitoneumisusedasthesemipermeablemembraneOsmosisisusedtoremovefluidPeritonealcatheterisplacedinsurgeryUsedforpatientswhodonotlivecloset

6、oadialysiscenterPeritonealDialysisAdvantagesLesscomplicatedequipmentandsuppliesLessadverseeffectsbecausefluidandelectrolytechangeisslowerDisadvantagesRequiresmoretimePeritonitisRenalFailureChapter31CausesofAcuteRenalFailurePrerenalPhysiologicaleventcausinghypoperfusionIntrarenalAcuteda

7、magetorenalparenchymaPostrenalObstructiontoflowofurineoutofthekidneyChronicRenalFailureSlow,progressive,irreversibleProgressivedestructionofnephronsDiabetesmellitusandhypertensionarethemostcommoncausesMorecommoninAfricanAmericans,Hispanics,andNativeAmericansChronicRenalFailureSlowthe