Acute Renal Failure Patient Regarding Prevention

The population of interest in the proposed evidence-based project includes adults; (i) with a primary diagnosis of hypertension (values >140/90 mmHg or a mean daytime systolic BP of130 mm for diabetic patients), (ii) aged 18 years or over, and (iii) able to express themselves in written or spoken English. Patients with a diagnosis of end-stage renal disease, severe cognitive impairment or any other form of illness that would make their participation in the quality improvement

The role of diuretics in heart failure is to reduce the fluid retention by diuresis (1). Patient should be monitored closely to prevent over diuresis that will subsequently lead to hypotension and renal impairment. Diuretic used is commonly associated with hypokalemia (1). Thus, additional potassium needs to be given concurrent to diuretic treatment (1). Patient’s daily weight must be recorded and aimed for reduction of body weight >4.5 kg in 5 days after treatment (7). Angiotensin converting enzyme inhibitor (ACE-I) is a first line agent in treating heart failure, especially when there is evidence of reduced in ejection fraction <40% as it improve survival rate of patient (1). Patient needs to be advised regarding side effects of the drug which are, dry cough, hypotension, renal insufficiency, hyperkalemia and angioedema. Antihypertensive agents that can be given in patient with heart failure are beta blocker, ACE-I and aldosterone antagonist. If the blood pressure is persistently high despite treatment with beta blocker, ACE-I and ARB, calcium channel blocker such as amlodipine can be added as this drugs has negative inotropic effect

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

Chronic kidney disease (CKD) is a worldwide problem that is currently three times higher for African Americans, Hispanics, Pacific Islanders, American Indians and seniors (The National Kidney Foundation, 2013). CKD occurs when the kidneys are damaged by a pathogen or injury and they can no longer adequately maintain proper levels of regulated chemicals in the bloodstream. There are many risk associated with CKD. According to the National Kidney Foundation, two of the major risks are Chronic Renal Failure (CRF) and Cardiovascular Disease. Currently twenty million American adults have CKD and millions of others are at increased risk. Age has no barrier on getting CKD. People with pre-existing health issues, and a part of certain population

PICOT question: In elderly patient with congestive heart failure, how adequate multidisciplinary education compare with lack of education could reduce hospital readmission rates over a 6-month period? The research questions are: Does multidisciplinary education help elderly patient with CHF to adequately manage the disease at home? Does improve knowledge in the disease could decrease hospital readmissions in CHF patient? The hypothesis states that multidisciplinary approach and proper patient education will decrease readmission rate in elderly patients with CHF. The purpose of the study seeks to articulate the problem of lack of education for older patients with congestive heart failure regarding how to manage

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

In this journal article, the author entails the impact of congestive heart failure (CHF) on individuals all around the world, specifically focusing on how can nurses help their patients suffering with CHF and keep it under control. The Purpose of this journal article is to provide nurses with more knowledge related to CHF discussing the cause of CHF, sign and symptoms, lifestyle interventions, such as diet and exercise, in comparison to pharmacological management to prevent or delay the progression of the disease. William & Wilkins (2012) specially highlights the difference between right and left sided CHF. This journal article is conducted to quantify the nurses with tools to help their patients that suffer with congestive heart failure (CHF).

In the United States, over 5 million patients have heart failure (HF) and approximately 20 million patients have chronic kidney disease (CKD). Both conditions are linked by multiple risk factors including obesity, hypertension, diabetes mellitus, tobacco abuse, and increasing age. The presence of HF increases the risk of CKD and vice versa. Nearly one third of all patients with HF and 70% of Medicare patients with HF have Stage III CKD or greater and approximately 50% of dialysis dependent end stage renal disease (ESRD) patients will develop HF.

It is quite recognized in nursing that most heart failure patients do not take proper care of their heart failure once returning home from a stay at the hospital. They are reluctant to change their years of dietary and poor activity habits, and do not follow up with their physicians as they are directed to. Their desire to read all of the provided information is frowned upon as being too much, especially with the additional verbal information they receive from their doctors, nurses, and dieticians while in the hospital. It has been observed that the patient needs a simpler method of managing their heart failure at home. With this in mind, the goal of this project is to recognize that the patient is the primary stakeholder whom needs an easy to read and follow set of instructions that they will use to help them manage their heart failure throughout the day. A Heart Failure Quick Reference Tool (see Appendix A for heart failure tool steps) and nurse teaching materials were researched and developed, and a select number of nurses were educated. Though the information was well received by the patients and staff, the given amount of time available to

Marck et al. stated that from the 1143 dialysis patients who participated in the Renal Physician Association (RPA) survey, “20% of patients reported that they were uncomfortable to somewhat uncomfortable discussing care with a nurse, dietitian, or technician, and 20% believed that the instructions they received from the staff were unclear” (2014). Knowing this, it is vital that healthcare providers are aware of this communication issues and will find a way to increase good communication with their patients to make sure that before discharge, the patients are educated with their disease processes and the possible complications before, during, and after hemodialysis. From the 649 providers who participated in the RPA survey, 94% of them said that “it was easy to communicate with patients” (Marck et al., 2014). This is an indicative that providers need to work harder to ensure that their patients are given actual patient education and be able to demonstrate active

The results were incorporated into three main themes, patient factors, physician factors and systemic factors. For patient factors theme, the unpreparedness of patient to follow the recommended management plan is one of most challenging issue as expressed by majority participants. This attitude result poor prognosis when the patients remain reluctance to accept the fact about their illness after plenty of consultation took place and no action is initiated. The patient preferences to avoid or skip the drug therapy and continue the unhealthy lifestyle bring frustration among the doctors due to incapability to help without patient willingness to cooperate thus increase more workload on the future when the patient return to the clinic already with severe complications. The study also addressed that doctors

The kidneys are important organs in your body to help filter waste. Sometimes organs may fail and cause further problems within your body. There are treatments available for kidney failure including dialysis and a kidney transplant. Both treatments do involve life changes and the patient must stay healthy. It is important to learn about your body and learn the signs and symptoms of when something goes wrong.

Acute renal failure is a disorder of the urinary system. It involves the loss of kidney function and may occur suddenly. Acute renal failure occurs when blood flow to the kidneys is decreased. There are numerous reasons why there may be a decrease in renal function. A urinary tract obstruction, low blood pressure, illness, inflammation of the kidneys, and harmful substances are examples of causes of acute renal failure. These causes have different origins. The causes are separated into prerenal, intrarenal, and postrenal. Prerenal causes of acute renal failure are caused by a sudden drop in blood pressure. It may also be due to an "interruption of blood flow to the kidneys from severe injury or illness"(Stanbridge College, 2014). Prerenal is the most common cause of acute renal failure. Intrarenal is caused by harmful substances, infection, and inflammation. These cause direct damage to the kidneys. Postrenal is due to a decrease in urine flow. Obstruction of urine may be caused by renal calculi, injury, strictures, an enlarged prostate, or a tumor in the bladder.

In patients with heart failure, hypovolemia, cirrhosis, nephrotic syndrome, or hypoalbuminemia, renal function may be further compromised. BUN, creatinine clearance, and urine output should be monitored closely (Lexi-Comp, 2016).

A descriptive cross-sectional study was conducted; the questionnaire was well structured and was developed after reviewing the literature extensively. The study was conducted after approval from the Institutional Ethical Committee of NKP Salve Institute of Medical Sciences & Research Center, Nagpur.