Introduction to the Emergency
When an emergency situation occurs, patients with renal failure need extra care due to prevailing circumstances. For instance, there may be power interruption for several hours or days, or lack of clean drinking water. In such a case, there should be an emergency kit for basic necessities needed by the people. The kit should have the first aid supplies, clean water, and food among other items to allow a person to maintain his/her life for at least a few days.
In the case of renal failure patients, they require other items for their emergency preparedness to help cater for their needs. The kit should have an emergency contact number of a doctor or a nearby dialysis center. There should also be related medicine and dosages for three days. In case the patient is also diabetic, he or she should have medicine to control his/her blood sugar for at least one week. These should include glucose monitoring strips, insulin, and surgical wipes. The kit should also include food for 3-day emergency (Ashley and Currie, 2009).
These items should be in a bag or a container that is easily portable in case of evacuation or movement. The stock should not also consist of any expired drugs. Patients who use APD (automated peritoneal dialysis) machine may have to rely on manual intervention until they have access to power.
Pathophysiology
The patient should avoid nephrotoxins, have fluid, and maintain the level pressure of urine using catecholamines. The patient should also avoid situations of increased oxygen use, and maintain osmotic diuretics and vasodilators.
Signs/Symptoms
Kidneys help people in regulating electrolyte balance, acid and base level, blood pressure, and production of urine. Some refer to kidney failure as renal failure. This condition is caused by disease or injury to kidney normally resulting in its dysfunction. Some of the common symptoms may include low discharge of fluids, changes in mental processes, back pain, and alterations in urine quantity and quality (Abuelo, 1995).
There are chronic and acute renal failures. Acute renal failure results from interruption of normal flow of blood to kidney. This condition may be triggered off by an injury or accident. Occasionally, complex surgical operations may also interfere with the normal blood flow. At the same time, it may also results from a drug overdose, which causes all the body organs to dysfunction.
In most cases, symptoms of acute renal failure are not easily identified by the patients unless they visit the doctor for other conditions. Only a medical advice, after which a doctor will set an acute diagnosis, may reveal a condition of acute renal failure in an individual. Acute renal failure symptoms may include increased thirst, swelling legs, increased pulse rate, restlessness, reduced appetite, vomiting, nausea, fatigue or dizziness. In some cases, patients may also have back pains, usually above the waist, but below the rib cage.
On the other hand, chronic renal failure occurs as a result of chronic kidney disease. The disease usually reduces the normal function of the kidney gradually for many years. Chronic renal failure normally results from a long-term uncontrollable high blood pressure and diabetes mellitus (What are the symptoms of renal failure? n.d.). However, sometimes, chronic kidney disease may be also caused by genetic conditions like polycystic.
People with chronic renal failure normally have the symptoms which cause their renal status to fall below a given level (What are the symptoms of renal failure? n.d.). This depends on the glomerular filtration rate and indicates how kidneys filter liquid. When the rate of glomerular filtration falls below 30 percent, then patient is likely to experience symptoms, such as nausea or vomiting, fluid retention, easy bruising, cognitive change, anemia, and personality change (What are the symptoms of renal failure? n.d.). Difficulty in breathing may occur because fluid may accumulate in heart or lungs. Sometimes, cognitive impairment results in seizures (What are the symptoms of renal failure? n.d.).
Treatment
Basic Treatment
Acute renal failure may have different treatments depending on the cause. Some cases may involve replacement of blood or body fluids. We must also discontinue the use of medications that can cause sudden kidney failure. At times, the patient may require prescriptions to improve the function of his/her kidney. Occasionally, surgery may be the best option for managing acute renal failure condition (Rudd, 2009).
The treatment for acute renal failure may include administration of IV fluids in case of dehydration. This is a direct injection of fluids into the blood stream using a tube inserted into a vein. In case of an interruption or injury to the affected kidney, then the patient may require blood donation.
Some conditions may make the patient stop using medications, this can cause sudden kidney failure. The best treatment for acute renal failure is to prescribe some of drugs which may include certain antibiotics, chemotherapy drugs, and ibuprofen.
Some cases may require the use of prescription medications for treatment of acute renal failure. When the patient has an autoimmune disorder, then the prescription may involve administering of immunosuppressants. Medications will vary depending on the main cause of renal failure.
Acute renal failure may involve a surgical intervention. This may be in cases when there are blockages in the urinary system. Kidney will restore its normal operations once the intervention removes the blockage. The main suspect in this case is the kidney stone. In case some difficulties occur while removing the blockage, a patient may have a catheter inserted to allow for the flow of urine around the blockage.
Paramedic Level Treatment
In case of emergency, the patient should continue receiving a continuous ambulatory peritoneal dialysis (CAPD). However, interruptions of power may cause the patients to rely on manual exchanges. Patients should also start monitoring their diets within the next three days if the power failure is prolonged, but patients using hemodialysis should immediately start monitoring their diets.
In cases of emergency, a patient may require a procedure referred to as dialysis in treating an acute renal failure. This is a complex procedure that involves making the blood to run through a machine that filters and cleanses it from wastes before returning it to the body. Dialysis acts as a temporary measure for managing an acute renal failure until a permanent solution is available that will restore the kidney to its normal functions. However, in severe cases, dialysis may continue until a kidney transplant occurs.
Paramedics can give the patient fluids for rehydrating the body. They can also provide pin management drugs such as morphine. However, they must determine pain severity, medical history, physical status of the patient, and allergies so as to administer drugs.
Patient may experience due to increased oxygen consumption. Paramedics can give oxygen to the patient for oxygenation using mask placed over the mouth and nose through cannula tube.
Definitive Care
We have noted that symptoms of renal failure “vary depending on the direct cause” (Chambers, 2005). However, there are some common symptoms that may be present in patients for months. They may include insomnia, nausea and vomiting, anxiety, anorexia, depression, and lethargy. Severe pathological symptoms will only appear in the last two weeks of patient’s life.
Palliative care is necessary for patients who do not want to undergo dialysis treatment. This is necessary for managing the symptoms and easing the end of life anxiety.
Managing the patient could involve putting him or her in a Gold Standards Framework register. There should also be discussion about the patient’s preferred care and death place. Palliative care should also take into account the reasons for a patient refusal for treatment.
Before the transplant, there are tests for compatibility to avoid chances of rejection. There should be diet monitoring, no consumption of alcohol, smoking, and only use prescribed medications.
During the transplant, doctors must manage wound complications, bleeding, vascular thrombosis, ureteral stenosis and obstruction, and lymphocele conditions.
After the procedure, the patient needs a rest of up to seven days in hospital. There are also regular follow-ups and blood tests. The patient expects to recover within 6 months. The subsequent years involve x-rays and regular checkups.
Prognosis (Morbidity and Mortality)
A patient may reject the new kidney transplanted. Thus, doctors should administer drugs that suppress immunity for the rest of the patient’s life (immunosuppressive therapy). This medication needs cancer screening and diabetes monitoring. Any successful transplant needs regular check-ups with regular medication.
Conversely, there could be chronic rejection of the transplanted organ. The patient may suffer cardiovascular disease due effects of surgery complications. Renal replacement therapy may prolong a patient’s life. There are also home hemodialyis and peritoneal dialysis three times in a week.
Long Term Care
The first care should focus on managing abnormal urination. Patient urine vole changes with his/her conditions. For instance, the state of Oliguria (low urine production) results in urine production below 400 ml. The diuretic time causes the production of urine over 2500 ml. On the other hand, urine color also changes. An acute renal failure may result in production of urine that looks muddy and has a soy sauce color. Urine gravity also becomes low.
Patients should keep to bed to reduce the level of metabolic wastes. There should also be accurate records for urine volume and color watch. This also involves observing urine gravity every hour. Patients should also manage their urine aliquots correctly. They should use diuretic based on their doctors’ advice and take note of its side and favorable effects. Any fall in urine volume below 17 ml per hour requires immediate doctor’s attention.
We should also manage fluid retention in patients. In this case, we look at body’s edema, management of breath, back pain, urine production and take care of hydrothorax. At this point, we should maintain the normal level of body fluid and observe cutaneous changes in the patient. The patient should also increase urine production. This may call for taking restriction water with certain minerals. We should also observe the patient’s body weight. This stage also requires records of both the fluid intake, its absorption, and urine’s production within 24 hours. The use of diuretics should be based on the doctor’s instructions. We should also avoid intramuscular injections.
This is the third stage of managing serum potassium (hyperkalemia) in patients. We should ensure that serum potassium is at its normal level. This involves administering a low potassium diet. There are also inspection of blood pressure, pulse rate, and breathing every two hours. In severe conditions, doctors should conduct a blood test to determine potassium level, and administer immediate, possible treatment. In cases of acute pulmonary edema, management involves providing high-concentration oxygen, improving venous access and preparing emergency kits.
Prevention
It is usually the aged patients who are at high risks of renal failure. This is because of weak body resistance to the changes in the environment. Prevention of renal failure generally involves regular activities we can undertake on a daily basis. For instance, we can prevent renal attack through drinking plenty of water, observing the dietetic hygiene, keeping fresh air indoors, engaging in sports, and avoiding strenuous activities leading to drenching in sweat. People should also engage in these activities so as to avoid cases of renal failures (Ashley and Currie, 2009).
First, we should prevent hypertension or high blood pressure. This is because cases of hypertension normally make certain populations susceptible to renal failure due to risks they present to kidneys. Hypertension may affect direct functions of the kidneys and make it prone to failure. Second, aged people should prevent an infection of any type to affect their organs. Infections reduce the normal functions of the renal system and may disrupt the normal functions of the kidneys. Third, people should not engage in drug abuse. This is because drugs are harmful to kidneys. We should avoid medication with renal toxicities or reduce its intake to maximum. Fourth, we should always strive and prevent diabetes. Diabetes normally leads to cases of renal failure. Therefore, treatment for the existing cases diabetes is necessary to control nephropathy that results from diabetes inducements. Regular hospital checks are also necessary for aged people who are prone to the above conditions.
References
Abuelo, G. (1995). Renal Failure: Diagnosis & Treatment. New York: Springer.
Ashley, C. and Currie, A. (2009). The Renal Drug Handbook, 3rd ed. Oxford: Radcliffe.
Chambers, G. (2005). Supportive Care for the Renal Patient. Leicester: Renal and Palliative Care Group.
Rudd, N. (2009). A Guide to Prescribing for Patients with Advanced Malignancy. New York: John Wiley.
Twycross, R. (2010). Palliative Care Formulary. Thousand Oaks: Sage.
What are the symptoms of renal failure? (n.d.) Web.