M is a 72 year-old widow with neprohritic syndrome, temporal arthritis, osteoporosis, severe hypertension and Myeloma. M has two daughters however she lives on her own. Her present complaints are: - itching, poor appetite, nausea, lower back pain and lethargy…
Multiple substances such as, water, urea, creatinine, uremic toxins, and drugs move from the blood into the dialysate, thus facilitating removal from the blood. Solutes are transported across the membrane by either passive diffusion or ultrafiltration. M also received 7 sessions of Plasma Exchange. Plasma Exchange is a procedure in which blood is separated into different parts: red cells, white cell, platelets and plasma. The plasma is removed from the blood and a plasma substitute replaced. M had chemotherapy. Chemotherapy is the treatment which uses anti-cancer drugs to kill cancer (Myeloma) cells. Myeloma is the cancer that affects cells in the bone marrow called plasma cells leading to damage to the kidney. Haemodialysis and Plasma Exchange will correct M's blood chemistry and therefore relieve her present symptoms.
M is hypertensive due to fluid overload or as a result of the failure of the kidneys. The Management of M's hypertension will have the highest priority. As Redmond and McClelland (2006) noted prompt recognition and treatment of hypertension are essential because cardiovascular disease including coronary artery disease, atherosclerosis, stroke and left ventricular hypertrophy are the most common cause of death in patients with kidney disease. Risk reduction measures to prevent cardiovascular disease may delay the progression of kidney disease (in ARF or is the effect here Reno protective). ACE inhibitors or angiotensin receptor blockers (ARBs) are the drug of choice (Thomas 2004); however deterioration in renal function may follow initiation of treatment with these medications (DOH 2005, BNF 2006). Since hypertension can have deleterious effects on both cardiovascular and kidney functions, the long-term protection provided by ACE inhibitors (or ARBs) out weighs the risk they pose (Thomas 2004) (this is for ERF is it the same for ARF - CHECK).
Because acute renal failure is a catabolic state, the patient can become nutritionally deficient. Total caloric intake should be 30 to 45 kcal (126 to 189 kJ) per kg per day, most of which should come from a combination of carbohydrates and lipids. In patients who are not receiving dialysis, protein intake should be restricted to 0.6 g per kg per day. Patients who are receiving dialysis should have a protein intake of 1 to 1.5 g per kg per day (Agrawal 2000).
The patient has hyperphosphatemia. Phosphate is normally excreted by the kidney and phosphate retention and hyperphosphatemia may occur in ARF. Phosphate - binding agents may be used to retain phosphate ion in the gut. The most common agent is calcicihew, although M is on this drug she needs education on when to take the tablets or maybe increase the dosage.
Caloric intake shou ...
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