Gender Ethnicracial And Life Span Considerations

Some experts report that the concentrating ability of the kidneys decreases with advancing age. Oliguria in the geriatric patient, therefore, may be diagnosed with urine production of as much as 600 mL/day. Elderly patients may have a decreased blood flow, decreased kidney mass, decreased filtering surface, and decreased glomerular filtration rate. The elderly, therefore, are more susceptible to insults that result in ARF, and their mortality rates tend to be higher. Older men have the added risk of preexisting renal damage because of the presence of benign prosta-tic hypertrophy. There are no known racial or ethnic considerations.


HISTORY. When you elicit the patient's history, look for a disorder that can lead to prerenal, intrarenal, or postrenal ARF. Question the patient about recent illnesses, infections, or injuries, and take a careful medication history with attention to maximum daily doses and self-medication patterns. Determine the patient's urinary patterns and document information such as frequency of voiding, approximate voiding volume, and pattern of daily fluid intake. Evaluate the patient for a recent history of gastrointestinal (GI) problems, such as anorexia, nausea, and changes in bowel patterns. Some patients have a recent history of weight gain, edema, headache, confusion, and sleepiness.

PHYSICAL EXAMINATION. The patient appears seriously ill and often drowsy, irritable, confused, and combative because of the accumulation of metabolic wastes. In the oliguric phase, the patient may show signs of fluid overload such as hypertension, rapid heart rate, peripheral edema, and crackles when you listen to the lungs. Patients in the diuretic phase appear dehydrated, with dry mucous membranes, poor skin turgor, flat neck veins, and orthostatic hypotension. The patient may have increased bleeding tendencies, such as petechiae, ecchymosis of the skin, and bloody vomitus (hematemesis).

PSYCHOSOCIAL. The patient with ARF may be highly anxious because of the unknown outcome of the problem. Anxiety may increase as symptoms such as hemorrhage or pain from an obstructing calculus appear. Because ARF may occur as an iatrogenic problem (a problem caused by the treatment of a disease), you may need to explain to the patient or significant others that the problem was not avoidable and is a potential complication of the underlying disorder.

Diagnostic Highlights

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