Hepatorenal Sendrom Tanısı Olan Bireylerde Hemşirelik Bakımı/ Nursing Care in Individuals with Hepatorenal Syndrome

Year 2021, Volume: 16 Issue: 1, 19 - 29, 31.01.2021

Pınar Ongün İnci Kırtıl Deniz Öztekin

https://doi.org/10.47565/ndthdt.2021.29

Abstract

Hepatorenal sendrom, karaciğer yetmezliği olan hastalarda görülen en yaygın komplikasyonlardan biridir. Azotemi, oligüri, glomerüler
filtrasyon hızının azalması ve inatçı assitin artmasıyla ortaya çıkan böbrek yetmezliği tablosudur. Böbreklerde yapısal bir sorun yoktur. Hepatorenal
sendrom oluşumuna portal hipertansiyon, splenik arteriyel vazodilatasyon sebep olur. Sonuç olarak, renal hipoperfüzyona neden olan renal vazokonstrüksiyon
gelişir. Karaciğer transplantasyonu gerçekleşen hastalarda ameliyat sırasındaki yetersiz perfüzyona bağlı gelişen akut tübüler nekroz,
ameliyat sonrası hipovolemi ve ilaçlara bağlı gelişen nefrotoksisite, karaciğer nakli sonrası böbrek yetmezliğinin diğer önemli nedenlerindendir.
Tedavide amaç, splenik ve sistemik vazokonstrüksiyonun düzeltilmesi, böbreklerin vazodilatasyonunun sağlanması ve sodyum dengesi ile
birlikte normovoleminin sağlanmasıdır. Hemşirelik bakımında; klinikte hastanın hemodinamisinin stabil olması sağlanmalı, laboratuvar bulguları
izlenmeli ve hastanın durumu sıklıkla değerlendirilmelidir. Ayrıca hasta sıvı-elektrolit dengesizlikleri yönünden izlenmelidir. Hepatorenal sendroma
bağlı olarak hastanın saatlik diürez miktarı, ortalama arter basıncı, kreatinin klirensi ve serum kreatin gibi kritik değerlerindeki ani değişimler,
su ve tuz tutulumuna bağlı olarak ortaya çıkan ödem hastanın hemodinamisinin olumsuz etkilenmesine neden olur. Özellikle yoğun
bakım ünitelerinde hastaların izlemi önem taşımaktadır.

Keywords

Hepatorenal sendrom, Böbrek yetmezliği, Hemşirelik bakımı

Nursing Care in Individuals with Hepatorenal Syndrome

Abstract

Hepatorenal syndrome is one of the most common complications seen in patients with liver failure. Azotemia,
oliguria, decreased glomerular filtration rate, and renal failure manifested by increased persistent acidity. There
is no structural problem in the kidneys. Portal hypertension and splenic arterial vasodilation cause the formation
of hepatorenal syndrome. As a result, renal vasoconstriction causes of renal hypoperfusion. Acute tubular
necrosis due to inadequate perfusion during surgery, postoperative hypovolemia, and drug-induced
nephrotoxicity in patients with liver transplantation are other important causes of renal failure after liver
transplantation. To correct splenic and systemic vasoconstriction, to provide vasodilatation of the kidneys, and to
provide normovolemia with sodium balance are the treatment aims. In nursing care; In the clinic, the patient's
hemodynamics should be stabilized, laboratory findings should be monitored and the patient's condition should
be evaluated frequently. Also, the patient should be monitored in terms of fluid-electrolyte imbalances. Sudden
changes in critical values such as the patient's urine output, mean arterial pressure, creatinine clearance and
serum creatinine due to hepatorenal syndrome, edema due to water and salt retention cause the patient's
hemodynamics to be negatively affected. Monitoring of patients is important, especially in intensive care units.

Keywords

Hepatorenal syndrome, Kidney failure, Nursing care

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