Chronic Renal Failure

Question 1

Definition

Answer 1

End Stage Renal Disease (ESRD)

Long-term kidney failure
• There is no recovery from the damage/insult to the kidney

Question 2

Stages of CKD

Answer 2

Stage 1: Kidney damage w/ normal renal function GFR > 90 ml/min but with proteinuria (3 months or more)

Stage 2: Kidney damage w/ mild loss of renal function GFR 60-89 ml/min w/ proteinuria

Stage 3: Mild to severe loss of renal function GFR 30-59 ml/min

Stage 4: Severe loss of renal function GFR 15-29 ml/min

Stage 5: End-stage renal disease GRF less 15 ml/min

Question 3

Pathophysiology

Answer 3

Uremia occurs which is the raised level of urea and other nitrogenous waste compounds in the blood which are usually filtered by the kidneys

Decline renal function and decrease in the glomerular filtration rate

Hypertension

Question 4

Clinical Manifestations

Answer 4

Severity of signs and symptoms depend on the extent of the damage

Neurological: confusion, tremors, seizures, behavior changes, burning of the soles of feet, restless legs syndrome

Integumentary: skin color changes, dry flaky skin, ecchymosis, thin brittle nails, thinning hair

Cardiovascular: hypertension, edema, engorged neck necks, pericardial effusion, pericarditis, hyperkalemia, hyperlipidemia

Pulmonary: crackles, SoB, pleuritic pain, tachypnea, kussmaul’s respirations

Gastro intestinal: nausea and vomiting, metabolic taste, ammonia breath, hiccups and constipation

Question 5

Diagnostic findings

Answer 5

 Elevated BUN (>24 mg/dL) and Creatinine (> 1.2 mg/dL)

 Sodium (>135 mg/dL) and water retention

 Metabolic Acidosis

 Anemia

 Calcium and Phosphorous imbalance

Question 6

Nutrition Therapy

Answer 6

Low protein

Low sodium

Low potassium

High carbohydrates

Fluid restriction 500-600mls per day

Vitamin supplements

Question 7

Nursing management

Answer 7

Monitors for complications

Assess progress

• fluid and electrolytes,
• pulmonary function
• preventing infection
• nutrition

Provides physical and emotional support

• safety and protection
• activity, rest and comfort

Keeps the family informed of progress
- psychological

Teaches about nursing management
- knowledge deficit

Question 8

Fluid and electrolyte

Answer 8

Vital signs

Intake and output (Limit Fluids)

• Oral
• Intravenous

Monitoring electrolyte levels

• Na
• K

Daily weights
Monitor respiratory function
Assess skin turgor

Question 9

Pulmonary function

Answer 9

Vital signs

Turn and position

Encourage deep breathing and coughing

Auscultate chest

Spirometry readings

Provide rest periods to reduce metabolic rate

Question 10

Preventing infection

Answer 10

Asepsis is critical with invasive lines

Urinary catheters are use only as necessary to prevent UTI

Vital signs

WBC

Question 11

Activity rest and Comfort

Answer 11

Provide frequent rest periods to decrease metabolic rate

Assess for fatigue

Provide skin care to prevent skin break down use emollients for dry excoriated skin

Question 12

Psychological

Answer 12

Assess family responses to situation
Assess client coping patterns
Ask open ended questions about
    -  Role changes
    - Changes in lifestyle
    -  Sexual changes

Question 12

Safety & Protection

Answer 12

Vital signs

Monitor lab values

- Na
- K
- FBC

ECG changes

Fluid overload

Headaches

Neurological changes