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CHRONIC RENAL FAILURE
Chronic renal failure involves progressive, irreversible destruction of the nephrons. The end result is a systemic disease that affects every body organ…...
ESRD Fact
• African Americans and Native Americans have highest incidence of ESRD.
• African Americans more likely to develop ESRD from hypertension
• Native Americans more likely to develop ESRD from Diabetes.
Stages of Chronic Renal Failure
• Diminished Renal Reserve
• Renal Insufficiency
• End-stage Renal Disease (ESRD)
Body System Effects
Neurologic System
• Depression of CNS – lethargy– apathy– decreased ability to concentrate– altered mental ability
• Peripheral neuropathy
Body System Effects
Fluids, Electrolytes, Acid-base
• Hyperkalemia
• Calcium
• Magnesium
• Sodium
• Metabolic acidosis
Body System Effects
Cardiovascular System
• hypertension
• edema
• acceleration of atherosclerotic vascular disease
• CHF
Body System Effects
Respiratory System
• dyspnea
• pulmonary edema (from CHF)
• uremic lung
Body System Effects
Hematologic System
• Anemia
• Bleeding Tendencies
• Infection
Body System Effects
Urinary System
• Early sign is polyuria and specific gravity decreases due to inability to concentrate urine.
• Later signs - oliguria and/or anuria
Body System Effects
Gastrointestinal System
• Inflammation of the GI tract
• Ulcers
• Anorexia, nausea
Body System Effects
Musculoskeletal System
• Renal Osteodystrophy– osteomalacia– Osteitis fibrosa– metastatic calcification
Body System Effects
Integument System
• yellowish discoloration to skin
• pruritis
• uremic frost
• ecchymosis
• dry & brittle hair
Body System Effects
Reproductive System
• decreased libido
• decreased sexual function
• females: anovulation/menstrual changes
• males: decreased testosterone
• improved with dialysis
Psychologic Effects
• Personality & Behavior changes
• Withdrawal
• Depression
• Body Image
• Dull affect
• Grief
Collaborative Treatment - CRF
• PC: Fluid Management
• PC: Electrolyte Imbalances
• PC: Hypertension
• PC: Anemia
PC: Fluid Imbalances
• Fluid restriction
• Dialysis
PC: Electrolyte Imbalances
• Hyperkalemia
• Hypocalcemia
• Phosphate excess
PC: Hypertension
• Antihypertensive agent most commonly used are: – calcium channel blockers – ACE inhibitors
• Be cautious about causing hypotension
PC: Anemia
Anemia due to decreased production of erythropoietin.
• Administration of Erythropoietin - IV or SQ
• Monitor hemoglobin & hematocrit
Nursing Diagnoses
• Impaired skin integrity
• Risk for injury
• Activity intolerance
• Risk for infection
• Anticipatory Grieving
• Self-esteem disturbances
• Risk for sexual dysfunction
Altered Nutrition
• Special Dietary Needs– fluid restriction– protein restriction– sodium restriction– potassium restriction
Dialysis
• Treatment to correct fluid and electrolyte imbalances and remove waste products in renal failure.– Peritoneal Dialysis (PD)– Hemodialysis Dialysis (HD)
General Principles of Dialysis
Solutes and water move across the membrane from the blood to the dialysate– Diffusion– Osmosis
Peritoneal Dialysis
• Peritoneum acts as semi-permeable membrane for exchange
• Different PD systems APD & CAPD
• Dialysis Exchange– infusion– dwell– drain
Problems with Peritoneal Dialysis
• Infection, Infection, Infection• (Did someone say infection?)
• mechanical problems
• abdominal discomfort
Hemodialysis
Vascular Access– Shunts– AV Fistula’s and
Grafts– Vascular access
catheters
Dialysis Procedure
• Take blood out of arterial side - send to dialysis unit.
• Blood enters unit, filtered with dialysate, and returned to vein.
• Process takes 3-4 hours.
• Unit removes various amount of fluid - usually no more than 1.0-1.5 kg wt.
Complications HD
• Hypotension
• Hepatitis
• Sepsis
• Blood loss
Renal Failure Summary • ARF can lead to :
– Death
– Normal recovery ( may take 12 months)
– Chronic Renal Failure
• CRF treated by – PD, CAPD
– HD
– Transplantation
• EVERY BODY SYSTEM AFFECTED