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    Pathophysiology Nanda: Elysse Francis

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    Chronic renal failure is a progressive loss of kidney function that cannot be reversed. It involves 5 stages as glomerular filtration rate declines from normal to less than 15 ml/min. Symptoms do not appear until over 75% of function is lost. Common causes include hypertension, diabetes, infections, and collagen vascular diseases. Treatment focuses on managing complications through dialysis, medication, diet, and potentially transplant. Nursing care monitors for fluid balance issues, nutrition, infection risk, and other symptoms to optimize patient health and quality of life.

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    Pathophysiology Nanda: Elysse Francis

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    Chronic renal failure is a progressive loss of kidney function that cannot be reversed. It involves 5 stages as glomerular filtration rate declines from normal to less than 15 ml/min. Symptoms do not appear until over 75% of function is lost. Common causes include hypertension, diabetes, infections, and collagen vascular diseases. Treatment focuses on managing complications through dialysis, medication, diet, and potentially transplant. Nursing care monitors for fluid balance issues, nutrition, infection risk, and other symptoms to optimize patient health and quality of life.

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    Chronic renal failure is a progressive loss of kidney function that cannot be reversed. It involves 5 stages as glomerular filtration rate declines from normal to less than 15 ml/min. Symptoms do not appear until over 75% of function is lost. Common causes include hypertension, diabetes, infections, and collagen vascular diseases. Treatment focuses on managing complications through dialysis, medication, diet, and potentially transplant. Nursing care monitors for fluid balance issues, nutrition, infection risk, and other symptoms to optimize patient health and quality of life.

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    36 views1 page

    Pathophysiology Nanda: Elysse Francis

    Uploaded by

    api-290887208
    Chronic renal failure is a progressive loss of kidney function that cannot be reversed. It involves 5 stages as glomerular filtration rate declines from normal to less than 15 ml/min. Symptoms do not appear until over 75% of function is lost. Common causes include hypertension, diabetes, infections, and collagen vascular diseases. Treatment focuses on managing complications through dialysis, medication, diet, and potentially transplant. Nursing care monitors for fluid balance issues, nutrition, infection risk, and other symptoms to optimize patient health and quality of life.

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    Chronic Renal Failure

    Pathophysiology
    A progressive, irreversible disease in which kidney function does not recover. S/S are sparse until >75% of glomerular filtration is lost.
    Five stages 1) Normal GFR >90ml/min with normal kidney function/ no obvious kidney disease, renal reserve 2) Nephron damage,

    NANDA

    Fluid volume overload r/t inability of kindeys to maintain fluid balance


    CO r/t SV, dysrhythmias, FVOPVR

    GFR 60-89ml/min, metabolic wastes accumulate in blood 3) GFR 30-59ml/min, nephrons cannot manage metabolic wastes, fluid &
    electrolyte balance 4) Severe CKD GFR 15-29ml/min 5) ESRD GFR <15ml/min excessive amounts of urea and creatinine build up in
    blood & kidneys cannot maintain homeostasis. Severe fluid, electrolyte & acid-base imbalance. Fatal unless treated to sustain life or
    kidney transplant.

    Inadequate nutrition r/t inability to ingest/digest food, absorb nutrients


    resulting from physiologic changes
    Risk for infection r/t skin breakdown, chronic disease, malnutrition
    Fatigue r/t kidney disease, anemia, energy production

    S/S

    Neuro: lethargy, insomnia,


    confusion, encephalopathy,
    seizures, attention span,
    coma, paresthesias, tremors,
    asterixis

    CV: HTN, peripheral edema,


    cardiomyopathy, HF,
    pericardial effusion, cardiac
    tamponade, hypotension

    Resp: dyspnea, tachypnea,


    uremic pneumonitis, crackles,
    Kussmaul respirations,
    pulmonary edema

    Hematologic: anemia,
    bruising, bleeding

    GI: anorexia, N/V/D, metallic


    taste, uremic halitosis,
    gastritis, constipation

    Urinary: polyuria, nocturia,


    oliguria, anuria, proteinuria,
    hematuria

    Skin: skin turgor, yellow


    cast skin, dry, pruritis,
    bruising, uremic frost (late)

    Musculoskeletal: weakness,
    osteomalacia, fractures

    Common Causes

    Prolonged/severe HTN

    DM

    Chronic glomerulopathies

    Chronic infections
    (pyleonephritis)

    Collagen diseases (SLE)

    Congenital anomalies
    (polycystic kidney disease)

    Nephrotoxic agents

    Gout

    Systemic Lupus Erythematosus

    Renal artery stenosis


    Risk Factors

    Advanced age

    African-Americans

    ARF

    Nursing interventions:

    Monitor fluid status: I&O, daily weights, FVO, edema, skin turgor

    Give prescribed medications

    Administer SQ erythropoietin as ordered

    Insert indwelling catheter to evaluate UO

    Monitor urinary elimination, UO hourly

    Provide frequent rest periods

    Institute bleeding precautions

    Monitor for bleeding

    Assess cardiopulmonary status- heart and lung sounds, continuous


    cardiac monitoring, pulmonary edema

    Provide skin care measures

    Maintain fluid restrictions

    Monitor patients LOC

    Obtain specimens for laboratory testing

    Prepare patient for dialysis

    Monitor lab values and renal function studies

    Monitor post transplant status

    Treatments

    Hemodialysis or peritoneal dialysis

    HTN control

    Nutrition therapy: high-calorie, low-protein,


    low-phosphorus, low sodium, sodium & fluid
    restrictions

    Activity: rest when fatigued

    Meds:
    o
    ACEIs- control HTN
    o
    AntiDM- control glucose levels
    o
    Phosphate binders
    o
    Oral Ca+
    o
    Erythropoietin
    o
    Statins- control HL
    o
    Diuretics- fluid balance control

    Surgery:
    o
    Insertion of dialysis catheter
    o
    Kidney transplant

    Diagnostics
    Renal US
    KUB x-ray
    CT scan
    Aortorenal angiography
    Cystoscopy
    Retrograde pyelography
    Renal biopsy

    Goals
    The patient will:

    Maintain an acceptable fluid balance

    Improve tolerance to activity

    Report a in anxiety

    Labs

    Blood studies & CBC: creatinine, BUN, electrolytes, H/H, hyperglycemia,


    hypertriglyceridemia
    UA: hematuria, proteinuria, glucosuria, alterations in specific gravity, casts
    and crystals
    ABGs: low blood pH, low CO2, low HCO3
    24 hour urine collection: creatinine clearance, protein

    Teaching

    Monitor daily intake of carbs, proteins, sodium and K+

    Diet, exercise, take medications as prescribed

    Monitor fluid intake according to fluid restrictions

    Avoid antacids containing magnesium

    Take rest periods from activity

    Type of dialysis, care of access site, assess site patency by feeling


    for a thrill or listening for a bruit, S/S of infection

    Measure and monitor BP & weight at home

    S/S associated with electrolyte imbalances and when to report to


    MD

    Follow a medication regimen


    Will have no signs of skin breakdown
    Remain free of pulmonary edema
    Maintain hemodynamic stability
    Maintain adequate ventilation & oxygenation
    Maintain adequate UO
    Maintain intact oral MM
    Discuss fears or concerns

    Elysse Francis

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