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35 terms

Chronic Renal Failure

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Chronic Renal Failure
-Progressive loss of renal function over a period of months or years
-5 stages ending in End Stage Renal Disease (occurs when GFR < 15 ml/min)
-Kidneys able to function until 80% of GFR is lost/90% of nephrons are lost
Risk Factors for Chronic Renal Failure
-Diabetic neuropathy
-HTN
-Glomerulonephritis
-Polycystic disease
-Other
Diagnostic Findings for Chronic Renal Failure
-Elevated BUN & creatinine clearance
-Urine specific gravity fixed at 1.01
-Uremia (urine in blood)
-Decreased platelets
-Anemia
-Loss of erythropoeiten
-Inadequate clearance of fluid & electrolytes
Electrolyte Values for Chronic Renal Failure
-Hyperkalmeia
-Hyperphosphatemia
-Hypermagnesemia
-Azotemia
-Hypocalcemia
-Metabolic acidosis
Psychological Manifestations of Chronic Renal Disease
-Denial
-Depression
-Anxiety
Cardiovascular Manifestations of Chronic Renal Disease
-HTN
-HF
-Dysrhythmias
Gastrointestinal Manifestations of Chronic Renal Disease
-Anorexia
-N/V
-Uremic fetor
-GI bleeds
-Peptic ulcer
-Gastritis
Uremic fetor
is a urine-like odor on the breath of persons with uremia.[1] The odor occurs from the smell of ammonia, which is created in the saliva as a breakdown product of urea.
Endocrine Manifestations of Chronic Renal Disease
-Hyperparathyroidism
-Thyroid abnormalities
-Infertility
Secondary hyperparathyroidism refers to the
excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia low blood calcium levels
Metabolic Manifestations of Chronic Renal Disease
-Carbohydrate intolerance
-Hyperlipidemia
-Gout
Hematologic Manifestations of Chronic Renal Disease
-Anemia
-Bleeding (platelet dysfunction)
-Infection
Neurologic Manifestations of Chronic Renal Disease
-Fatigue
-HA
-Confusion
-Lethargy
-Seizures
-Coma
-Retinopathy
Respiratory Manifestations of Chronic Renal Disease
-Uremic lung
-Pulmonary edema
-Dyspnea
-Pneumonia
Integumentary Manifestations of Chronic Renal Disease
-Pallor
-Pruritus
-Yellow/Grey discoloration
-Dry, scaly skin
Peripheral Neuropathies of Chronic Renal Disease
-Motor weakness
-Restless legs syndrome
Prescribed Diet for Chronic Renal Failure
-Low protein w/ supplemental amino acids
-Fluid restriction
-Sodium restriction (no canned soups, prepared foods, cured meats)
-Potassium restriction (no salt subs, oranges, bananas, melons, tomatoes, prunes, legumes)
-Calcium replacement but phosphate restriction (no cheese, milk, ice cream)
Nursing Interventions for Chronic Renal Failure
-Monitor plan care for HTN & HF
-Prepare pt for dialysis or kidney transplant
-Monitor I/O
-Monitor VS
treatment
ant htn, diuretics
erythropoietin epogen procrit arancesp for anemia
phosphate binders adn vit d for renal osteodystrophy
treatment
fluid restriction 600-1000 based on output
avoid use of sedatives and hypnotics because of kidney problems
Nursing Interventions for Chronic Renal Failure
-Meds need to be evaluated d/t inability to excrete properly
-Monitor lab results (pH, electrolytes, BUN, creatinine, CBC)
Nursing Interventions for Chronic Renal Failure
-Medicate for N/V
-Observe for signs of infection
-Provide periods of rest between activities
-Weigh daily
stages of chronic renal failure
diminished renal reserve normal bun and creatinien levels no symptoms gfr 60-89%
stages of chronic renal failure
renal insufficiency
gfr 25% of normal
bun and creatinine are increased from azotemia decreased urine creatinine clearance
mild anemia
Azotemia is a
medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
Azotemia
All forms of azotemia are characterized by a decrease in the glomerular filtration rate (GFR) of the kidneys and increases in blood urea nitrogen (BUN) and serum creatinine concentrations.
stages of chronic renal failure
end stage renal failure uremia
gfr is less than 10% severe azotemia
high potassium, high sodium, and hyperphosphatemia
stages of chronic renal failure
end stage renal failure
metabolic acidosis
altered renin angiotension system
decreased erythropoietin production
endocrine effects
hyperparathyrodism cause low calcium and high phosphorous cause renal ostedystrophy
hematologic effects
aneamia and bleeding
cardiovascular effects
high blood pressure
chf
uremic
pericarditis
pericardial effusion
heart disease
GI effects
anorexia
NV
ammonia odor uremic fector to breath
pud
metabolic system effect
high blood sugar
hyperlipidemia
gout
HYPOPROTEINEMIA
neuro system effect
cns depression
peripheral neuropathy
seizures
sleep problems
MS system effect
renal osterdystrophy tissue calcification