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