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