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CHRONIC RENAL FAILURE.

CHRONIC RENAL FAILURE. PRESENTED BY: SANTHOSH THOMAS. LECTURER,YNC. Learning objectives. The students will be able to :- Define chronic renal failure List the causes of chronic renal failure. Elaborate the pathophysiology .

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CHRONIC RENAL FAILURE.

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  1. CHRONIC RENAL FAILURE. PRESENTED BY: SANTHOSH THOMAS. LECTURER,YNC.

  2. Learning objectives. • The students will be able to :- • Define chronic renal failure • List the causes of chronic renal failure. • Elaborate the pathophysiology. • List the clinical manifeststions,assessment and diagnostic findings and complications. • Explain the management(Dietary,medical and nursing management.)

  3. Definition. • Chronic renal failure/CKD, or ESRD, is a progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic and fluid and electrolyte balance fails, resulting in uremia or azotemia (retention of urea and other nitrogenous wastes in the blood).

  4. Causes. • Diabetes mellitus (leading cause); • Hypertension; • Chronic glomerulonephritis; • Pyelonephritis; • Obstruction of the urinary tract; • Hereditary lesions, as in polycystic kidney disease; • Vascular disorders; infections; • Medications; or toxic agents.

  5. Pathophysiology. Renal function declines Waste products accumulate inside the body. Uremia develops Symptoms arise in different systems of body.

  6. Stages of Chronic renal failure/CKD. • Stage 1 with normal or high GFR (GFR > 90 mL/min) • Stage 2 Mild CKD (GFR = 60-89 mL/min) • Stage 3A Moderate CKD (GFR = 45-59 mL/min) • Stage 3B Moderate CKD (GFR = 30-44 mL/min) • Stage 4 Severe CKD (GFR = 15-29 mL/min) • Stage 5 End Stage CKD (GFR <15 mL/min)

  7. Clinical manifestations. • Cardiovascular manfestations: • Hypertension. • Heart failure. • Pulmonary edema. • Pericarditis. • Dermatologic symptoms: • Severe itching. • Uremic frost (the deposit of urea crystals on the skin)

  8. Other Systemic Manifestations. • Anorexia, nausea, vomiting, and hiccups.(GI System) • Neurologic changes, including altered levels of consciousness, inability to concentrate, muscle twitching, and seizures, have been observed

  9. Assessment and Diagnostic Findings. • GLOMERULAR FILTRATION RATE Decreased GFR can be detected by creatinineclearence. • Sodium And Water Retention. • Acidosis • Anemia : Due to inadequate erythropoetin production. • Calcium and phosphorus imbalance.

  10. Complications. • Hyperkalemia due to decreased excretion, metabolic acidosis, catabolism, and excessive intake (diet, medications, fluids) • Pericarditis, pericardial effusion, and pericardial tamponade due to retention of uremic waste products and inadequate dialysis

  11. Hypertension due to sodium and water retention and malfunction of the renin–angiotensin–aldosterone system • Anemia due to decreased erythropoietin production, decreased RBC life span, bleeding in the GI tract from irritatint toxins, and blood loss during hemodialysis.

  12. Bone disease and metastatic calcifications due to retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated aluminum levels.

  13. Medical Management. • Antacids. Hyperphosphatemia and hypocalcemia are treated with aluminum-based antacids that bind dietary phosphorus in the GI tract. • Antihypertensive and Cardiovascular Agents. • Antiseizure Agents(keprra-500 mg twice daily) • Erythropoietin(50-100 units/kg IV/SC 3 times weekly initially)

  14. Nutritional Therapy. • Dietary intervention is necessary with deterioration of renal function and includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance sodium losses, and some restriction of potassium.

  15. At the same time, adequate caloric intake and vitamin supplementation must be ensured. • Protein is restricted because urea, uric acid, and organic acids accumulate in the blood as end products.

  16. Dialysis. • Hyperkalemia is usually prevented by ensuring adequate dialysis treatments with potassium removal and careful monitoring of all medications, both oral and intravenous, for their potassium content.

  17. Other therapies. • Hemofilteration/ Hemdiafilteration. • Kidney transplantation. • Hemodialysis. • Peritoneal dialysis.

  18. The patient is placed on a potassium-restricted diet. Occasionally Kayexalate, a cation-exchange resin, administered orally, may be needed. • The patient with increasing symptoms of chronic renal failure is referred to a dialysis and transplantation center.

  19. Nursing management. • ASSESSMENT: • History Collection • Physical examination.

  20. Nursing Management- Nursing diagnosis. • Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water • Imbalanced nutrition: less than body requirements related to anorexia, nausea and vomiting, dietary restrictions, and altered oral mucous membranes

  21. Deficient knowledge regarding condition and treatment regimen • Activity intolerance related to fatigue, anemia, retention of waste products, and dialysis procedure

  22. Low self-esteem related to dependency, role changes, changes in body image, and sexual dysfunction

  23. Promoting Home And Community-based Care. • Teaching Patients Self-Care. The nurse plays an extremely important role in teaching the patient with ESRD. Because of the extensive teaching needed, the home care nurse, dialysis nurse, and nurse in the outpatient

  24. setting all provide ongoing education and reinforcement while monitoring the patient’s progress and compliance with the treatment regimen

  25. A nutritional referral and explanations of nutritional needs are helpful because of the numerous dietary changes required.

  26. The patient is taught how to check the vascular access device for patency and how to take precautions, such as avoiding venipunctures and blood pressure measurements on the arm with the access device.

  27. When you should report to health care provider. • Worsening signs and symptoms of renal failure (nausea, vomiting, change in usual urine output [if any], ammonia odor on breath) • Signs and symptoms of hyperkalemia (muscle weakness ,diarrhea, abdominal cramps)

  28. Signs and symptoms of access problems (clotted fistula or graft, infection)

  29. GerontologicConsiderations. • Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure.

  30. Summary. • Today we have discussed on the definition, causes,pathophysiology,clinical manifestations ,stages,complications, assessment and diagnostic findings of chronic renal failure. • We have also discussed on management of chronic renal failure.

  31. Conclusion. • Now a days chronic renal failure is a disease that requires atmost attention and care. Knowledge about the disease is essential in the health care set up.

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