Fact sheet: Diabetic Kidney Disease

Diabetes is the number one cause of CKD. Over a number of years diabetes causes damage to the tiny blood vessels in your kidney. It is important to manage your diabetes well. Keeping your blood sugar in a healthy range will slow down the damage to your kidney. All types of diabetes cause kidney disease. Each kidney contains up to one million nephrons, the filtering units of the kidneys. Inside a nephron is a tiny set of looping blood vessels called the glomerulus. Damage to these filters caused by diabetes is called Diabetic Kidney Disease - and can also be known as Diabetic Nephropathy (refer to animations for more info). Healthy blood sugar Keeping your blood sugar in a healthy range is very important. Your blood sugar is controlled by the food that you eat, and by the insulin or medications that you take. Four important steps are:

take your insulin or medications as prescribed by your doctor every day eat a healthy diet, avoiding foods that are high in sugar - an Accredited Practicing Dietitian is the best person to advise you on the best diet for your personal health profile test your blood sugar level regularly visit your health professional regularly

Healthy weight Being overweight is the cause of diabetes for many people. Reducing weight can reduce the need for medications to control the diabetes. If the diabetes is better controlled you are less likely to get kidney disease. Steps to achieve a healthy weight are:

avoid foods that are high in sugar and fat - an can advise on your diet - the changes to your diet should be possible to maintain every day if you need support to lose weight you may benefit from joining an accredited weight loss organisation - talk to your doctor about this do exercise every day, at a level that is safe for you - see our Fitness section

Healthy feet The blood supply to your feet can also be damaged by your diabetes. Any damage to your feet may heal slowly. When your sugar is high you may be at more risk of infections. Those with chronic kidney disease also heal slower and are at more risk of infections. Unhealthy feet can lead to amputations, and the damage often starts with a small cut. Four important steps to care for your feet are:

wear protective and well fitted shoes outdoors visit a podiatrist regularly - they will advise how offen you need to visit treat any minor cuts seriously - apply antiseptic and a basic dressing - seek advice from your doctor if there are any signs of infection or

healing does not occur with a week

keep your blood sugar in normal range

Healthy eyes The blood supply to your eyes can also be damaged by your diabetes. Any damage to your eyes will reduce your vision. Some damage is permanent, but some blood vessel damage can be fixed with minor laser surgery. Three important steps to care for your eyes are:

visit an eye specialist annually keep your blood sugar in a normal range use prescribed glasses or contact lenses to give you good vision - poor vision can lead to falls.

DIABETIC KIDNEY DISEASE Diabetic Kidney Disease worsens diabetic complications such as nerve and eye damage, as well as increasing the risk of cardiovascular (heart) problems. Diabetic nephropathy damages blood vessels including those in your kidney filters and if severe, can lead to kidney failure. Signs that you and your doctor will monitor, in particular for diabetic kidney disease, are:

Increasing amounts of albumin (or protein) in urine A slightly raised level of the protein albumin in the urine (albuminuria) is an early warning sign for diabetic kidney disease. As the filters thicken, larger amounts of albumin and other proteins are lost (proteinuria). Proteinuria can lead to problems with the bodys fluid balance and result in swelling (oedema), often in the legs, feet, face and hands. Increased urine protein Associated with damage to other parts of the kidney causing scarring and reduced kidney function. This damage is similar for Type 1 and Type 2 diabetes and can only be seen under a high-powered microscope so your doctor may speak to you about having a kidney biopsy. Rising blood pressure Slowly increasing protein is usually linked with a rise in blood pressure. This rise is small at first and may only be detected by taking blood pressure over 24-hours. Even small rises in blood pressure need to be treated, as uncontrolled high blood pressure increases the risk of kidney damage. Declining kidney function The kidney filtration rate does not usually begin to fall until diabetic kidney disease is well established. Once filtration is reduced, it tends to fall at a steady rate unless the right treatment is given in which case the kidney damage will stabilise until diabetic kidney disease is well established. Maintaining normal blood glucose levels is important in helping reduce kidney problems in people with diabetes.

What are the complications of diabetic kidney disease? If you have diabetic kidney disease, the other complications of diabetes can be made worse, including:-

Cardiovascular disease Cardiovascular or heart disease includes all diseases and conditions of the heart and blood vessels, such as arteries and veins. The most common diseases and conditions include heart attack, heart failure, stroke and blockages in the blood vessels. The risk of cardiovascular disease is much higher in people with chronic kidney disease, particularly if they have diabetes. Retinopathy This is a complication causing blindness or visual impairment. There is an increased risk of retinopathy for people with Type 1 diabetes and diabetic kidney disease. This risk is not yet well understood for Type 2 diabetes. Some ethnic backgrounds may put people with diabetic kidney disease at greater risk of retinopathy.

Neuropathy People with diabetes may be at more risk of damage to their nerve fibres (neuropathy). This can cause weakness in the arms and legs or problems in organs, e.g. digestive tract, heart and sexual organs. Fact sheet: Diabetic Kidney Disease

Diabetes is the number one cause of CKD. Over a number of years diabetes causes damage to the tiny blood vessels in your kidney. It is important to manage your diabetes well. Keeping your blood sugar in a healthy range will slow down the damage to your kidney. All types of diabetes cause kidney disease. Each kidney contains up to one million nephrons, the filtering units of the kidneys. Inside a nephron is a tiny set of looping blood vessels called the glomerulus. Damage to these filters caused by diabetes is called Diabetic Kidney Disease - and can also be known as Diabetic Nephropathy (refer to animations for more info). Healthy blood sugar Keeping your blood sugar in a healthy range is very important. Your blood sugar is controlled by the food that you eat, and by the insulin or medications that you take. Four important steps are:

take your insulin or medications as prescribed by your doctor every day eat a healthy diet, avoiding foods that are high in sugar - an Accredited Practicing Dietitian is the best person to advise you on the best diet for your personal health profile test your blood sugar level regularly visit your health professional regularly

Healthy weight Being overweight is the cause of diabetes for many people. Reducing weight can reduce the need for medications to control the diabetes. If the diabetes is better controlled you are less likely to get kidney disease. Steps to achieve a healthy weight are:

avoid foods that are high in sugar and fat - an can advise on your diet - the changes to your diet should be possible to maintain every day if you need support to lose weight you may benefit from joining an accredited weight loss organisation - talk to your doctor about this

do exercise every day, at a level that is safe for you - see our Fitness section

Healthy feet The blood supply to your feet can also be damaged by your diabetes. Any damage to your feet may heal slowly. When your sugar is high you may be at more risk of infections. Those with chronic kidney disease also heal slower and are at more risk of infections. Unhealthy feet can lead to amputations, and the damage often starts with a small cut. Four important steps to care for your feet are:

wear protective and well fitted shoes outdoors visit a podiatrist regularly - they will advise how offen you need to visit treat any minor cuts seriously - apply antiseptic and a basic dressing - seek advice from your doctor if there are any signs of infection or healing does not occur with a week keep your blood sugar in normal range

Healthy eyes The blood supply to your eyes can also be damaged by your diabetes. Any damage to your eyes will reduce your vision. Some damage is permanent, but some blood vessel damage can be fixed with minor laser surgery. Three important steps to care for your eyes are:

visit an eye specialist annually keep your blood sugar in a normal range use prescribed glasses or contact lenses to give you good vision - poor vision can lead to falls.

Look, listen and learn online - view How diabetes occurs (Virtual Medical Centre) or visit The Diabetes Channel (excellent education videos) and audio fact sheets via Australian Diabetes Council. KHA Kidney Health Resources: *Chronic Kidney Disease *Kidney Health and Blood Pressure *Proteinuria *Your heart and CKD Kidney Health Australia works closely with Diabetes Australia and the Australian Diabetes Council to collaborate and to educate that diabetes is a major cause of kidney failure. DIABETIC KIDNEY DISEASE Diabetic Kidney Disease worsens diabetic complications such as nerve and eye damage, as well as increasing the risk of cardiovascular (heart) problems. Diabetic nephropathy damages blood vessels including those in your kidney filters and if severe, can lead to kidney failure. Signs that you and your doctor will monitor, in particular for diabetic kidney disease, are:

Increasing amounts of albumin (or protein) in urine A slightly raised level of the protein albumin in the urine (albuminuria) is an early warning sign for diabetic kidney disease. As the filters thicken, larger amounts of albumin and other proteins are lost (proteinuria). Proteinuria can lead to problems with the bodys fluid balance and result in swelling (oedema), often in the legs, feet, face and hands. Increased urine protein Associated with damage to other parts of the kidney causing scarring and reduced kidney function. This damage is similar for Type 1 and Type 2 diabetes and can only be seen under a high-powered microscope so your doctor may speak to you about having a kidney biopsy. Rising blood pressure Slowly increasing protein is usually linked with a rise in blood pressure. This rise is small at first and may only be detected by taking blood pressure over 24-hours. Even small rises in blood pressure need to be treated, as uncontrolled high blood pressure increases the risk of kidney damage. Declining kidney function The kidney filtration rate does not usually begin to fall until diabetic kidney disease is well established. Once filtration is reduced, it tends to fall at a steady rate unless the right treatment is given in which case the kidney damage will stabilise until diabetic kidney disease is well established. Maintaining normal blood glucose levels is important in helping reduce kidney problems in people with diabetes.

What are the complications of diabetic kidney disease? If you have diabetic kidney disease, the other complications of diabetes can be made worse, including:

Cardiovascular disease Cardiovascular or heart disease includes all diseases and conditions of the heart and blood vessels, such as arteries and veins. The most common diseases and conditions include heart attack, heart failure, stroke and blockages in the blood vessels. The risk of cardiovascular disease is much higher in people with chronic kidney disease, particularly if they have diabetes. Retinopathy This is a complication causing blindness or visual impairment. There is an increased risk of retinopathy for people with Type 1 diabetes and diabetic kidney disease. This risk is not yet well understood for Type 2 diabetes. Some ethnic backgrounds may put people with diabetic kidney disease at greater risk of retinopathy. Neuropathy People with diabetes may be at more risk of damage to their nerve fibres (neuropathy). This can cause weakness in the arms and legs or problems in organs, e.g. digestive tract, heart and sexual organs.

Diabetes also affects your kidneys in other ways Changes to the immune system that occur in diabetes make a person more vulnerable to kidney and Urinary Tract Infections (UTIs). Nerve damage can also affect your bladder making it more difficult to pass urine. Urine build up in the bladder can create a back flow into your kidneys resulting in scarring. If you have diabetes, your chance of kidney damage greatly increases if you smoke and/or have high blood pressure, high cholesterol or proteinuria. It is also affected by:

Family history and genetic factors Some studies suggest that if there is a family history of high blood pressure or cardiovascular disease, your risk of diabetic nephropathy increases. Currently the genes for diabetic nephropathy have not been identified, but if your parent(s)

have this condition, then you are more likely to have it. Hyperglycaemia Also known as high blood sugar, it is a strong risk factor for developing diabetic nephropathy. It damages the small blood vessels in the kidneys, particularly to the capillaries in the kidney filters. Control of blood sugar levels may slow down the development of diabetic nephropathy. If you have diabetic nephropathy, regular monitoring of your blood sugar levels is very important. You may need adjustments to your diabetic medication as insulin is excreted via the kidneys. Good control of blood sugar levels and blood pressure can reduce, or in some cases, prevent further kidney damage.

Which factors increase the risk of diabetic kidney disease? About one third of all people with diabetes develop Diabetic Kidney Disease, which may affect your kidney function by causing: Damage to blood vessels Even with the use of injected insulin, diabetes can cause damage to the small blood vessels in the body. The tiny blood vessels in the filters of the kidney (the glomeruli) may also be affected. In the early stage, this damage causes small amounts of protein in the urine. At a later stage, so much protein can be lost from the blood that water moves into the body tissues and causes swelling. After a number of years, the kidney filters can fail completely. Damage to nerves Diabetes can also damage the nerves in many parts of the body. When the bladder is affected, it may be difficult to pass urine. If urine builds up in the bladder, the pressure can make it to flow back into the kidneys causing scarring and kidney damage. Some factors increasing the risk of diabetic kidney disease cannot be changed Duration of diabetes Early signs of Chronic Kidney Disease in people with diabetes is less than 10% in the first ten years and rises to between 2030% over the next ten years. If diabetes is diagnosed late, urine protein may be present. Family history and genetic factors The genes for diabetic kidney disease have not been identified. However some studies suggest that for people with diabetes, a family history of high blood pressure or heart disease can increase the risk of diabetic kidney disease. Age A natural, slow decline is the kidneys ability to filter blood occurs as you get older. During adulthood, approximately 8% of kidney function appears to be lost with each decade of life. Aboriginal and Torres Strait Islander heritage Diabetes is more common in people of Aboriginal or Torres Strait Island descent. Subscribe to our Kidney Community News To receive our monthly Kidney Community News - email subscribe@kidney.org.au providing your name, address details and interest in CKD. You may also ring 1800 4 543 639 and our staff will sign you up, or simply subscribe from our home page.

GOOD NEWS - YOU CAN LOWER YOUR RISK OF DIABETIC KIDNEY DISEASE

The risk of Type 2 diabetes can be reduced by up to 60% by adopting a healthy and active lifestyle, especially losing weight. This may mean using medication as well as making healthy lifestyle choices. Take control of your own health - your health care team will give you advice about how YOU can take positive steps to avoid this diagnosis. If you have diabetes, you should have a blood test for kidney function and have your urine checked for microalbuminuria at least once a year. Some other important actions are:

ensure your insulin levels and diabetic control is excellent be aware of and maintain good blood pressure control be a non-smoker QUIT 13 78 48 ask for free Quit Pack treat urine infections (UTIs) immediately Eat low GI carbohydrates choose the right foods - consult your doctor or dietitian about a suitable diet

to maintain a healthy weight and maintain healthy cholesterol levels

drink alcohol in moderation maintain a positive 'stay well' attitude do things to relax and reduce stress in your daily life

PREVENTION

To protect your kidneys, these tips can help:

Be aware of your family medical history - if close blood family relatives have had kidney disease or other chronic disease, you may be 'at risk' too? Ask what their health problems were and be aware of the risk. If you are at 'increased risk' of developing kidney disease - ask your GP for a kidney health check.

Maintain healthy cholesterol levels. Eat a healthy diet full of fresh fruit and vegetables. Maintain healthy weight for your height - being overweight increases your risk of developing diabetes and high blood pressure which are major risk factors for kidney disease. Be aware of your Body Mass Index (BMI). Low Glycaemic index (GI) foods - enter < 55) Be a non-smoker - smokers are 3 times more likely to have reduced kidney function, and 4 to 5 times greater risk of heart attack and stroke! Make physical activity a regular habit - 30 minutes of regular moderate-intensity physical activity. Drink water instead - water satisfies thirst without any calories or kilojoules. Drink alcohol in moderation - limit alcohol to 2 standard drinks per day for men, 1 per day for women. If you have diabetes, maintain good blood glucose control. Taking medications as prescribed by your doctor. Maintain a positive 'stay well' attitude, do things that help you to relax and reduce stress.

WHAT ARE THE SYMPTOMS OF KIDNEY DISEASE? There are no warning signs for CKD and individuals can lose up to 90% of their kidney function before they feel any symptoms - and by then it's too late. The symptoms of reduced kidney function may include:

high blood pressure changes in the amount and number of times urine is passed, e.g. at night changes in the appearance of urine blood in the urine puffiness e.g. legs and ankles pain in the kidney area tiredness

loss of appetite difficulty sleeping headaches lack of concentration itching shortness of breath nausea and vomiting bad breath and a metallic taste in the mouth

These symptoms may worsen gradually as kidney function declines. However, the symptoms are very general and may be caused by other illness. If you are you are at increased risk of kidney disease, as explained above, or are experiencing many of these symptoms, ask your doctor for a kidney health check. WHAT ARE THE STAGES OF KIDNEY FAILURE - WHAT DO THEY MEAN? These images represent different stages used by doctors to determine the severity of chronic kidney disease:

Early stages of kidney failure - small amount of kidney damage, although GFR may be normal

Often there are no symptoms in the early stages of kidney disease, blood tests can be normal. There may be scarring and blockages that change blood flow to parts of the kidney so they don't work as well as they should. There is an increased risk of heart disease. You doctor can help you reduce your risk of heart disease.

Middle stages of kidney failure - sometimes discovered because level of waste product in the blood rises

Some people begin to feel unwell and notice an increase in urine frequency. Blood pressure can rise as the kidneys slow down. High blood pressure further increases the risk of heart disease, heart attack and stroke. Early signs of bone disease may be present. Anaemia may appear, caused when there are not enough red blood cells in the blood to carry oxygen around the body. Symptoms include weakness, fatigue and a shortness of breath.

Later stages of kidney failure

High blood pressure almost always occurs. You may start to notice changes in the amount of urine you pass. Lack of energy, increased tiredness and reduced appetite are common symptoms. You may need to make dietary changes, including limiting the use of salt or reducing the amount of potassium or phosphorus in your diet.

End-Stage Kidney Disease (ESKD)

The kidneys are only functioning at 10-15 per cent of their capacity and are unable to properly filter waste products, remove extra water from the body and help maintain the blood's chemical balance. This is the time to consider commencing dialysis or having a kidney transplant.

Adjusting to kidney failure is more difficult for some people than others, even with time to prepare for it. When there is no time to prepare, the sudden impact makes dealing with kidney failure much harder.

The underlying pathophysiology defect in type 2 diabetes is characterized by the following three disorders (1) peripheral resistance to insulin, especially in muscles cells: (2) increased production of glucose by the liver, and (3) altered pancreatic secretion. Increased tissue resistance to insulin generally occurs first and eventually followed by impaired insulin secretions. The pancreas produces insulin, yet insulin resistance prevents its proper use at the cellular level. Glucose cannot enter target cells and accumulates in the blood streams, resulting in hyperglycemia. The high blood glucose levels often stimulate an increase in insulin production by the pancreas: thus. Type 2 diabetic individuals often have excessive insulin production (hyperinsulinemia). Insulin resistance refers to tissue sensitivity to insulin. Intracellular reaction are diminished, making insulin less effective at stimulating glucose uptake by the tissues and regulating glucose release by the liver. If blood glucose levels are elevated consistently for a significant period of time, the kidneys filtration mechanism is stressed, allowing blood proteins to leak into the urine. As a result, the pressure in the blood vessels of the kidney increases. It is thought that the elevated pressure serves as the stimulus the level of nephropathy.

The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus. At this stage, the kidney

may start allowing more albumin (protein) than normal in the urine, and this can be detected by sensitive tests for albumin. As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed. Now the amounts of albumin being excreted in the urine increases, and may be detected by ordinary urinalysis techniques. At this stage, a kidney biopsy clearly shows diabetic nephropathy and eventually leads to Chronic renal failure

NCP
Chronic Renal Failure (CRF) is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Nursing Care Plans

Below contains five nursing care plans for patients with chronic renal failure. 1. Fluid Volume Excess Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria. 2. Home Nursing Care Plans 5 Chronic Renal Failure Nursing Care Plans

5 Chronic Renal Failure Nursing Care Plans

Posted by: Matt Vera in Nursing Care Plans December 22, 2011 Last updated on July 11th, 2013 0 628 Views

Definition
Contents [hide]

1 Definition 2 Nursing Goal 3 Nursing Care Plans

o o o o

3.1 Fluid Volume Excess 3.2 Acute Pain 3.3 Altered Renal Tissue Perfusion 3.4 Impaired Urinary Elimination

o o

3.5 Altered Nutrition: Less than Body Requirements 3.6 Other Possible Nursing Care Plans

Chronic Renal Failure (CRF) is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Nursing Care Plans

Below contains five nursing care plans for patients with chronic renal failure. Fluid Volume Excess Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria. Acute Pain Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any caused or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his/her costovertebral area/flank.
Home Nursing Care Plans 5 Chronic Renal Failure Nursing Care Plans

5 Chronic Renal Failure Nursing Care Plans

Posted by: Matt Vera in Nursing Care Plans December 22, 2011 Last updated on July 11th, 2013 0 628 Views

Definition
Contents [hide]

1 Definition 2 Nursing Goal 3 Nursing Care Plans

o o o o

3.1 Fluid Volume Excess 3.2 Acute Pain 3.3 Altered Renal Tissue Perfusion 3.4 Impaired Urinary Elimination

o o

3.5 Altered Nutrition: Less than Body Requirements 3.6 Other Possible Nursing Care Plans

Chronic Renal Failure (CRF) is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Nursing Care Plans

Below contains five nursing care plans for patients with chronic renal failure. Fluid Volume Excess Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria. Acute Pain Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any caused or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his/her costovertebral area/flank. Altered Renal Tissue Perfusion For optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result of BUN, Creatinine, Uric Acid Level.
Home Nursing Care Plans 5 Chronic Renal Failure Nursing Care Plans

5 Chronic Renal Failure Nursing Care Plans

Posted by: Matt Vera in Nursing Care Plans December 22, 2011 Last updated on July 11th, 2013 0 628 Views

Definition
Contents [hide]

1 Definition 2 Nursing Goal 3 Nursing Care Plans

o o o o

3.1 Fluid Volume Excess 3.2 Acute Pain 3.3 Altered Renal Tissue Perfusion 3.4 Impaired Urinary Elimination

o o

3.5 Altered Nutrition: Less than Body Requirements 3.6 Other Possible Nursing Care Plans

Chronic Renal Failure (CRF) is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Nursing Care Plans

Below contains five nursing care plans for patients with chronic renal failure. Fluid Volume Excess Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.
View this document on Scribd

Acute Pain Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any caused or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his/her costovertebral area/flank. Altered Renal Tissue Perfusion For optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result of BUN, Creatinine, Uric Acid Level.

Impaired Urinary Elimination Renal Failure is a problem which results to loss of kidney functions and as GFR decrease, the kidney cannot excrete nitrogenous product and fluid causing impaired in Urinary elimination and together with prolonged use of medications such as NSAIDs this will lead to further kidney destruction which may thus decreasing the glomerular filtration and destroying of the remaining nephrons. This will result into inability of the kidney to concentrate urine which makes the patient to have a nursing diagnosis of impaired urinary elimination.

Home Nursing Care Plans 5 Chronic Renal Failure Nursing Care Plans

5 Chronic Renal Failure Nursing Care Plans

Posted by: Matt Vera in Nursing Care Plans December 22, 2011 Last updated on July 11th, 2013 0 628 Views

Definition

Contents [hide]

1 Definition 2 Nursing Goal 3 Nursing Care Plans

o o o o o o

3.1 Fluid Volume Excess 3.2 Acute Pain 3.3 Altered Renal Tissue Perfusion 3.4 Impaired Urinary Elimination 3.5 Altered Nutrition: Less than Body Requirements 3.6 Other Possible Nursing Care Plans

Chronic Renal Failure (CRF) is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Nursing Care Plans

Below contains five nursing care plans for patients with chronic renal failure. Fluid Volume Excess Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.
View this document on Scribd

Acute Pain Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any caused or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his/her costovertebral area/flank.
View this document on Scribd

Altered Renal Tissue Perfusion For optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result of BUN, Creatinine, Uric Acid Level. Impaired Urinary Elimination Renal Failure is a problem which results to loss of kidney functions and as GFR decrease, the kidney cannot excrete nitrogenous product and fluid causing impaired in Urinary elimination and together with prolonged use of medications such as NSAIDs this will lead to further kidney destruction which may thus decreasing the glomerular filtration and destroying of the remaining nephrons. This will result into inability of the kidney to concentrate urine which makes the patient to have a nursing diagnosis of impaired urinary elimination. Altered Nutrition: Less than Body Requirements Due restricted foods and prescribed dietary regimen, an individual experiencing renal problem cannot maintain ideal body weight and sufficient nutrition. At the same time patients may experience anemia due to decrease erythropoietic factor that cause decrease in production of RBC causing anemia and fatigue