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Disease
Description
* Chronic renal failure, or end-stage renal disease
(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.
Signs and Symptoms
* Cardiovascular: hypertension, pitting edema (feet,
hands, sacrum), periorbital edema, pericardial
friction rub, engorged neck veins, pericarditis,
pericardial effusion, pericardial tamponade,
hyperkalemia, hyperlipidemia.
* Integumentary: gray-bronze skin color, dry flaky
skin, pruritus, ecchymosis, purpura , thin brittle
nails, coarse thinning hair.
* Pulmonary: crackles; thick, tenacious sputum;
depressed cough reflex,: pleuritic pain; shortness of
breath; tachypnea; Kussmaul-type respirations;
uremic pneumonitis (“uremic lung”)
* Gastrointestinal: ammonia odor to breath (fetor
uremicus), metallic taste, mouth ulcerations and
bleeding, anorexia, nausea and vomiting, hiccups,
constipation or diarrhea, bleeding from
gastrointestinal tract.
* Neurologic: weakness and fatigue, confusion,
inability to concentrate, disorientation, tremors,
seizures, asterixis, restlessness of legs, burning of
soles of feet, behavior changes.
* Musculoskeletal: muscle cramps, loss of muscle
strength, renal osteodystrophy, bone pain,
fractures, foot drop.
* Reproductive: amenorrhea, testicular atrophy,
infertility, decrease libido.
* Hematologic: anemia, thrombocytopenia.
Diagnostic Procedures
* Blood tests ( to determine blood cell counts,
electrolytes levels, and kidney function.
* Urine tests
* Chest x-ray – a diagnostic test that uses
invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto
film.
* Bone scan- a nuclear imaging method to
evaluate any degenerative and/ or arthritic
changes in joints; to detect bone diseases and
tumors; to determine the cause of bone pain or
inflammation.
* Renal ultrasound- a non-invasive test in which a
transducer is passed over the kidney producing
sound waves which bounce off the kidney,
transmitting a picture of the organ on a video
screen. The test is use to determine the size and
shape of the kidney, and to detect a mass, kidney
stone, cyst or other obstruction or abnormalities.
* Electrocardiogram (ECG or EKG- a test that
records the electrical activity of the heart, shows
abnormal rhythms (arrhythmias or dysrhythmias),
and detects heart muscle damage.
*Assess nutritional status and address
factors contributing to nutritional imbalance.
* Assess patient’s understanding about the
condition and it treatment, explain renal function,
and assist patient to identify ways to incorporate
lifestyle changes related to illness and treatment.
* Assess factors contributing to fatigue.
* Assess patient’s and family’s responses and
reaction o illness and treatment. Encourage open
discussion of concerns about changes produced by
diasease and treatment.
* Assess for and monitor collaborative
problems (eg, hyperkalemia, pericarditis,
pericardial effusion and pericardial tamponade,
hypertension, anemia ,bone disease, and metastatic
calcifications.
Medical Management
* Complication can be prevented or delayed by
administering prescribed antihypertensive,
cardiovascular agents, anticonvulsants,
erythropoietin, iron supplements, phosphate-
binding agents, and calcium supplements.
* Dietary interventions needed with careful
regulation of protein intake, fluid intake to balance
fluid losses and sodium intake and with some
restriction of potassium.
* Adequate intake of calories and vitamins is
ensured. Calories are supplied with carbohydrates
and fats to prevent wasting.
* Protein is restricted; protein must be of high
biologic value (dairy products, eggs, meats.
* Vitamin supplementation.
* Fluid allowance is 500 to 600 mL of fluid or more
than 24- hour urine output.
Pharmacologic Management
*Hyperphosphatemia and hypocalcemia are treated
with aluminum-based antacids or calcium
carbonate; both must be given with food.
*Hypertension is managed by intravascular volume
control and antihypertensive medication.
* Heart failure and pulmonary edema are treated
with fluid restriction, low-sodium diet, diuretics,
inotropic agents, and dialysis.
* Metabolic acidosis is treated, if necessary, with
sodium bicarbonate supplements or dialysis.
*Patient is observed for early evidence of neurologic
abnormalities.
*The onset of seizures,type,duration,and general
effect on patient are recorded; physician is notified
immediately and patient is protected from injury
* Intravenous diazepam or phenytoin is administered to
control seizure.
*
Anemia is treated with recombinant human
erythropoietin; hematocrit is monitored frequently.
monitored.
*Patient is referred to a dialysis and transplantation
center early in the course of progressive renal
disease. Dialysis is initiated when patient cannot
maintain a reasonable lifestyle with conservative
treatment.
Other Nursing Interventions
Managing Excess Fluid Volume
*Assess fluid status and identify potential
sources of imbalanced.
*Monitor patient’s progress and complication with
treatment regimen.
Promoting Balance Nutrition
* Implement a dietary program to ensure
proper nutritional intake within the limits of the
treatment regimen.
* Provide a referral for a nutritional
consultation.
Educating the patient and Family
Teaching Patient’s Self-Care
* Provide ongoin g explanations and information to
patient and family concerning ESRD, treatment
options, and potential complications.
*Teach patient and family what problems to
report: signs of worsening renal failure,
hyperkalemia, assess problems.
* Provide medication teaching and show patient
undergoing hemodialysis how to assess vascular
access for patency and precaution to take.
Continuing Care
*Provide assistance and emotional support to
patient and family in dealing with dialysis and it’s
long term implications.
*Stress the importance of follow-up
examinations and treatment.
*Refer patient to home care nurse for
continued monitoring and support.
NURSING CARE
PLAN
Nursing diagnosis
by the client.