2. J Winterbottom 2005 Chronic Renal Failure (CRF) (End stage renal disease ) (ESRD)

3. J Winterbottom 2005

4. Kidney Function  Detoxify blood  Increase calcium absorption  Stimulate RBC production –erythropoietin  Regulate blood pressure, electrolyte and fluids –Urine formation –Filtration –GFR =the total rate of filtration of blood by the kidney

5. J Winterbottom 2005

6. Chronic Renal Failure  CRF or ESRD is a Progressive, irreversible deterioration in renal function in which the body ability to maintain metabolic and fluid and electrolyte balance fails, resulting in uremia or azotemia and marked affect on all body system  Uremia or azotemia – retention of urea and other nitrogenous wastes in the blood  CRF or ESRD is a Progressive, irreversible deterioration in renal function in which the body ability to maintain metabolic and fluid and electrolyte balance fails, resulting in uremia or azotemia and marked affect on all body system  Uremia or azotemia – retention of urea and other nitrogenous wastes in the blood

7. J Winterbottom 2005 Stages of Chronic Renal Failure  Diminished Renal Reserve Normal BUN, and serum creatinine absence of symptoms  Renal Insufficiency occurs when 75% to 90% of nephron function is lost. At this point BUN and Creatinine levels rise. The patient may develop polyuria and nocturia i  ESRD the final stage of CRF, occurs when there is less than 10% nephron function remaining. At this point all renal function are severely impaired.  Diminished Renal Reserve Normal BUN, and serum creatinine absence of symptoms  Renal Insufficiency occurs when 75% to 90% of nephron function is lost. At this point BUN and Creatinine levels rise. The patient may develop polyuria and nocturia i  ESRD the final stage of CRF, occurs when there is less than 10% nephron function remaining. At this point all renal function are severely impaired.

8. J Winterbottom 2005 Common causes of Chronic Renal Failure  Glomerulonephritis25%  Diabetes Mellitus25%  Hypertension10%  Chronic pylonephritis/reflux10%  Polycystic kidney disease10%  Interstitial nephritis5%  Obstruction3%  Unknown12%

9. J Winterbottom 2005 Clinical feature  neurologic =- weakness, confusion, tremors, seizures and behavior changes  Gastrointestinal =- anorexia, nausea, vomiting, hiccups, constipation or diarrhea, mouth ulceration and bleeding  Hematologic =- anemia and thrombocytopenia  Pulmonary =- shortness of breath, crakles, pleurtic pain, haemoptysis and P odema  Cardiovascular =- hypertension, pitting edema, pericarditis, P effusion, neck vein distended,high K and lipid

10. J Winterbottom 2005  Muscuoloskeletal =- muscle cramps, bone pain and fracture and renal osteodystrophy  Urinary system =- oliguria, unuria,protein uria and haematouria  Reproductive =- amenorrhea,testicular atrophy,infertility and decreased libido  Integumentry =- dry skin, pruritus and thining hair  Electrolyte disturbance

11. J Winterbottom 2005 Diagnostics Tests  Renal Ultrasound Obstruction in urinary collecting system Number,size & symmetry of kidneys  Bladder Xray Calculi, tumours & cysts  Renal Biopsy Determine extent of pathology

12. J Winterbottom 2005  Protein in urine  Elevated biochemistry results i.e. CreatinineUreaPotassium  Anaemia from decreased RBC production shortened RBC survival

13. J Winterbottom 2005 Management of chronic renal failure  Determine and treat cause  Optimise salt and water balance  Identify appropriate dietary advice  Control hypertension  Control electrolyte imbalance  Prevent and treat renal bone disease  Early detection and treatment of infection  Modify drug therapy inline with decline in renal function  Detect and treat any complications  Prepare for dialysis and transplant programme

14. J Winterbottom 2005 Treating ESRD 4 forms of treatment;  HAEMODIALYSIS  PERITONEAL DIALYSIS (CAPD)  TRANSPLANTATION  CONSERVATIVE

15. J Winterbottom 2005 Complication  Metabolic acidosis, electrolyte disturbance  Pulmonary edema  Anemia, heart failure  HTN, ureimic pericarditis  Low immune  Death

16. J Winterbottom 2005 Nursing process  Assessment =-  Assess chief complain  Assess fluid status  Assess nutritional condition  Assess V\S  Assess LOC  Assess knowledge

17. J Winterbottom 2005 Nursing diagnosis  Fluid volume excess R\L to decrease GFR and sodium retention  Goal =- maintain fluid balance  N intervention =-  Assess patient for S\S of hypervolemia  Monitor intake and out put  Monitor serum electrolyte  Fluid allowance should be distributed through out the day

18. J Winterbottom 2005  Restrict sodium and water intake if there is evidence of fluid excess  Auscultate lung for sings of fluid over load  Weight the patient daily  Reassess fluid status

19. J Winterbottom 2005 altered nutrition less than body requirement R\L to anorexia,nausea, vomiting and restrict diet altered nutrition less than body requirement R\L to anorexia,nausea, vomiting and restrict dietGoal=- Maintaining adequate nutrition =- N. intervention =- Assess nutritional status Restrict protein intake, if the patient on dialysis protein will be increased to replace loss of amino acid during dialysis

20. J Winterbottom 2005  Con=-  Increase carbohydrate diet to provide additional calories  Restrict food containing high sodium and potassium  Maintain regular dialysis  Reassess nutritional status  Impaired skin integrity R\L to uremic frost and change in sweating gland

21. J Winterbottom 2005  Impaired level of consciousness R\L to the effect of urea on CNS  Risk for infection R\L to alteration in the immune system  Risk for bleeding R\L to platelet dysfunction  Risk for collaborative problems  Knowledge deficit regarding disease, diet,treatment and complication

22. J Winterbottom 2005 Any Questions