2. Stella Lawal NUR 532 Molloy College

3. Response to the following questions  How many pair of kidney does a person has?  Where are they located?  What are the functions of the kidneys?

4. Chronic kidney failure  Major health concern in the United States and worldwide  The ninth leading cause of death in the U.S.A.  Affects as many as 25 million people.  More than 500,000 people have end-stage renal disease (ESRD)

5.  An estimated 920,000 patients on dialysis through out the world.  The figure increases by approximately 7-9% per year. (Chamney, Pugh-Clarke, & Kafkia, 2009, Journal of Renal Care) (Wells, 2011, Nephrology Nursing Journal)

7.  To provide 27 nurses with information and understanding necessary to care, monitor and educate their patients with chronic kidney failure  Dorothea Orem (Theory of Self-Care Deficit)  Believed that people have a natural ability for self- care  Management of patients with chronic kidney failure is critical for positive quality of life

8.  At the end of the lesson, the students will be able to: Define chronic kidney failure List the risk factors of chronic kidney failure Identify stages of kidney disease Identify signs and symptoms of chronic kidney failure Identify the association of chronic kidney failure with cardiovascular disease List the complications and the treatment of chronic kidney failure Understand the general management required to deal with chronic kidney failure’s patient.

10.  Filter blood  Remove wastes  Control body’s fluid balance  Regulate the balance of electrolytes

11.  Diabetes – Glucose sugar >110 mg/dl  Hypertension - >130/80 mmHg  Metabolic Syndrome Abdominal obesity (waist circumference: men>40 inches & women >35 inches) Triglycerides (fatty acid) >150mg/dl HDL cholesterol (men <40 mg/dl & women <50 mg/dl)  Urinary Tract Infections

12.  Family history  Older age  Black Race  Smoking  Obesity

13.  Asymptomatic disorder  Noticeable in well advanced damage  Symptoms (Subjective) – patient’s feelings Lower back pain Fatigue Nausea/Vomiting Decrease in appetite Edema of feet, ankles or around the eyes

14.  Signs (Objective) – detect by others Anemia Hematuria Hyperkalemia Albuminuria Decrease urine output

15.  Glumerular Filteration Rate:  Test that measures the volume of waste filtered out of the plasma per minute.  Stages:  Stage I - Kidney damage with normal or increased GFR ≥ 90ml/min  Stage II - Kidney damage with decrease GFR 60 – 89ml/min

16.  Stage III Moderately decreased GFR 30 – 59  Stage IV Severely decreased GFR 15 – 29  Stage V Kidney failure < 15ml/min

17.  Hypertension  Excess calcium and phosphorus could not be eliminated  Resulting into calcification (coronary & arterial stiffness)  Narrow arteries reduce vascular compliance  Increase systolic blood pressure  Left ventricular hypertrophy and myocardial ischemia (Drawz & Rahman, 2009, American College of Physicians)

18.  Anemia  Decrease red blood cell  Decline in synthesis of erythropoietin  Prolong anemia could result to congestive heart failure  Reduce tissue oxygen could cause increase in heart rate

19.  Metabolic Abnormalities  Decrease in normal homeostasis due to decline GFR and synthesis of renal hormones  Hyperkalemia and metabolic acidosis  Diabetes  High glucose damage arteries (hard)  Fatty material that builds up inside blood vessels can block flow of blood (heart attack or stroke)

20.  Hypertension  Antihypertensive Therapy (protects and reduces progression of disease ACE inbitors e.g. Captopril, Enalapril, Lisinopril ARBS (Angiotensin II RAeceptor Blockers) e.g Diovan  Hyperlipidemia  Dyslipidemia: LDL < 100 mg/dl  Statin Therapy

21.  Metabolic Syndrome  Metabolic acidosis – sodium bicarbonate  Hyperphostemia  Limit dietary phosphate e.g. dairy products, peas, beer  Phosphate binders take with meals - calcium carbornate  Volume Overload  Restrict dietary sodium  Diuretic therapy – Furosomide & Hydrochorothiazide

22.  Hyperkalemia  Low potassium diet, Kayexalate  Renal Osteodystrophy: changes in mineral metabolism and bone structure  Calcitrol  Malnutrition

23.  Hemodialysis Therapy  Replaces kidney functions  Filters waste  Remove extral fluids  Balances electrolytes  Hemodialysis Access  AV Fistula: Preferred, months to mature  Cuffed Tunneled Catheters: Central venous cathers and can be used immediately after placement  AV Grafts: AV fistula with synthetic material

25.  AV Fistula – abnormal passageway between an artery and a vein

27.  Peritoneal Dialysis:  Removal and transferring of body soluble substances and water across the peritoneum using peritoneal solution introduced into and from peritoneal cavity.  Peritoneal dialysis catheters can be used immediately after placement.  Kidney Transplantation

29.  Smoking Cessation Reduces cardiac events by 50% in the first 2 years  Brisk walk for half an hour per day Reduces relative risk by 20%  Reducing weight to a body mass index of 25 inches  Monitor intake of: carbohydrate, sodium, high cholesterol diet, (Jenkins & Kirk, 2010, Journal of Renal Care)

30. 1. List 2 risk factors of chronic kidney failure (a) Hypertension (b) Diabetes 2.Identify the most common manifestation of kidney disease (a) Edema (b) Pain (c) Albuminuria (d) Heart failure

31. 3. All of the following are among the preventive measures of chronic kidney disease EXCEPT: (a) Exercise (b) Weight reduction (c) Smoking cessation (d) Drinking alcohol