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Chronic renal failure

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Pinky Rathee

CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD) Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.

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BY PINKY RATHEE M.Sc. Nursing CHRONIC RENAL FAILURE
DEFINITION CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD) Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
ETIOLOGY AND RISK FACTORS OF CRF CRF may result from an episode or acute renal failure or it may develop insidiously over many years. Obstruction Nephro-toxins Acute renal failure Polycystic kidney disease
CONT…  Chronic glomerulonephritis  Repeated episodes of poly-nephritis  Systemic disease- diabetes mellitus, hypertension, systemic lupus erythematous, poly-arteritis sickle cell disease, amyloidosis.
STAGES OF CHRONIC KIDNEY DISEASE STAGES 1 WITH NORMAL OR HIGH GFR >90 ml/min. STAGE 2 MILD CKD 60-90 ml/min. STAGE 3 A STAGE 3 B MODERATE CKD 45-59ml/min. 30-44ml/min. STAGE 4 SEVERE CKD 15-29ml/min. STAGE 5 END STAGE CKD <15ml/min.
PATHOPHYSIOLOGY OF CHRONIC RENAL FAILURE
PATHOPHYSIOLOGY Decreased renal blood flow, primary kidney disease, damage from other disease, urine outflow obstruction Decreased glomerular filteration rate Hypertrophy of remaining nephrons Inability to concentrate urine Further loss of nephron function Loss of excretory renal function and non excretory renal function
LOSS OF EXCRETORY RENAL FUNCTIONS • DECREASED LIBIDO • INFERTILITY DISTURBANCES IN REPRODUCTION • DELAYED HEALING • INFECTION IMMUNE DISTURBANCES • ADVANCED ATHEROSCLEROSISINCREASED PRODUCTION OF LIPIDS • ERRATIC BLOOD GLUCOSE LEVELIMPAIRED INSULIN ACTION • ANEMIA, PALLORFAILURE TO PRODUCE ERYTHROPOIETIN • DECREASED CALCIUM ABSORPTION:- OSTEODYSTROPHYAND HYPOCALCEMIA FAILURE TO CONVERT INACTIVE FORMS OF CALCIUM
LOSS OF NON-EXCRETORY RENAL FUNCTIONS • METABOLIC ACIDOSIS DECREASED HYDROGEN SECRETION AND DECREASED BICARBONATE REABSORPTION • HYPERPHOSPHATEMIA→DECREASED CALCIUM ABSORPTION→ HYPOCALCEMIA→ HYPER-PARATHYROIDISM→ DECREASED POTASSIUM EXCRETION→ HYPERLKALEMIA DECREASED PHOSPHATE EXCRETION • HYPERKALEMIA DECREASED POTASSIUM EXCRETION • WATER RETENTION CAUSING • HYPERTENSION, HEART FAILURE, EDEMA DECREASED SODIUM REABSORPTION IN TUBULE • UREMIA CAUSING • INCREASED BUN, CREATININE, URIC ACID, PROTEINURA, PERIPHERAL NERVE CHANGES, PERICARDITIS, PRURITIS, CNS CHANGES, BLEEDING TENDENCIES DECREASED EXCRETION OF NITROGENOUS WASTE
CLINICAL MANIFESTATION OF CHRONIC RENAL FAILURE
 INTEGUMENTORY CHANGES:- SKIN-VERY DRY BECAUSE OF ATROPHY OF SWEAT GLAND. PRURITIS-EXCORIATED SKIN. SKIN COLOR-UROCHROMS PIGMENTS. MUEHRCKE’S LINE UREMIC FROST
 MUSCULOSKELETAL CHANGES • RENAL OSTEODYSTROPHY OSTEOPOROSIS OSTEOSCLEROSIS OSTEOMALACIA OSTEITIS FIBROSA
 HEMATOLOGIC CHANGES ANEMIA, FATIGUE, WEAKNESS, COLD INTOLERANCE AS KIDNEYS ARE TO PRODUCE ERYTHROPOIETIN. HEMOLYSIS, CLOTTING ABNORMALITIES. BLEEDING TENDENCIES AS ACCUMULATION OF UREMIC INTERFERE WITH PLATLET ADHESIVENESS.
 IMMUNOLOGIC CHANGES MORE SUSCEPTIBLE TO INFECTION. SUPRESSION OF DELAYED HYPERSENSITIVITY.
 METABOLIC CHANGES NORMAL RATIO OF BUN TO CREATININE IS 10:1 HYPOPROTEINURIA INCREASED SERUM URIC ACID CARBOHYDRATE INTOLERANCE METABOLIC ACIDOSIS AS KIDNEYS FAIL TO EXCRETE HYDROGEN IONS.
 CHANGES IN MEDICATION TOXICITY • MEDICATION TOXICITY
 CARDIO-VASCULAR CHANGES HYPERTENSION ATHEROSCLEROSIS LEFT VENTRICULAR DYSTROPHY AND HEART FAILURE DUE TO VOLUME OVERLOAD. ACCELERATED DUE TO ABNORMAL LIPID METABOLISM, ARTERIAL CALCIFICATION.
 RESPIRATORY CHANGES PULMONARY EDEMA. UREMIC LUNG METABOLIC ACIDOSIS AS A RESULT OF RESPIRATORY CHANGES TO HYDROGEN IONS.
 GASTROINTESTINAL CHANGES ANOREXIA, NAUSEA, VOMITING CONSTANT BITTER, METALLIC OR SALTY TASTE EXPERIENCED. BREATH- UREMIC FETOR, AMMONIA, FISHY LIKE SMELL. CONSTIPATION, ULCER.
 REPRODUCTIVE CHANGES • MENSTURAL IRREGULARITY • AMENORRORHEA, IMPOTENCE. ENDOCRINE CHANGES • HYPOTHYROIDISM
 NEUROLOGIC CHANGES • PERIPHERAL NEUROPATHY- BURNING FAT, GAIT CHANGES, PARAPLEGIA. • IMPAIRED COGNITIVE FUNCTION. PSYCHOLOGICAL CHANGES • FINANCIAL STRESS • LIFE-STYLE CHANGES
DIAGNOSTIC TEST FOR CHRONIC RENAL FAILURE
MEDICAL MANAGEMENT OF CHRONIC RENAL FAILURE
MEDICAL MANAGEMENT OF CRF • HYPERKALEMIA • PERICARDITIS • HYPERTENSION • ANEMIA PREVENT COMPLICATIONS-
ADMINISTRATION OF:- ANTI-HYPERTENSIVES ERYTHROPOIETIN IRON SUPPLEMENTS PHOSPHATE BINDING AGENTS CALCIUM SUPPLEMENTS ADEQUATE DIALYSIS
DIETARY INTERVENTIONS:- • FLUID ALLOWANCE 500-600ml MORE THAN THE PREVIOUS DAY 24hrs. URINE OUTPUT. • CARBOHYDRATE & FAT INTAKE 40- 50kcal/kg/day. • DIET RESTRICTION PROTEIN 1g/kg/day. • VITAMIN SUPPLEMENTS.
• DIALYSIS THERAPY • POTASSIUM REMOVAL • POTASSIUM RESTRICTED DIET (KAYEXALATE) HYPERKALEMIA:-
HYPERPHOSPHATEMIA & HYPOCALCEMIA PREVENTION & TREATMENT:- ALUMINIUM BASED ANTACIDS. CARBONATE-CARBONATE AND PHOSPHATE BINDING ANTACIDS.
NEUROLOGICAL ABNORMALITIES • OBSERVE FOR SLIGHT TWITCHING, HEADACHE, DELIRIUM, SEIZURES. • IV DIAZEPAM OR PHENYTOIN. ANEMIA • EPOGEN (RECOMBINANT HUMAN ERYTHROPOIETIN)
SURGICAL MANAGEMENT
.
1. FLUID VOLUME EXCESS RELATED TO DECREASED URINE OUTPUT, DIETARY EXCESS & RETENSION OF SODIUM AND WATER SECONDARY TO DISEASE PROCESS.
2. ALTERED NUTRITION LESS THAN BODY REQUIREMENT RELATED TO ANOREXIA, NAUSEA, VOMITING, DIETARY RESTRICTION, ALTERED ORAL MUCUS MEMBRANES SECONDARY TO DISEASE PROCESS.
3. ACTIVITY INTOLERANCE RELATED TO FATIGUE, RETENTION OF WASTE PRODUCT AND DIALYSIS PROCEDURES SECONDARY TO CHRONIC RENAL FAILURE.
4. SELF-ESTEEM DISTURBANCE RELATED TO DEPENDANCY, ROLE CHANGE, CHANGE IN BODY IMAGE AND CANGE IN SEXUAL FUNCTION SECONDARY TO DISEASE PROCESS.
5. RISK FOR HYPERKALEMIA, PERICARDITIS, PERICARDIAL EFFUSION, PERICARDIAL TEMPONATE, HYPERTENSION, ANEMIA, BONE DISEASE, METASTATIC CALCIFICATION RELATED TO DISEASE PROCESS.
6. KNOWLEDGE DEFICIT REGARDING CONDTION AND TREATMENT MODALITIES RELATED TO DISEASE PROCESS.
7. RISK FOR IMPAIRED SKIN INTEGRITY RELATED TO EDEMA, DRY SKIN AND PRURITIS
8. RISK OF INFECTION RELATED TO INDEWELLING PERITONEAL CATHETER, VENI-PUNCTURE CONNECTION OF TUBING DURING HEMODIALYSIS.
,

More Related Content

Chronic renal failure

  • 1. BY PINKY RATHEE M.Sc. Nursing CHRONIC RENAL FAILURE
  • 2. DEFINITION CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD) Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
  • 3. ETIOLOGY AND RISK FACTORS OF CRF CRF may result from an episode or acute renal failure or it may develop insidiously over many years. Obstruction Nephro-toxins Acute renal failure Polycystic kidney disease
  • 4. CONT…  Chronic glomerulonephritis  Repeated episodes of poly-nephritis  Systemic disease- diabetes mellitus, hypertension, systemic lupus erythematous, poly-arteritis sickle cell disease, amyloidosis.
  • 5. STAGES OF CHRONIC KIDNEY DISEASE STAGES 1 WITH NORMAL OR HIGH GFR >90 ml/min. STAGE 2 MILD CKD 60-90 ml/min. STAGE 3 A STAGE 3 B MODERATE CKD 45-59ml/min. 30-44ml/min. STAGE 4 SEVERE CKD 15-29ml/min. STAGE 5 END STAGE CKD <15ml/min.
  • 7. PATHOPHYSIOLOGY Decreased renal blood flow, primary kidney disease, damage from other disease, urine outflow obstruction Decreased glomerular filteration rate Hypertrophy of remaining nephrons Inability to concentrate urine Further loss of nephron function Loss of excretory renal function and non excretory renal function
  • 8. LOSS OF EXCRETORY RENAL FUNCTIONS • DECREASED LIBIDO • INFERTILITY DISTURBANCES IN REPRODUCTION • DELAYED HEALING • INFECTION IMMUNE DISTURBANCES • ADVANCED ATHEROSCLEROSISINCREASED PRODUCTION OF LIPIDS • ERRATIC BLOOD GLUCOSE LEVELIMPAIRED INSULIN ACTION • ANEMIA, PALLORFAILURE TO PRODUCE ERYTHROPOIETIN • DECREASED CALCIUM ABSORPTION:- OSTEODYSTROPHYAND HYPOCALCEMIA FAILURE TO CONVERT INACTIVE FORMS OF CALCIUM
  • 9. LOSS OF NON-EXCRETORY RENAL FUNCTIONS • METABOLIC ACIDOSIS DECREASED HYDROGEN SECRETION AND DECREASED BICARBONATE REABSORPTION • HYPERPHOSPHATEMIA→DECREASED CALCIUM ABSORPTION→ HYPOCALCEMIA→ HYPER-PARATHYROIDISM→ DECREASED POTASSIUM EXCRETION→ HYPERLKALEMIA DECREASED PHOSPHATE EXCRETION • HYPERKALEMIA DECREASED POTASSIUM EXCRETION • WATER RETENTION CAUSING • HYPERTENSION, HEART FAILURE, EDEMA DECREASED SODIUM REABSORPTION IN TUBULE • UREMIA CAUSING • INCREASED BUN, CREATININE, URIC ACID, PROTEINURA, PERIPHERAL NERVE CHANGES, PERICARDITIS, PRURITIS, CNS CHANGES, BLEEDING TENDENCIES DECREASED EXCRETION OF NITROGENOUS WASTE
  • 11.  INTEGUMENTORY CHANGES:- SKIN-VERY DRY BECAUSE OF ATROPHY OF SWEAT GLAND. PRURITIS-EXCORIATED SKIN. SKIN COLOR-UROCHROMS PIGMENTS. MUEHRCKE’S LINE UREMIC FROST
  • 12.  MUSCULOSKELETAL CHANGES • RENAL OSTEODYSTROPHY OSTEOPOROSIS OSTEOSCLEROSIS OSTEOMALACIA OSTEITIS FIBROSA
  • 13.  HEMATOLOGIC CHANGES ANEMIA, FATIGUE, WEAKNESS, COLD INTOLERANCE AS KIDNEYS ARE TO PRODUCE ERYTHROPOIETIN. HEMOLYSIS, CLOTTING ABNORMALITIES. BLEEDING TENDENCIES AS ACCUMULATION OF UREMIC INTERFERE WITH PLATLET ADHESIVENESS.
  • 14.  IMMUNOLOGIC CHANGES MORE SUSCEPTIBLE TO INFECTION. SUPRESSION OF DELAYED HYPERSENSITIVITY.
  • 15.  METABOLIC CHANGES NORMAL RATIO OF BUN TO CREATININE IS 10:1 HYPOPROTEINURIA INCREASED SERUM URIC ACID CARBOHYDRATE INTOLERANCE METABOLIC ACIDOSIS AS KIDNEYS FAIL TO EXCRETE HYDROGEN IONS.
  • 16.  CHANGES IN MEDICATION TOXICITY • MEDICATION TOXICITY
  • 17.  CARDIO-VASCULAR CHANGES HYPERTENSION ATHEROSCLEROSIS LEFT VENTRICULAR DYSTROPHY AND HEART FAILURE DUE TO VOLUME OVERLOAD. ACCELERATED DUE TO ABNORMAL LIPID METABOLISM, ARTERIAL CALCIFICATION.
  • 18.  RESPIRATORY CHANGES PULMONARY EDEMA. UREMIC LUNG METABOLIC ACIDOSIS AS A RESULT OF RESPIRATORY CHANGES TO HYDROGEN IONS.
  • 19.  GASTROINTESTINAL CHANGES ANOREXIA, NAUSEA, VOMITING CONSTANT BITTER, METALLIC OR SALTY TASTE EXPERIENCED. BREATH- UREMIC FETOR, AMMONIA, FISHY LIKE SMELL. CONSTIPATION, ULCER.
  • 20.  REPRODUCTIVE CHANGES • MENSTURAL IRREGULARITY • AMENORRORHEA, IMPOTENCE. ENDOCRINE CHANGES • HYPOTHYROIDISM
  • 21.  NEUROLOGIC CHANGES • PERIPHERAL NEUROPATHY- BURNING FAT, GAIT CHANGES, PARAPLEGIA. • IMPAIRED COGNITIVE FUNCTION. PSYCHOLOGICAL CHANGES • FINANCIAL STRESS • LIFE-STYLE CHANGES
  • 24. MEDICAL MANAGEMENT OF CRF • HYPERKALEMIA • PERICARDITIS • HYPERTENSION • ANEMIA PREVENT COMPLICATIONS-
  • 25. ADMINISTRATION OF:- ANTI-HYPERTENSIVES ERYTHROPOIETIN IRON SUPPLEMENTS PHOSPHATE BINDING AGENTS CALCIUM SUPPLEMENTS ADEQUATE DIALYSIS
  • 26. DIETARY INTERVENTIONS:- • FLUID ALLOWANCE 500-600ml MORE THAN THE PREVIOUS DAY 24hrs. URINE OUTPUT. • CARBOHYDRATE & FAT INTAKE 40- 50kcal/kg/day. • DIET RESTRICTION PROTEIN 1g/kg/day. • VITAMIN SUPPLEMENTS.
  • 27. • DIALYSIS THERAPY • POTASSIUM REMOVAL • POTASSIUM RESTRICTED DIET (KAYEXALATE) HYPERKALEMIA:-
  • 28. HYPERPHOSPHATEMIA & HYPOCALCEMIA PREVENTION & TREATMENT:- ALUMINIUM BASED ANTACIDS. CARBONATE-CARBONATE AND PHOSPHATE BINDING ANTACIDS.
  • 29. NEUROLOGICAL ABNORMALITIES • OBSERVE FOR SLIGHT TWITCHING, HEADACHE, DELIRIUM, SEIZURES. • IV DIAZEPAM OR PHENYTOIN. ANEMIA • EPOGEN (RECOMBINANT HUMAN ERYTHROPOIETIN)
  • 31. .
  • 32. 1. FLUID VOLUME EXCESS RELATED TO DECREASED URINE OUTPUT, DIETARY EXCESS & RETENSION OF SODIUM AND WATER SECONDARY TO DISEASE PROCESS.
  • 33. 2. ALTERED NUTRITION LESS THAN BODY REQUIREMENT RELATED TO ANOREXIA, NAUSEA, VOMITING, DIETARY RESTRICTION, ALTERED ORAL MUCUS MEMBRANES SECONDARY TO DISEASE PROCESS.
  • 34. 3. ACTIVITY INTOLERANCE RELATED TO FATIGUE, RETENTION OF WASTE PRODUCT AND DIALYSIS PROCEDURES SECONDARY TO CHRONIC RENAL FAILURE.
  • 35. 4. SELF-ESTEEM DISTURBANCE RELATED TO DEPENDANCY, ROLE CHANGE, CHANGE IN BODY IMAGE AND CANGE IN SEXUAL FUNCTION SECONDARY TO DISEASE PROCESS.
  • 36. 5. RISK FOR HYPERKALEMIA, PERICARDITIS, PERICARDIAL EFFUSION, PERICARDIAL TEMPONATE, HYPERTENSION, ANEMIA, BONE DISEASE, METASTATIC CALCIFICATION RELATED TO DISEASE PROCESS.
  • 37. 6. KNOWLEDGE DEFICIT REGARDING CONDTION AND TREATMENT MODALITIES RELATED TO DISEASE PROCESS.
  • 38. 7. RISK FOR IMPAIRED SKIN INTEGRITY RELATED TO EDEMA, DRY SKIN AND PRURITIS
  • 39. 8. RISK OF INFECTION RELATED TO INDEWELLING PERITONEAL CATHETER, VENI-PUNCTURE CONNECTION OF TUBING DURING HEMODIALYSIS.
  • 40. ,